title: Poliovirus excretion among persons with primary immune deficiency disorders: summary of a seven-country study series.
abstract: BACKGROUND
  Persons with primary immune deficiency disorders (PID), especially those disorders affecting the B-cell system, are at substantially increased risk of paralytic poliomyelitis and can excrete poliovirus chronically. However, the risk of prolonged or chronic excretion is not well characterized in developing countries. We present a summary of a country study series on poliovirus excretion among PID cases.
  
  
  METHODS
  Cases with PID from participating institutions were enrolled during the first year and after obtaining informed consent were tested for polioviruses in stool samples. Those cases excreting poliovirus were followed on a monthly basis during the second year until 2 negative stool samples were obtained.
  
  
  RESULTS
  A total of 562 cases were enrolled in Bangladesh, China, Iran, Philippines, Russia, Sri Lanka, and Tunisia during 2008-2013. Of these, 17 (3%) shed poliovirus, including 2 cases with immunodeficient vaccine-derived poliovirus. Poliovirus was detected in a single sample from 5/17 (29%) cases. One case excreted for more than 6 months. None of the cases developed paralysis during the study period.
  
  
  CONCLUSIONS
  Chronic polioviruses excretion remains a rare event even among individuals with PID. Nevertheless, because these individuals were not paralyzed they would have been missed by current surveillance; therefore, surveillance for polioviruses among PID should be established.
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.affiliation: Chumakov Institute of Poliomyelitis and Viral Encephalitides of Russian Academy of Medical Sciences, Moscow, Russia.
authors.forename: Olga
authors.initials: O
authors.lastname: Ivanova
authors.affiliation: Institut Pasteur, Tunis El Manar University, Tunis, Tunisia.
authors.forename: Nadia
authors.initials: N
authors.lastname: Driss
authors.affiliation: University of the Philippines, Manila.
authors.forename: Marysia
authors.initials: M
authors.lastname: Tiongco-Recto
authors.affiliation: Medical Research Institute, Colombo, Sri Lanka.
authors.forename: Rajiva
authors.initials: R
authors.lastname: da Silva
authors.affiliation: Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Shohreh
authors.initials: S
authors.lastname: Shahmahmoodi
authors.affiliation: ICDDR, B, Dhaka, Bangladesh.
authors.forename: Hossain M S
authors.initials: HM
authors.lastname: Sazzad
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Ondrej
authors.initials: O
authors.lastname: Mach
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Anna-Lea
authors.initials: AL
authors.lastname: Kahn
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Roland W
authors.initials: RW
authors.lastname: Sutter
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa; D001208:Asia; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007153:Immunologic Deficiency Syndromes / Q000150:complications*; D007223:Infant; D008297:Male; D011051:Poliomyelitis / Q000453:epidemiology* / Q000821:virology*; D017955:Poliovirus / Q000302:isolation & purification*; D012426:Russia; D017201:Virus Shedding; D055815:Young Adult
keywords: OPV; poliovirus excretion; primary immune deficiency; vaccine-derived polioviruses