title: Shedding and reversion of oral polio vaccine type 3 in Mexican vaccinees: comparison of mutant analysis by PCR and enzyme cleavage to a real-time PCR assay.
abstract: A uracil-to-cytosine mutation at nucleotide position 472 of oral poliovirus vaccine type 3 (OPV3) contributes to the development of vaccine-associated paralytic poliomyelitis (VAPP). To analyze OPV3 shedding patterns, we previously used the multistep method of mutant analysis by PCR and enzyme cleavage (MAPREC). This involves conventional reverse transcription-PCR to detect OPV3, followed by a restriction digest to quantify position 472 reversion. Real-time PCR detects and quantifies nucleic acid as PCR occurs and avoids postreaction processing. The goal of this study was to compare a real-time PCR method to MAPREC. Seventy-three stool samples from Mexican OPV recipients underwent the reverse transcription-PCR step of MAPREC and real-time PCR. Real-time PCR identified 23% more OPV3-positive samples than conventional reverse transcription-PCR. When reversion was compared, the revertant proportion (RP), defined as the percentage of revertants in a sample, differed by < or =10% in 21/25 (84%) samples. The four samples differing by >10% were obtained within 5 days of OPV administration. The real-time PCR assay identified samples with an RP of > or =85% with 94% sensitivity and 86% specificity compared to MAPREC. The mean difference in RP between the two methods was 3.6% (95% confidence interval, -0.3 to 7.5%). Real-time PCR methods reliably detect OPV3, and reversion estimates correlate more consistently with MAPREC when OPV3 reversion rates are high. Detecting VAPP-related mutations by real-time PCR is rapid and efficient and can be useful in monitoring ongoing global polio eradication efforts.
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.
authors.forename: Devasena
authors.initials: D
authors.lastname: Gnanashanmugam
authors.forename: Meira S
authors.initials: MS
authors.lastname: Falkovitz-Halpern
authors.forename: Anthony
authors.initials: A
authors.lastname: Dodge
authors.forename: Melanie
authors.initials: M
authors.lastname: Fang
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Wong
authors.forename: Melissa
authors.initials: M
authors.lastname: Esparza
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hammon
authors.forename: Enrique E
authors.initials: EE
authors.lastname: Rivas-Merelles
authors.forename: Jose I
authors.initials: JI
authors.lastname: Santos
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Maldonado
mesh_terms: D005243:Feces / Q000821:virology; D006801:Humans; D008800:Mexico; D017354:Point Mutation / Q000235:genetics; D017955:Poliovirus / Q000235:genetics / Q000302:isolation & purification*; D011055:Poliovirus Vaccine, Oral / Q000009:adverse effects* / Q000235:genetics*; D016133:Polymerase Chain Reaction / Q000379:methods*; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods*; D012680:Sensitivity and Specificity; D017201:Virus Shedding
chemical_list: D011055:Poliovirus Vaccine, Oral