title: Screening for long-term poliovirus excretion among children with primary immunodeficiency disorders: preparation for the polio posteradication era in Bangladesh.
abstract: BACKGROUND
  Persons with primary immune deficiency disorders (PIDD) who receive oral poliovirus vaccine (OPV) may transmit immunodeficiency-associated vaccine-derived polioviruses (iVDPVs) and cause paralytic polio. The objective of this study was to identify children with PIDD in Bangladesh, and estimate the proportion with chronic poliovirus excretion.
  
  
  METHODS
  Patients admitted at 5 teaching hospitals were screened for PIDD according to standardized clinical case definitions. PIDD was confirmed by age-specific quantitative immunoglobulin levels. Stool specimens were collected from patients with confirmed PIDD.
  
  
  RESULTS
  From February 2011 through January 2013, approximately 96 000 children were screened, and 53 patients were identified who met the clinical case definition for PIDD. Thirteen patients (24%) had age-specific quantitative immunoglobulins results that confirmed PIDD. Of these, 9 (69%) received OPV 3-106 months before stool specimen collection. Among 11 patients, stool specimens from 1 patient tested positive for polioviruses 34 months after OPV ingestion. However, the poliovirus isolate was not available for genetic sequencing, and a subsequent stool specimen 45 days later was negative.
  
  
  CONCLUSIONS
  The risk of chronic poliovirus excretion among children with PIDD in Bangladesh seems to be low. The national polio eradication program should incorporate strategies for screening for poliovirus excretion among patients with PIDD.
authors.affiliation: icddr,b.
authors.forename: Hossain M S
authors.initials: HM
authors.lastname: Sazzad
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Jeanette J
authors.initials: JJ
authors.lastname: Rainey
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: Ondrej
authors.initials: O
authors.lastname: Mach
authors.affiliation: World Health Organization.
authors.forename: Jayantha B L
authors.initials: JB
authors.lastname: Liyanage
authors.affiliation: National Polio and Measles Laboratory, Institute of Public Health.
authors.forename: Ahmed Nawsher
authors.initials: AN
authors.lastname: Alam
authors.affiliation: Bangabandhu Sheikh Mujib Medical University, Dhaka.
authors.forename: Choudhury A
authors.initials: CA
authors.lastname: Kawser
authors.affiliation: Rajshahi Medical College Hospital, Rajshahi, Bangladesh.
authors.forename: Asgar
authors.initials: A
authors.lastname: Hossain
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: Sutter
authors.affiliation: icddr,b Stanford University, California, USA.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Luby
mesh_terms: D000293:Adolescent; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D060740:Disease Eradication / Q000379:methods* / Q000458:organization & administration; D005243:Feces / Q000821:virology; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007136:Immunoglobulins / Q000097:blood; D007153:Immunologic Deficiency Syndromes / Q000150:complications*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening; D017955:Poliovirus / Q000302:isolation & purification*; D011055:Poliovirus Vaccine, Oral / Q000008:administration & dosage* / Q000009:adverse effects*; D015995:Prevalence; D017201:Virus Shedding
chemical_list: D007136:Immunoglobulins; D011055:Poliovirus Vaccine, Oral
keywords: immunodeficiency-associated vaccine-derived poliovirus (iVDPV); oral poliovirus vaccine; polio; primary immunodeficiency disorders; screening; vaccine associated paralytic polio