title: Vaccine-derived poliomyelitis 12 years after infection in Minnesota.
abstract: A 44-year-old woman with long-standing common variable immunodeficiency who was receiving intravenous immune globulin suddenly had paralysis of all four limbs and the respiratory muscles, resulting in death. Type 2 vaccine-derived poliovirus was isolated from stool. The viral capsid protein VP1 region had diverged from the vaccine strain at 12.3% of nucleotide positions, and the two attenuating substitutions had reverted to the wild-type sequence. Infection probably occurred 11.9 years earlier (95% confidence interval [CI], 10.9 to 13.2), when her child received the oral poliovirus vaccine. No secondary cases were identified among close contacts or 2038 screened health care workers. Patients with common variable immunodeficiency can be chronically infected with poliovirus, and poliomyelitis can develop despite treatment with intravenous immune globulin.
authors.affiliation: Minnesota Department of Health, St. Paul, MN 55164, USA. aaron.devries@state.mn.us
authors.forename: Aaron S
authors.initials: AS
authors.lastname: DeVries
authors.forename: Jane
authors.initials: J
authors.lastname: Harper
authors.forename: Andrew
authors.initials: A
authors.lastname: Murray
authors.forename: Catherine
authors.initials: C
authors.lastname: Lexau
authors.forename: Lynn
authors.initials: L
authors.lastname: Bahta
authors.forename: Jaime
authors.initials: J
authors.lastname: Christensen
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cebelinski
authors.forename: Susan
authors.initials: S
authors.lastname: Fuller
authors.forename: Susan
authors.initials: S
authors.lastname: Kline
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Wallace
authors.forename: Jing H
authors.initials: JH
authors.lastname: Shaw
authors.forename: Cara C
authors.initials: CC
authors.lastname: Burns
authors.forename: Ruth
authors.initials: R
authors.lastname: Lynfield
mesh_terms: D000328:Adult; D000595:Amino Acid Sequence; D017074:Common Variable Immunodeficiency / Q000150:complications*; D017809:Fatal Outcome; D005243:Feces / Q000821:virology; D005260:Female; D006801:Humans; D055256:Infectious Disease Incubation Period; D008279:Magnetic Resonance Imaging; D011051:Poliomyelitis / Q000175:diagnosis / Q000209:etiology*; D017955:Poliovirus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D011055:Poliovirus Vaccine, Oral / Q000009:adverse effects* / Q000276:immunology; D016415:Sequence Alignment; D013116:Spinal Cord / Q000473:pathology
chemical_list: D011055:Poliovirus Vaccine, Oral