Poliovirus Excretion among Persons with Primary Immune Deficiency Disorders: Summary of Data from Enhanced Poliovirus Surveillance in Egypt, 2011-2014

Abstract

Background: If exposed to oral poliovirus vaccine (OPV), persons with primary immune deficiency disorders (PID) are at increased risk of paralytic poliomyelitis; and can chronically excrete poliovirus. However, the risk of excretion of vaccine derived poliovirus among immunodeficient persons (iVDPV) is not well characterized. We present summary of data from poliovirus surveillance project among PID patients collected between 2011 and 2014 from 11 Egyptian Governorates. Methods: Stool was tested for polioviruses in suspected or confirmed PID children regardless of whether Acute Flaccid Paralysis (AFP) was present or not. Those excreting poliovirus were followed until three consecutive negative stool samples were obtained. Results: There were 122 patients with suspected or confirmed PID identified; 13/122 (11%) excreted poliovirus; of these, 6 excreted iVDPVs, the remaining 7 excreted Sabin virus. The duration of iVDPV excretion ranged from 1 to 21 months. AFP was detected in 3/6 (50%) of those excreting iVDPVs. All iVDPV excretors had history of receiving OPV. Conclusions: Chronic poliovirus excretion in PID patients is rare, however, poliovirus eradication requires removal of all polioviruses from circulation; and because PID individuals are not necessarily paralyzed they might be missed by current poliovirus surveillance based on detection of AFP. To achieve poliovirus eradication, surveillance for polioviruses among PID patients should be routinely conducted in all countries, and poliovirus antiviral therapy must be made available for those with chronic excretion.

Poliovirus excretion following vaccination with live poliovirus vaccine in patients with primary immunodeficiency disorders: clinicians’ perspectives in the endgame plan for polio eradication

“…Most international reports associate iVDPV excretion with patients with antibody deficiency disorders [ 13 , 14 ]. SCID and combined immunodeficiencies are inherited predominantly in an autosomal recessive manner, thus in inbred populations, the collective results of the AFP surveillance confirmed that the majority of iVDPV cases were among combined immunodeficiency patients rather than among antibody deficiency disorders [ 15 , 16 ]. As SCID newborn screening is absent in Egypt, the discovery of most SCID patients is delayed after having received several OPV doses.…”

“…As reported by Driss et al [ 19 ] a Tunisian patient diagnosed with MHC II deficiency exhibited sequential infection by 9 different enterovirus serotypes within a 2-year period. El-Sayed et al [ 15 ] also reported on a PID patient who demonstrated evolution of VDPV in his stool samples over time which again highlights the importance of follow up as they may demonstrate intermittent shedding or evolution with time.…”

Patients with Primary Immunodeficiencies Are a Reservoir of Poliovirus and a Risk to Polio Eradication

“…Although few cross-sectional studies have been conducted to identify iVDPV among PID patients without paralysis ( 12 , 17 – 21 ), this study identified the largest number of PID patients both with antibody and combined immune deficiencies. This study also constituted a large number of countries with worldwide distribution from four continents (Asia, Africa, Europe, and South America).…”

Prolonged Excretion of Poliovirus among Individuals with Primary Immunodeficiency Disorder: An Analysis of the World Health Organization Registry

“…The striking concentration of iVDPV cases in the Middle East and North Africa may be due to: (1) an increased risk of PID due to co-sanguinity ( 29 ) and (2) an interest of immunologists in these Regions to strengthen surveillance for PID and create immunodeficiency registries. In particular, iVDPV surveillance projects have taken place in Egypt ( 30 ), Iran ( 31 ), and Tunisia ( 20 ).…”