Poliovirus excretion in Guatemalan adults and children with HIV infection and children with cancer

Asturias, Edwin J.; Grazioso, Carlos; Luna‐Fineman, Sandra; Torres, Olga; Halsey, Neal A.

doi:10.1016/j.biologicals.2006.03.002

Cited by 19 publications

(10 citation statements)

References 14 publications

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“…These studies did not reveal prolonged excretion of vaccine-related poliovirus by HIV-infected adults [15,29,30] or children [30]. In one study [31] three HIV-infected children from South Africa were found to be shedding vaccine-related polioviruses in specimens obtained between 15 and 42 months after the last known dose of OPV, suggesting possible long-term persistence.…”

Section: Discussionmentioning

confidence: 99%

Limited duration of vaccine poliovirus and other enterovirus excretion among human immunodeficiency virus infected children in Kenya

et al. 2009

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BackgroundImmunodeficient persons with persistent vaccine-related poliovirus infection may serve as a potential reservoir for reintroduction of polioviruses after wild poliovirus eradication, posing a risk of their further circulation in inadequately immunized populations.MethodsTo estimate the potential for vaccine-related poliovirus persistence among HIV-infected persons, we studied poliovirus excretion following vaccination among children at an orphanage in Kenya. For 12 months after national immunization days, we collected serial stool specimens from orphanage residents aged <5 years at enrollment and recorded their HIV status and demographic, clinical, immunological, and immunization data. To detect and characterize isolated polioviruses and non-polio enteroviruses (NPEV), we used viral culture, typing and intratypic differentiation of isolates by PCR, ELISA, and nucleic acid sequencing. Long-term persistence was defined as shedding for ≥ 6 months.ResultsTwenty-four children (15 HIV-infected, 9 HIV-uninfected) were enrolled, and 255 specimens (170 from HIV-infected, 85 from HIV-uninfected) were collected. All HIV-infected children had mildly or moderately symptomatic HIV-disease and moderate-to-severe immunosuppression. Fifteen participants shed vaccine-related polioviruses, and 22 shed NPEV at some point during the study period. Of 46 poliovirus-positive specimens, 31 were from HIV-infected, and 15 from HIV-uninfected children. No participant shed polioviruses for ≥ 6 months. Genomic sequencing of poliovirus isolates did not reveal any genetic evidence of long-term shedding. There was no long-term shedding of NPEV.ConclusionThe results indicate that mildly to moderately symptomatic HIV-infected children retain the ability to clear enteroviruses, including vaccine-related poliovirus. Larger studies are needed to confirm and generalize these findings.

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Section: Discussionmentioning

confidence: 99%

Limited duration of vaccine poliovirus and other enterovirus excretion among human immunodeficiency virus infected children in Kenya

et al. 2009

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“…Nonetheless, others did not find prolonged VDPV shedding in a cohort of 38 X-linked agammaglobulinemia (XLA) patients [78], 16 PID patients [79], and 346 IgG-or IgA-deficient patients [77], suggesting that these chronic carriers are incidental cases. In HIV-positive individuals, who predominantly have T cell defects but may develop humoral deficits, prolonged VDPV shedding (>6 months) has not been reported [67][68][69][80][81][82], except for one study in which person-to-person transmission however could not be excluded [68,69].…”

Section: Enterovirusmentioning

confidence: 85%

The Role of Prolonged Viral Gastrointestinal Infections in the Development of Immunodeficiency-Related Enteropathy

Ven

Konijnenburg

Wensing

et al. 2011

Clinic Rev Allerg Immunol

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Patients with primary immunodeficiencies are prone to develop enteropathy of unknown pathogenesis. We hypothesize that ineffective clearance of gastrointestinal pathogens, particularly viruses, in combination with defective immune regulation may cause inflammatory enteropathy in certain immunodeficient hosts. We reviewed publications related to prolonged enteric viral infection, immunodeficiency, and the subsequent development of inflammatory enteropathy. Prolonged infection with especially enteroviral infections was reported more often in immunocompromised hosts than in healthy individuals. Protracted enteric viral shedding was not always associated with the presence or duration of gastrointestinal symptoms. The development of immunodeficiencyassociated enteropathy after prolonged viral infections was described in sporadic cases. Clinical consequences of viral gut infections in immunocompromised hosts comprise isolation issues and supportive care. Prospective studies in cohorts of immunodeficient patients are required to study the impact of prolonged enteric viral replication with respect to the pathogenesis of non-infectious enteropathy.

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“…In 2 studies, the stools of 28 and 419 HIV-infected adults who were living with or nearby to children immunized with OPV during national immunization days in the Central African Republic and Cote d'Ivoire were found to contain no detectable poliovirus [26,27]. A cross-sectional study in Guatemala examined the stools of 94 HIV-infected children (median age, 3.6 years) who had not received OPV for at least 6 months along with 101 HIV-infected adults and also found no detectable poliovirus [16]. In contrast, a cross-sectional study in South Africa examined 164 stool samples from hospitalized HIV-infected children and found 13 containing OPV-derived strains, 5 from children who had not received OPV for >6 months [17,18].…”

Section: Discussionmentioning

confidence: 99%

“…OPV is given to children regardless of HIV status at 3, 4, 5, and 18 months of age per the Zimbabwean vaccination schedule. During the study period, supplementary vaccination campaigns providing additional OPV doses were held [6][7][8][9][10][11][12][13][14][15][16][17][18] Enrollment occurred between September 2008 and December 2010 at 2 community clinics in Chitungwiza. Initial inclusion criteria included age between 2 and 4 months, a birth mother with known HIV status, and plans to receive OPV according to the national schedule.…”

Section: Study Design and Populationmentioning

confidence: 99%

“…Two prospective studies did not show vaccine poliovirus shedding beyond 6 months, but they were small, and 1 had very low retention rates [14,15]. Of 2 cross-sectional studies, 1 detected no poliovirus in stool samples from 94 HIV-infected Guatemalan children 6 months to ≥10 years after their last OPV dose, but the other did detect VDPV in the stools of hospitalized HIV-infected South African children [16][17][18]. However, as a cross-sectional study, it is unclear whether these isolates were cVDPV acquired in the community or iVDPV from chronic infection in the individual children.…”

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confidence: 99%

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Vaccine Poliovirus Shedding and Immune Response to Oral Polio Vaccine in HIV-Infected and -Uninfected Zimbabwean Infants

Troy¹,

Musingwini²,

Halpern³

et al. 2013

The Journal of Infectious Diseases

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Background. With prolonged replication, attenuated polioviruses used in oral polio vaccine (OPV) can mutate into vaccine-derived poliovirus (VDPV) and cause poliomyelitis outbreaks. Individuals with primary humoral immunodeficiencies can become chronically infected with vaccine poliovirus, allowing it to mutate into immunodeficiency-associated VDPV (iVDPV). It is unclear if children perinatally infected with the human immunodeficiency virus (HIV), who have humoral as well as cellular immunodeficiencies, might be sources of iVDPV.Methods. We conducted a prospective study collecting stool and blood samples at multiple time points from Zimbabwean infants receiving OPV according to the national schedule. Nucleic acid extracted from stool was analyzed by real-time polymerase chain reaction for OPV serotypes.Results. We analyzed 825 stool samples: 285 samples from 92 HIV-infected children and 540 from 251 HIV-uninfected children. Poliovirus shedding was similar after 0-2 OPV doses but significantly higher in the HIVinfected versus uninfected children after ≥3 OPV doses, particularly within 42 days of an OPV dose, independent of seroconversion status. HIV infection was not associated with prolonged or persistent poliovirus shedding. HIV infection was associated with significantly lower polio seroconversion rates.Conclusions. HIV infection is associated with decreased mucosal and humoral immune responses to OPV but not the prolonged viral shedding required to form iVDPV.

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Poliovirus excretion in Guatemalan adults and children with HIV infection and children with cancer

Cited by 19 publications

References 14 publications

Limited duration of vaccine poliovirus and other enterovirus excretion among human immunodeficiency virus infected children in Kenya

Limited duration of vaccine poliovirus and other enterovirus excretion among human immunodeficiency virus infected children in Kenya

The Role of Prolonged Viral Gastrointestinal Infections in the Development of Immunodeficiency-Related Enteropathy

Vaccine Poliovirus Shedding and Immune Response to Oral Polio Vaccine in HIV-Infected and -Uninfected Zimbabwean Infants

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