title: Use of a novel real-time PCR assay to detect oral polio vaccine shedding and reversion in stool and sewage samples after a mexican national immunization day.
abstract: During replication, oral polio vaccine (OPV) can revert to neurovirulence and cause paralytic poliomyelitis. In individual vaccinees, it can acquire specific revertant point mutations, leading to vaccine-associated paralytic poliomyelitis (VAPP). With longer replication, OPV can mutate into vaccine-derived poliovirus (VDPV), which causes poliomyelitis outbreaks similar to those caused by wild poliovirus. After wild poliovirus eradication, safely phasing out vaccination will likely require global use of inactivated polio vaccine (IPV) until cessation of OPV circulation. Mexico, where children receive routine IPV but where OPV is given biannually during national immunization days (NIDs), provides a natural setting to study the duration of OPV circulation in a population primarily vaccinated with IPV. We developed a real-time PCR assay to detect and distinguish revertant and nonrevertant OPV serotype 1 (OPV-1), OPV-2, and OPV-3 from RNA extracted directly from stool and sewage. Stool samples from 124 children and 8 1-liter sewage samples from Orizaba, Veracruz, Mexico, collected 6 to 13 weeks after a NID were analyzed. Revertant OPV-1 was found in stool at 7 and 9 weeks, and nonrevertant OPV-2 and OPV-3 were found in stool from two children 10 weeks after the NID. Revertant OPV-1 and nonrevertant OPV-2 and -3 were detected in sewage at 6 and 13 weeks after the NID. Our real-time PCR assay was able to detect small amounts of OPV in both stool and sewage and to distinguish nonrevertant and revertant serotypes and demonstrated that OPV continues to circulate at least 13 weeks after a NID in a Mexican population routinely immunized with IPV.
authors.affiliation: Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California 94305-5208, USA. sbtroy@stanford.edu
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Troy
authors.forename: Leticia
authors.initials: L
authors.lastname: Ferreyra-Reyes
authors.forename: Chunhong
authors.initials: C
authors.lastname: Huang
authors.forename: Nadim
authors.initials: N
authors.lastname: Mahmud
authors.forename: Yu-Jin
authors.initials: YJ
authors.lastname: Lee
authors.forename: Sergio
authors.initials: S
authors.lastname: Canizales-Quintero
authors.forename: Harry
authors.initials: H
authors.lastname: Flaster
authors.forename: Renata
authors.initials: R
authors.lastname: Báez-Saldaña
authors.forename: Lourdes
authors.initials: L
authors.lastname: García-García
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Maldonado
mesh_terms: D005243:Feces / Q000821:virology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008800:Mexico; D009154:Mutation; D017955:Poliovirus / Q000302:isolation & purification / Q000472:pathogenicity*; D023321:Poliovirus Vaccines / Q000008:administration & dosage*; D012367:RNA, Viral / Q000235:genetics / Q000302:isolation & purification; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods*; D012722:Sewage / Q000821:virology*; D014773:Virology / Q000379:methods; D014774:Virulence; D017201:Virus Shedding
chemical_list: D023321:Poliovirus Vaccines; D012367:RNA, Viral; D012722:Sewage