title: Persistence of vaccine-derived polioviruses among immunodeficient persons with vaccine-associated paralytic poliomyelitis.
abstract: To estimate long-term poliovaccine virus persistence among immunodeficient patients with vaccine-associated paralytic poliomyelitis (iVAPP), cases reported in the United States during 1975-1997 were reviewed, with subsequent follow-up and virological testing. Six (16.2%) of 37 subjects excreted poliovaccine viruses for > or =6 months. Partial genomic sequencing of their available poliovirus isolates showed considerable divergence from the prototype Sabin strain in all cases. Poliovirus persistence declined over time since the last oral poliovaccine dose: at 6 months, 19.4%; 1 year, 14.3%; 5 years, 4%; and 10 years, 0% (P<.05) of patients. Despite the high prevalence of poliovaccine virus persistence among patients with iVAPP, this group appears to be an unlikely source of poliovirus reintroduction in developed countries because of the rarity and high fatality rate of iVAPP and the possible spontaneous clearance of polioviruses. These results are important for developing "endgame" strategies for the Global Poliomyelitis Eradication Program.
authors.affiliation: Respiratory and Enteric Viruses Branch, National Center for Infectious Diseases, and National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. nkhetsuriani@cdc.gov
authors.forename: Nino
authors.initials: N
authors.lastname: Khetsuriani
authors.forename: D Rebecca
authors.initials: DR
authors.lastname: Prevots
authors.forename: Linda
authors.initials: L
authors.lastname: Quick
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Elder
authors.forename: Mark
authors.initials: M
authors.lastname: Pallansch
authors.forename: Olen
authors.initials: O
authors.lastname: Kew
authors.forename: Roland W
authors.initials: RW
authors.lastname: Sutter
mesh_terms: D005243:Feces / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D014644:Genetic Variation; D016679:Genome, Viral; D006801:Humans; D017589:Immunization Programs / Q000592:standards; D007153:Immunologic Deficiency Syndromes / Q000150:complications / Q000453:epidemiology; D007223:Infant; D008297:Male; D011051:Poliomyelitis / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D017955:Poliovirus / Q000302:isolation & purification*; D011055:Poliovirus Vaccine, Oral / Q000009:adverse effects* / Q000235:genetics; D015397:Program Evaluation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014611:Vaccination / Q000009:adverse effects*
chemical_list: D011055:Poliovirus Vaccine, Oral