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J Infect Dis. 2014 Nov 1;210 Suppl 1:S373-9. doi: 10.1093/infdis/jiu221.

Screening for long-term poliovirus excretion among children with primary immunodeficiency disorders: preparation for the polio posteradication era in Bangladesh.

Author information

1
icddr,b.
2
Centers for Disease Control and Prevention, Atlanta, Georgia.
3
World Health Organization, Geneva, Switzerland.
4
World Health Organization.
5
National Polio and Measles Laboratory, Institute of Public Health.
6
Bangabandhu Sheikh Mujib Medical University, Dhaka.
7
Rajshahi Medical College Hospital, Rajshahi, Bangladesh.
8
icddr,b Stanford University, California, USA.

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.

KEYWORDS:

immunodeficiency-associated vaccine-derived poliovirus (iVDPV); oral poliovirus vaccine; polio; primary immunodeficiency disorders; screening; vaccine associated paralytic polio

PMID:
25316858
DOI:
10.1093/infdis/jiu221
[Indexed for MEDLINE]

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