title: Prevalence of prolonged and chronic poliovirus excretion among persons with primary immune deficiency disorders in Sri Lanka.
abstract: BACKGROUND
  The Global Polio Eradication Initiative, established in 1988, has made substantial progress toward achieving this target, with only 3 countries never having eliminated wild poliovirus. Persons with primary immune deficiency disorders (PIDD) exposed to OPV are at increased risk of vaccine-associated paralytic poliomyelitis (VAPP) and of prolonged excretion of Sabin polioviruses. However, the risk for prolonged excretion is not known. Therefore, we studied the prevalence of PIDD with long-term poliovirus excretion in Sri Lanka, a middle income country currently using OPV.
  
  
  METHODS
  We stimulated the referral of patients under the age of 35 years, with clinical features suggestive of immune deficiency to the single immunology clinic in the country, where these patients were investigated for the presence of PIDD. Stool samples from patients with PIDD were cultured for the presence of poliovirus (PV). Poliovirus isolates were tested for intratypic differentiation (ITD). The VP1 region of all poliovirus isolates was sequenced.
  
  
  RESULTS
  Of 942 patients investigated, 51 (5.4%) were diagnosed with PIDD. Five (10.2%) patients excreted poliovirus. A patient with X linked agammaglobulinemia (XLA) excreted a mixture of all three Sabin like (SL) poliovirus serotypes. One patient with severe combined immune deficiency (SCID) excreted SL type 2, and another with SCID excreted SL type 3. One patient with SCID excreted a P2 vaccine-derived poliovirus (VDPV 2), and another with common variable immune deficiency (CVID) excreted a VDPV 3. The 3 patients with SCID died before scheduled collection of subsequent samples one month later, while the patient with XLA had cleared the virus in stool sample collected after 3 and 11 months. The CVID patient with VDPV 3 excreted for 7 months, and has developed a 23 nucleotide divergence in VP1 (∼900 nucleotides) from the parental Sabin virus.
  
  
  CONCLUSIONS
  In our study, several patients with SCID, XLA and CVID excreted poliovirus. With improving health care quality patients with CVID and XLA may survive longer especially with provision of intravenous immune globulin. Regular screening of patients with PIDD for excretion of poliovirus is necessary to identify chronic excretors and make available specific therapies.
authors.affiliation: Department of Immunology, Medical Research Institute, Danister de Silva Mawatha, Colombo 08, Sri Lanka. nilhanrajivadesilva@yahoo.com
authors.forename: Rajiva
authors.initials: R
authors.lastname: de Silva
authors.forename: Sunethra
authors.initials: S
authors.lastname: Gunasena
authors.forename: Damayanthi
authors.initials: D
authors.lastname: Ratnayake
authors.forename: G D
authors.initials: GD
authors.lastname: Wickremesinghe
authors.forename: C D
authors.initials: CD
authors.lastname: Kumarasiri
authors.forename: B A W
authors.initials: BA
authors.lastname: Pushpakumara
authors.forename: Jagadish
authors.initials: J
authors.lastname: Deshpande
authors.forename: Anna Lea
authors.initials: AL
authors.lastname: Kahn
authors.forename: Roland W
authors.initials: RW
authors.lastname: Sutter
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005243:Feces / Q000821:virology; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000151:congenital* / Q000453:epidemiology*; D007223:Infant; D017955:Poliovirus / Q000302:isolation & purification*; D023321:Poliovirus Vaccines / Q000008:administration & dosage*; D015995:Prevalence; D013188:Sri Lanka / Q000453:epidemiology; D017201:Virus Shedding; D055815:Young Adult
chemical_list: D023321:Poliovirus Vaccines