The feasibility of identifying children with primary immunodeficiency disorders: preparation for the polio post-eradication era in Bangladesh.
BACKGROUND
Persons with primary immunodeficiency disorders (PIDD) who receive oral poliovirus vaccine (OPV) or are household contacts of OPV recipients are at risk of excreting immunodeficiency-associated vaccine-derived polioviruses (iVDPVs). iVDPVs can be transmitted and cause paralytic polio. The objective of this study was to determine the feasibility of identifying infants and young children with PIDD in Bangladesh, and among those identified, to estimate the proportion excreting iVDPVs.


METHODS
Patients admitted at 5 referral and teaching hospitals from the hospital catchment area were screened for PIDD using a standardized clinical case definition. PIDD was confirmed using results of testing for age-specific quantitative immunoglobulins (QIGs) levels. Stool specimens were collected according to WHO guidelines from children with confirmed PIDD.


RESULTS
During February-July 2009, 13 patients were identified who met the clinical case definition for PIDD; their median age was 1.4 years (range: 2 months to 10 years). Six (46%) of the patients had age-specific QIG results that confirmed PIDD. Stool specimens from four patients tested negative for polio vaccine viruses. All four had received OPV between 50 and 264 days prior to study recruitment.


CONCLUSIONS
Identifying children with PIDD at referral and teaching hospitals in Bangladesh is feasible, but a larger number of patients is needed to estimate the risk for iVDPV excretion. The national polio eradication program should expand surveillance for PIDD case-patients and regularly test persons with PIDD for poliovirus excretion. These efforts will be essential for developing effective prevention and control strategies following OPV cessation, especially for densely populated and tropical countries like Bangladesh where even a minimal iVDPV risk could have significant public health consequences.
International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh. sazzad@icddrb.org
Hossain M S
HM
Sazzad
Jeanette J
JJ
Rainey
Ondrej
O
Mach
Roland
R
Sutter
Serguei
S
Diordista
Choudhury A
CA
Kawser
Reaz
R
Mobarak
Didarul
D
Alam
Mahmood A
MA
Chowdhury
M Jahangir
MJ
Hossain
A S M Mainul
AS
Hasan
Stephen P
SP
Luby
D000914:Antibodies, Viral / Q000097:blood / Q000276:immunology; D001459:Bangladesh; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000175:diagnosis*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017955:Poliovirus / Q000276:immunology*; D011054:Poliovirus Vaccine, Inactivated / Q000009:adverse effects / Q000276:immunology*; D011055:Poliovirus Vaccine, Oral / Q000009:adverse effects / Q000276:immunology*; D014775:Virus Activation / Q000276:immunology*
D000914:Antibodies, Viral; D011054:Poliovirus Vaccine, Inactivated; D011055:Poliovirus Vaccine, Oral