Monovalent Type 1 Oral Poliovirus Vaccine in Newborns

El-Sayed, Nasr; El-Gamal, Yehia; Abbassy, Ahmed-Amr; Seoud, Iman; Salama, Maha M.; Kandeel, Amr; Hossny, Elham; Shawky, Ahmed M.; Hussein, Heba A.; Pallansch, Mark A.; Avoort, H. G. A. M. Van Der; Burton, Anthony; Sreevatsava, Meghana; Malankar, Pradeep; Wahdan, M. H.; Sutter, Roland W.

doi:10.1056/nejmoa0800390

Cited by 79 publications

(53 citation statements)

References 17 publications

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“…The design of the study of the comparative immunogenicity of mOPV1 versus tOPV has been described previously (15). Briefly, 530 newborns from three sites in Egypt located in Greater Cairo and Alexandria were randomly distributed into two groups (A and B).…”

Section: Methodsmentioning

confidence: 99%

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Shedding of Vaccine Viruses with Increased Antigenic and Genetic Divergence after Vaccination of Newborns with Monovalent Type 1 Oral Poliovirus Vaccine

Sanden

Pallansch

Kassteele

et al. 2009

J Virol

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For the final stages in the eradication of poliovirus type 1 (P1), the World Health Organization advocates the selective use of monovalent type 1 oral poliovirus vaccine (mOPV1). To compare the immunogenicity of mOPV1 with that of trivalent OPV (tOPV) in infants, a study was performed in Egypt in 2005. Newborns were vaccinated with mOPV1 or tOPV immediately after birth and were challenged with mOPV1 after 1 month. Vaccination with mOPV1 at birth resulted in significantly higher seroconversion against P1 viruses and lower excretion of P1 viruses than vaccination with tOPV. Intratypic differentiation of the viruses shed by the newborns revealed the presence of remarkably high numbers of antigenically divergent (AD) P1 isolates, especially in the mOPV1 study group. The majority of these AD P1 isolates (71%) were mOPV1 challenge derived and were shed by newborns who did not seroconvert to P1 after the birth dose. Genetic characterization of the viruses revealed that amino acid 60 of the VP3 region was mutated in all AD P1 isolates. Isolates with substitution of residue 99 of the VP1 region had significantly higher numbers of nonsynonymous mutations in the VP1 region than isolates without this substitution and were preferentially shed in the mOPV1 study group. The widespread use of mOPV1 has proven to be a powerful tool for fighting poliovirus circulation in the remaining areas of endemicity. This study provides another justification for the need to achieve high vaccination coverage in order to prevent the circulation of AD strains.

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Section: Methodsmentioning

confidence: 99%

“…In 2005/2006, a clinical study was conducted in Egypt to compare the immunogenicity of mOPV1 with that of the tOPV in newborns (15). Newborns were vaccinated with mOPV1 or tOPV as soon as possible after birth and were challenged with mOPV1 4 weeks later.…”

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confidence: 99%

Shedding of Vaccine Viruses with Increased Antigenic and Genetic Divergence after Vaccination of Newborns with Monovalent Type 1 Oral Poliovirus Vaccine

Sanden

Pallansch

Kassteele

et al. 2009

J Virol

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“…Most of these substitutions are synonymous (d n /d s ϭ 0.03, where d n is the rate of nonsynonymous substitutions and d s is the rate of synonymous substitutions) (8). However, previous studies have indicated that in Sabin strains, reversion of known attenuating sites can occur within the duration of a single infection and that VP1 substitutions accumulate more quickly than would be expected from the wild-type neutral substitution rate; multiple VP1 substitutions occur within the first month after administration of the vaccine dose (10)(11)(12)(13)(14)(15). In addition, most reported cVDPV isolates are recombinants with Sabin-derived capsid and enterovirus C (poliovirus and nonpoliovirus) noncapsid sequences, although the role of selection pressure in this process is not clear (1,2,11,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26).…”

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confidence: 99%

Sabin Vaccine Reversion in the Field: a Comprehensive Analysis of Sabin-Like Poliovirus Isolates in Nigeria

Famulare

Chang

Iber

et al. 2016

J Virol

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To assess the dynamics of genetic reversion of live poliovirus vaccine in humans, we studied molecular evolution in Sabin-like poliovirus isolates from Nigerian acute flaccid paralysis cases obtained from routine surveillance. We employed a novel modeling approach to infer substitution and recombination rates from whole-genome sequences and information about poliovirus infection dynamics and the individual vaccination history. We confirmed observations from a recent vaccine trial that VP1 substitution rates are increased for Sabin-like isolates relative to the rate for the wild type due to increased nonsynonymous substitution rates. We also inferred substitution rates for attenuating nucleotides and confirmed that reversion can occur in days to weeks after vaccination. We combine our observations for Sabin-like virus evolution with the molecular clock for VP1 of circulating wild-type strains to infer that the mean time from the initiating vaccine dose to the earliest detection of circulating vaccine-derived poliovirus (cVDPV) is 300 days for Sabin-like virus type 1, 210 days for Sabin-like virus type 2, and 390 days for Sabin-like virus type 3. Phylogenetic relationships indicated transient local transmission of Sabin-like virus type 3 and, possibly, Sabin-like virus type 1 during periods of low wild polio incidence. Comparison of Sabin-like virus recombinants with known Nigerian vaccine-derived poliovirus recombinants shows that while recombination with non-Sabin enteroviruses is associated with cVDPV, the recombination rates are similar for Sabin isolate-Sabin isolate and Sabin isolate-non-Sabin enterovirus recombination after accounting for the time from dosing to the time of detection. Our study provides a comprehensive picture of the evolutionary dynamics of the oral polio vaccine in the field. IMPORTANCEThe global polio eradication effort has completed its 26th year. Despite success in eliminating wild poliovirus from most of the world, polio persists in populations where logistical, social, and political factors have not allowed vaccination programs of sustained high quality. One issue of critical importance is eliminating circulating vaccine-derived polioviruses (cVDPVs) that have properties indistinguishable from those of wild poliovirus and can cause paralytic disease. cVDPV emerges due to the genetic instability of the Sabin viruses used in the oral polio vaccine (OPV) in populations that have low levels of immunity to poliovirus. However, the dynamics responsible are incompletely understood because it has historically been difficult to gather and interpret data about evolution of the Sabin viruses used in OPV in regions where cVDPV has occurred. This study is the first to combine whole-genome sequencing of poliovirus isolates collected during routine surveillance with knowledge about the intrahost dynamics of poliovirus to provide quantitative insight into polio vaccine evolution in the field. O ver the last 50 years, mass vaccination campaigns with oral polio vaccine (OPV) have been a key fa...

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“…For that reason, the Endgame Strategy aims for global cessation of type 2 OPV by switching from trivalent to bivalent OPV in routine immunization programs [53]. Such bivalent vaccines (type 1 and 3) are more immunogenic than trivalent OPV [54] and nearly as effective as the monovalent OPV formulations, especially in young children receiving their first polio immunization [55][56][57][58]. However, the risks of VAPP and vaccinederived polioviruses by reversion of the Sabin strains to a pathogenic strain still remain, and thus the global eradication of polio by using these OPVs is impossible.…”

Section: Opvmentioning

confidence: 99%

Alternative administration routes and delivery technologies for polio vaccines

Kraan

Stel

Kersten

et al. 2016

Expert Review of Vaccines

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Global polio eradication is closer than ever. Replacement of the live attenuated oral poliovirus vaccine (OPV) by inactivated poliovirus vaccine (IPV) is recommended to achieve complete eradication. Limited global production capacity and relatively high IPV costs compared to OPV spur the need for improved polio vaccines. The target product profile of these vaccines includes not only dose sparing but also high stability, which is important for stockpiling, and easy application important for (emergency) vaccination campaigns. In this review, the current status of alternative polio vaccine delivery strategies is given. Furthermore, we discuss the feasibility of these strategies by highlighting challenges, hurdles to overcome, and formulation issues relevant for optimal vaccine delivery. ARTICLE HISTORY

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Monovalent Type 1 Oral Poliovirus Vaccine in Newborns

Cited by 79 publications

References 17 publications

Shedding of Vaccine Viruses with Increased Antigenic and Genetic Divergence after Vaccination of Newborns with Monovalent Type 1 Oral Poliovirus Vaccine

Shedding of Vaccine Viruses with Increased Antigenic and Genetic Divergence after Vaccination of Newborns with Monovalent Type 1 Oral Poliovirus Vaccine

Sabin Vaccine Reversion in the Field: a Comprehensive Analysis of Sabin-Like Poliovirus Isolates in Nigeria

Alternative administration routes and delivery technologies for polio vaccines

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