title: Robustness against serum neutralization of a poliovirus type 1 from a lethal epidemic of poliomyelitis in the Republic of Congo in 2010.
abstract: In 2010, a large outbreak of poliomyelitis with unusual 47% lethality occurred in Pointe Noire, Republic of Congo. Vaccine-mediated immunity against the outbreak virus was never investigated. A wild poliovirus 1 (WPV1) isolated from a fatal case (termed PV1-RC2010) showed a previously unknown combination of amino acid exchanges in critical antigenic site 2 (AgS2, VP1 capsid protein positions 221SAAL → 221PADL). These exchanges were also detected in an additional 11 WPV1 strains from fatal cases. PV1-RC2010 escaped neutralization by three different mAbs relevant for AgS2. Virus neutralization was tested in sera from fatal cases, who died before supplementary immunization (n = 24), Gabonese recipients of recent oral polio vaccination (n = 12), routinely vaccinated German medical students (n = 34), and German outpatients tested for antipoliovirus immunity (n = 17) on Vero, human rhabdomyosarcoma, and human epidermoid carcinoma 2 cells. Fatal poliomyelitis cases gave laboratory evidence of previous trivalent vaccination. Neutralizing antibody titers against PV1-RC2010 were significantly lower than those against the vaccine strain Sabin-1, two genetically distinct WPV1s isolated in 1965 and 2010 and two genetically distinct vaccine-derived PV strains. Of German vaccinees tested according to World Health Organization protocols, 15-29% were unprotected according to their neutralization titers (<1:8 serum dilution), even though all were protected against Sabin-1. Phylogenetic analysis of the WPV1 outbreak strains suggested a recent introduction of virus progenitors from Asia with formation of separate Angolan and Congolese lineages. Only the latter carried both critical AgS2 mutations. Antigenetically variant PVs may become relevant during the final phase of poliomyelitis eradication in populations with predominantly vaccine-derived immunity. Sustained vaccination coverage and clinical and environmental surveillance will be necessary.
authors.affiliation: Institute of Virology, University of Bonn Medical Centre, 53127 Bonn, Germany;
authors.forename: Jan Felix
authors.initials: JF
authors.lastname: Drexler
authors.affiliation: Centre International de Recherches Médicales de Franceville, BP 769 Franceville, Gabon;
authors.forename: Gilda
authors.initials: G
authors.lastname: Grard
authors.affiliation: Chumakov Institute of Poliomyelitis and Viral Encephalitides, Moscow 142782, Russia;
authors.forename: Alexander N
authors.initials: AN
authors.lastname: Lukashev
authors.affiliation: Chumakov Institute of Poliomyelitis and Viral Encephalitides, Moscow 142782, Russia;
authors.forename: Liubov I
authors.initials: LI
authors.lastname: Kozlovskaya
authors.affiliation: Robert Koch Institute, National Reference Laboratory for Poliomyelitis and Enteroviruses, 13302 Berlin, Germany;
authors.forename: Sindy
authors.initials: S
authors.lastname: Böttcher
authors.affiliation: Netherlands Center for Infectious Disease Control, 3720, Bilthoven, The Netherlands;
authors.forename: Gökhan
authors.initials: G
authors.lastname: Uslu
authors.affiliation: Netherlands Center for Infectious Disease Control, 3720, Bilthoven, The Netherlands;
authors.forename: Johan
authors.initials: J
authors.lastname: Reimerink
authors.affiliation: Chumakov Institute of Poliomyelitis and Viral Encephalitides, Moscow 142782, Russia; Lomonosov Moscow State University, Moscow 119991, Russia;
authors.forename: Anatoly P
authors.initials: AP
authors.lastname: Gmyl
authors.affiliation: Ministry of Health, Pointe Noire, Republic of Congo; and.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Taty-Taty
authors.affiliation: Centre International de Recherches Médicales de Franceville, BP 769 Franceville, Gabon;
authors.forename: Sonia Etenna
authors.initials: SE
authors.lastname: Lekana-Douki
authors.affiliation: Centre International de Recherches Médicales de Franceville, BP 769 Franceville, Gabon;
authors.forename: Dieudonné
authors.initials: D
authors.lastname: Nkoghe
authors.affiliation: Institute of Virology, University of Bonn Medical Centre, 53127 Bonn, Germany;
authors.forename: Anna M
authors.initials: AM
authors.lastname: Eis-Hübinger
authors.affiliation: Robert Koch Institute, National Reference Laboratory for Poliomyelitis and Enteroviruses, 13302 Berlin, Germany;
authors.forename: Sabine
authors.initials: S
authors.lastname: Diedrich
authors.affiliation: Netherlands Center for Infectious Disease Control, 3720, Bilthoven, The Netherlands;
authors.forename: Marion
authors.initials: M
authors.lastname: Koopmans
authors.affiliation: Centre International de Recherches Médicales de Franceville, BP 769 Franceville, Gabon; Institut de Recherche pour le Développement, Unité Mixte de Recherche 224 (Maladies Infectieuses et Vecteurs: Écologie, Génétique, Évolution et Contrôle), Institut de Recherche pour le Développement/Centre National de la Recherche Scientifique/Unité Mixte 1, 34032 Montpellier, France drosten@virology-bonn.de eric.leroy@ird.fr.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Leroy
authors.affiliation: Institute of Virology, University of Bonn Medical Centre, 53127 Bonn, Germany; drosten@virology-bonn.de eric.leroy@ird.fr.
authors.forename: Christian
authors.initials: C
authors.lastname: Drosten
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D057134:Antibodies, Neutralizing; D002294:Carcinoma, Squamous Cell; D045744:Cell Line, Tumor; D002648:Child; D002522:Chlorocebus aethiops; D003223:Congo / Q000453:epidemiology; D058872:Epidemics / Q000517:prevention & control* / Q000706:statistics & numerical data; D016679:Genome, Viral; D006801:Humans; D032541:Mass Vaccination / Q000379:methods; D008875:Middle Aged; D008969:Molecular Sequence Data; D010802:Phylogeny; D011051:Poliomyelitis / Q000276:immunology* / Q000401:mortality*; D017955:Poliovirus / Q000235:genetics / Q000276:immunology* / Q000472:pathogenicity; D011055:Poliovirus Vaccine, Oral / Q000235:genetics / Q000276:immunology; D012208:Rhabdomyosarcoma; D014709:Vero Cells; D014774:Virulence; D055815:Young Adult
chemical_list: D057134:Antibodies, Neutralizing; D011055:Poliovirus Vaccine, Oral