Persistence of vaccine-derived polioviruses among immunodeficient persons with vaccine-associated paralytic poliomyelitis.
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.
Khetsuriani
Nino
N
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
Prevots
D Rebecca
DR
Quick
Linda
L
Elder
Melissa E
ME
Pallansch
Mark
M
Kew
Olen
O
Sutter
Roland W
RW
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*
D011055:Poliovirus Vaccine, Oral