Identification and Control of a Poliomyelitis Outbreak in Xinjiang, China

Luo, Hai‐Bin; Zhang, Yong; Wang, Xinqi; Wang, Yu; Ning, Wen; Yan, Dongmei; Wang, Huaqing; Wushouer, Fuerhati; Wang, Haibo; Xu, Aiqiang; Zheng, Jingshan; Li, Dexin; Cui, Hui; Wang, Jianping; Zhu, Shuangli; Feng, Zijian; Cui, Fuqiang; Ning, Jing; Hao, Lixin; Fan, Chen; Ning, Guijun; Yu, Haochen; Wang, Shiwen; Liu, Dawei; Wang, Dongyan; Fu, Jianping; Gou, Aili; Zhang, Guomin; Huang, Guohong; Chen, Yuansheng; Mi, Sha-Sha; Liu, Yanmin; Yin, Dapeng; Zhu, Hui; Fan, Xin-Chun; Li, Xinlan; Ji, Yixin; Li, Keli; Tang, Haishu; Xu, Wenbo; Wang, Yu; Yang, Weizhong

doi:10.1056/nejmoa1303368

Cited by 73 publications

(70 citation statements)

References 12 publications

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“…40,41 To achieve the goal of polio eradication, since 1978 China has implemented 3-dose OPV on newborns in months 2, 3 and 4 and an extra dose at 4 year old. 42 And poliovirus vaccination for the infants and young children was very popular in the rest of world. If 6-month infants to 5-year old children take EV71 vaccination, high titer poliovirus NTAb should exist in these young children.…”

Section: Discussionmentioning

confidence: 99%

The compatibility of inactivated-Enterovirus 71 vaccination with Coxsackievirus A16 and Poliovirus immunizations in humans and animals

Mao

Wang

Shao

et al. 2015

Human Vaccines & Immunotherapeutics

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Enterovirus 71 (EV71) is the key pathogen for Hand, Foot, and Mouth Disease (HFMD) and can result in severe neurological complications and death among young children. Three inactivated-EV71 vaccines have gone through phase III clinical trials and have demonstrated good safety and efficacy. These vaccines will benefit young children under the threat of severe HFMD. However, the potential immunization-related compatibility for different enterovirus vaccines remains unclear, making it hard to include the EV71 vaccine in Expanded Program on Immunization (EPI). Here, we measured the neutralizing antibodies (NTAbs) against EV71, Coxsackievirus A16 (CA16) and Poliovirus from infants enrolled in those EV71 vaccine clinical trials. The results indicated that the levels of NTAb GMTs for EV71 increased significantly in all 3 vaccine groups (high, middle and low dosages, respectively) post-vaccination. Seroconversion ratios and Geometric mean fold increase were significantly higher in the vaccine groups (7/9 and 8.9 ～228.1) than in the placebo group (1/10 and 0.8～1.7, P < 0.05). But no similar NTAb response trends were found in CA16 and 3 types of Poliovirus. The decrease of 3 types of Poliovirus NTAb GMTs and an increase of CA16 GMTs post-EV71-vaccination were found in vaccine and placebo groups. Further animal study on CA16 and poliovirus vaccine coimmunization or pre-immunization with EV71 vaccine in mice indicated that there was no NTAb cross-activity between EV71 and CA16/Poliovirus. Our research showed that inactivated-EV71 vaccine has good specific-neutralizing capacity and can be included in EPI.

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Section: Discussionmentioning

confidence: 99%

The compatibility of inactivated-Enterovirus 71 vaccination with Coxsackievirus A16 and Poliovirus immunizations in humans and animals

Mao

Wang

Shao

et al. 2015

Human Vaccines & Immunotherapeutics

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“…(17); along with the other countries in the Western Pacific region, China was certified as free of indigenous WPV in 2000 (18). However, the polio-free status was interrupted by the importation of type 1 WPV from Pakistan in August 2011; the outbreak was stopped 1.5 months later (19).…”

Section: Methodsmentioning

confidence: 99%

Limited and Localized Outbreak of Newly Emergent Type 2 Vaccine-Derived Poliovirus in Sichuan, China

Yan¹,

Zhang²,

Zhu³

et al. 2014

Clin. Vaccine Immunol.

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an outbreak caused by type 2 circulating vaccine-derived poliovirus (cVDPV) occurred in Aba County, Sichuan, China. During the outbreak, four type 2 VDPVs (>0.6% nucleotide divergence in the VP1 region relative to the Sabin 2 strain) were isolated from 3 patients with acute flaccid paralysis (AFP) and one close contact. In addition, a type 2 pre-VDPV (0.3% to 0.5% divergence from Sabin 2) that was genetically related to these type 2 VDPVs was isolated from another AFP patient. These 4 patients were all unimmunized children 0.7 to 1.1 years old. Nucleotide sequencing revealed that the 4 VDPV isolates differed from Sabin 2 by 0.7% to 1.2% in nucleotides in the VP1 region and shared 5 nucleotide substitutions with the pre-VDPV. All 5 isolates were closely related, and all were S2/S3/S2/S3 recombinants sharing common recombination crossover sites. Although the two major determinants of attenuation and temperature sensitivity phenotype of Sabin 2 (A 481 in the 5= untranslated region and Ile 143 in the VP1 protein) had reverted in all 5 isolates, one VDPV (strain CHN16017) still retained the temperature sensitivity phenotype. Phylogenetic analysis of the third coding position of the complete P1 coding region suggested that the cVDPVs circulated locally for about 7 months following the initiating oral poliovirus vaccine (OPV) dose. Our findings reinforce the point that cVDPVs can emerge and spread in isolated communities with immunity gaps and highlight the emergence risks of type 2 cVDPVs accompanying the trivalent OPV used. To solve this issue, it is recommended that type 2 OPV be removed from the trivalent OPV or that inactivated polio vaccine (IPV) be used instead.

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“…The transmission of wild poliovirus (WPV) [11], tuberculosis [12], and malaria [13] prevails at present in Pakistan. According to Centers for Disease Control and Prevention (CDC), a total of 198 WPV cases were reported in 2011 [14], while preventable disease put Pakistan at threat, non-communicable diseases are also raising vigorously in various cities of the country due to lack of concern of the authorities [15]. In Figure 2 portrays the percentage of deaths per 100,000 due to communicable diseases (38%), non-communicable diseases (50%) and injuries in Pakistan [16] however Figure 3 Illustrates the death rate per year.…”

Section: Pakistan Diseases Profilementioning

confidence: 99%

Missed Opportunities in Pakistan: The Never-Ending Struggles and Challenges in Clinical Research

Rehman¹,

Ahmed²

2017

Ann Clin Lab Res

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Pakistan among other South Asian developing countries is the seventh most populous country in the world. Despite offering inexpensive research resources, patient pool, well-established GCP compliant institutions and skilled researchers Pakistan has been unable to draw attention of multinational companies. Pakistan holds largest patient pool both treated and naïve, high burden of communicable diseases, established and accredited institutes, internationally certificated trainers yet Pakistan deal with challenges in global market. The division health facilities are mainly into private and public but due to unjust distribution of health sectors, rural remain the main area of concern due to lack of availability of the treatment. Even being an ideal site for clinical trials, Pakistan faces tremendous difficulties in achieving rank in international market due to fragmentation of national infrastructure and ethical consideration. Extensive investment and advancement is needed in improving the clinical research in Pakistan. This document discusses these challenges and failed opportunities in clinical research of Pakistan.

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Identification and Control of a Poliomyelitis Outbreak in Xinjiang, China

Abstract: The 2011 outbreak in China showed that poliomyelitis-free countries remain at risk for outbreaks while the poliovirus circulates anywhere in the world. Global eradication of poliomyelitis will benefit all countries, even those that are currently free of poliomyelitis.

Cited by 73 publications

References 12 publications

The compatibility of inactivated-Enterovirus 71 vaccination with Coxsackievirus A16 and Poliovirus immunizations in humans and animals

The compatibility of inactivated-Enterovirus 71 vaccination with Coxsackievirus A16 and Poliovirus immunizations in humans and animals

Limited and Localized Outbreak of Newly Emergent Type 2 Vaccine-Derived Poliovirus in Sichuan, China

Missed Opportunities in Pakistan: The Never-Ending Struggles and Challenges in Clinical Research

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