Clearance of Immunodeficiency-associated Vaccine-derived Poliovirus Infection With Pocapavir

Abstract

Pocapavir exhibits antiviral activity against both polio and nonpolio enteroviruses. There is limited experience of the use of this investigational drug in young children with enteroviral infection. We describe the successful clearance of prolonged immunodeficiency-associated vaccine-derived type 3 poliovirus infection by pocapavir in an infant with underlying X-linked agammaglobulinemia.

Sensitivity of the acute flaccid paralysis surveillance system for poliovirus in South Africa, 2016–2019

“…Two cases of iVDPV were detected, which yielded 34 specimens on follow-up. One iVDPV case had a date of onset of paralysis of 28 December 2017 [ 19 ], and the second case had a date of onset of paralysis of 2 October 2018 (unpublished). The two iVDPV cases are described briefly below.…”

“…The treatment was considered to be a success after no poliovirus was detected in the child’s stool from 2 days post-treatment. This case was described previously [ 19 ].…”

“…Despite having no wild poliovirus in the country in three decades, the NICD has processed samples from over 2000 AFP cases in the last 4 years, of which iVDPV was detected in 2. It is a tribute to the sensitivity of the AFP surveillance programme in South Africa that two iVDPVs were detected [ 19 ]. iVDPV does not arise in countries using an IPV-only regimen and may be misdiagnosed in countries without strong diagnostic capacity for primary immune deficiencies.…”

Update on Immunodeficiency-Associated Vaccine-Derived Polioviruses — Worldwide, July 2018–December 2019

“…Continued progress in the development of antiviral medications effective against polioviruses is needed to eliminate virus shedding in persons identified with persistent and chronic iVDPV infections. Pocapavir (a capsid inhibitor) has been administered on compassionate use basis for several patients excreting iVDPV, with mixed results (10). Complete clearing of virus has been observed in some recipients; however, rapid development of poliovirus resistance to Pocapavir has been frequently observed (10).…”

“…Pocapavir (a capsid inhibitor) has been administered on compassionate use basis for several patients excreting iVDPV, with mixed results (10). Complete clearing of virus has been observed in some recipients; however, rapid development of poliovirus resistance to Pocapavir has been frequently observed (10). Therefore, development of a treatment combining Pocapavir with a protease inhibitor currently called V-7404 that is expected to avoid antiviral resistance is continuing.…”