Transmission of Imported Vaccine‐Derived Poliovirus in an Undervaccinated Community in Minnesota

Alexander, James P.; Ehresmann, Kristen; Seward, Jane F.; Wax, Gary; Harriman, Kathleen; Fuller, Susan; Cebelinski, Elizabeth; Chen, Qi; Kew, Olen M.; Pallansch, Mark A.; Oberste, M. Steven; Schleiss, Mark R.; Davis, Jeffrey P.; Warshasky, Bryna; Squires, Susan G; Hull, Harry F.

doi:10.1086/596052

Cited by 97 publications

(70 citation statements)

References 25 publications

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“…Our findings reinforce the point that geographic isolation and limited outside contact do not protect against polio and that cVDPVs can emerge in any location where OPV is used at low rates of coverage (1,13,23,32). Therefore, it is critical that high rates of polio vaccine coverage and sensitive AFP and poliovirus surveillance be maintained in all countries to mitigate the risks of poliovirus transmission.…”

Section: Fig 2 Bayesian Markov Chain Montesupporting

confidence: 77%

Emergence and Localized Circulation of a Vaccine-Derived Poliovirus in an Isolated Mountain Community in Guangxi, China

Yan¹,

Li²,

Zhu³

et al. 2010

J Clin Microbiol

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, type 1 circulating vaccine-derived poliovirus (cVDPV) was isolated from one case patient with acute flaccid paralysis (AFP) and six unimmunized healthy contacts in isolated mountain villages in Guangxi, China. We conducted epidemiological investigations in the affected communities and nucleotide sequence analyses of the cVDPV isolates. The results of the investigations showed that the AFP patient, an unimmunized 10-year-old boy, and five laboratory-confirmed contacts lived in the same village; one contact lived in a neighboring village. Only ϳ27% of children 5 to 10 years of age in the affected villages had received three or more doses of the trivalent oral poliovirus vaccine (OPV). Nucleotide sequence analyses revealed that the cVDPV isolates differed from the Sabin 1 (S1) isolate at 1.4 to 2.2% of VP1 nucleotide positions and shared 12 nucleotide substitutions within VP1. All isolates were S1/S2/S1/S3 recombinants sharing common recombination junctions. Key determinants of attenuation were replaced. Phylogenetic analysis suggested that the cVDPV circulated locally for ϳ12 months following the initiating OPV dose. No VDPVs were found after mass OPV immunizations, conducted from May to June 2006, that targeted all children <12 years of age. Our findings reinforce the point that VDPVs can emerge and spread in isolated communities with immunity gaps. Maintenance of sensitive AFP and poliovirus surveillance is essential to permit early detection and a rapid response to VDPV circulation. China in 1994 (23, 38, 44). High levels of population immunity have been maintained throughout most of the country, and vigorous immunization responses to the detection of poliovirus circulation have subsequently protected against widespread poliovirus transmission. The WPVs (WPV type 1 [WPV1] and WPV3), introduced into communities bordering Myanmar in 1995 and 1996, were associated with only four paralytic poliomyelitis (polio) cases (44), and WPV1 imported into Qinghai, China, from northern India was associated with only one case in 1999 (45) Keys to the success in China are (i) a strong routine immunization program with trivalent oral poliovirus vaccine (tOPV) supplemented by synchronized mass campaigns in the form of national immunization days (NIDs) and subnational immunization days (SNIDs) (38), (ii) sensitive surveillance for cases of acute flaccid paralysis (AFP) (47), and (iii) rapid, detailed characterization of poliovirus isolates (23,47). The eradication of polio in China (40), whose population constitutes 23% of the world population, provided strong impetus to the World Health Organization's (WHO's) Global Polio Eradication Initiative, whose efforts have reduced the polio incidence by Ͼ99% since 1988, such that only four countries have never stopped WPV circulation (43). Circulation of indigenous wild poliovirus (WPV) ceased inSuccessful eradication of WPV, however, does not entirely eliminate risks of paralytic poliomyelitis. The primary weapon in polio eradication, OPV, is genetically unstable and can revert to incr...

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Section: Fig 2 Bayesian Markov Chain Montesupporting

confidence: 77%

Emergence and Localized Circulation of a Vaccine-Derived Poliovirus in an Isolated Mountain Community in Guangxi, China

Yan¹,

Li²,

Zhu³

et al. 2010

J Clin Microbiol

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“…Nevertheless, no paralytic diseases have been reported (27). Similarly, introduction of a cVDPV-1 in an unvaccinated community in the United States resulted in a single case of polio (in an immunocompromised child) (9).…”

Section: Discussionmentioning

confidence: 99%

A Cluster of Paralytic Poliomyelitis Cases Due to Transmission of Slightly Diverged Sabin 2 Vaccine Poliovirus

Короткова

Gmyl

Yakovenko

et al. 2016

J Virol

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IMPORTANCEThe oral poliovirus vaccine largely contributed to the nearly complete disappearance of poliovirus-caused poliomyelitis. Being generally safe, it can, in some cases, result in a paralytic disease. Two types of such outcomes are distinguished: those caused by slightly diverged (Sabin-like) viruses on the one hand and those caused by significantly diverged VDPVs on the other. This classification is based on the number of mutations in the viral genome region encoding a viral structural protein. Until now, only sporadic poliomyelitis cases due to Sabin-like polioviruses had been described, and in distinction from the VDPV-triggered outbreaks, they did not require broad-scale epidemiological responses. Here, an unusual outbreak of poliomyelitis caused by a Sabin-like virus is reported, which had an exceptionally high disease/infection ratio. This outbreak blurred the borderline between Sabin-like polioviruses and VDPVs both in pathogenicity and in the kind of responses required, as well as underscoring important gaps in understanding the pathogenicity, epidemiology, and evolution of vaccine-derived polioviruses.A s a result of the implementation of the Global Polio Eradication Initiative launched by the World Health Organization (WHO) in 1988, the worldwide incidence of paralytic poliomyelitis decreased by approximately 2 orders of magnitude. The success has been due largely to the use of two outstanding vaccines: the Salk inactivated polio vaccine (IPV) and Sabin live oral polio vaccine (OPV). Notwithstanding their obvious merits, these vaccines have drawbacks: the former fails to trigger a robust intestinal immunity and is unable therefore to prevent transmission of wild polioviruses, whereas the latter can be associated, although quite rarely, with cases of paralytic poliomyelitis, a circumstance especially important now that the incidence of the disease caused by wild polioviruses has substantially decreased.Two situations linked to the OPV-associated polio cases are usually distinguished. The disease may be triggered in vaccine recipients or their contacts by the original or slightly evolved (Sabinlike) vaccine viruses soon after the vaccination (1). Such cases are referred to as vaccine-associated paralytic poliomyelitis (VAPP).Other cases might be caused by markedly diverged vaccine viruses after their cryptic circulation or hidden evolution in a single organism before showing up. Such viruses are dubbed vaccine-derived polioviruses (VDPVs) (2). The current official criterion to classify an OPV-originated virus as a VDPV are the presence of 10 or more mutations in the region encoding the viral capsid protein

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“…The EEVS was halted in 2004 after Europe was declared polio free by the WHO in 2002. In September 2005, the EEVS was started up again after the detection of poliovirus in Indonesia and among the Amish in the United States: both of these populations had contacts with orthodox Protestants in the Dutch Bible Belt (7,8). The routine EEVS continues to date and is performed by analysis of 80 to 110 sewage grab samples collected every year at secondary schools and in residential areas in the Dutch Bible Belt.…”

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confidence: 99%

Polio and Measles Down the Drain: Environmental Enterovirus Surveillance in the Netherlands, 2005 to 2015

Benschop

Avoort

Jusic

et al. 2017

Appl Environ Microbiol

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Polioviruses (PVs) are members of the genus Enterovirus. In the Netherlands, the exclusion of PV circulation is based on clinical enterovirus (EV) surveillance (CEVS) of EV-positive cases and routine environmental EV surveillance (EEVS) conducted on sewage samples collected in the region of the Netherlands where vaccination coverage is low due to religious reasons. We compared the EEVS data to those of the CEVS to gain insight into the relevance of EEVS for poliovirus and nonpolio enterovirus surveillance. Following the polio outbreak in Syria, EEVS was performed at the primary refugee center in Ter Apel in the Netherlands, and data were compared to those of CEVS and EEVS. Furthermore, we assessed the feasibility of poliovirus detection by EEVS using measles virus detection in sewage during a measles outbreak as a proxy. Two Sabin-like PVs were found in routine EEVS, 11 Sabin-like PVs were detected in the CEVS, and one Sabin-like PV was found in the Ter Apel sewage. We observed significant differences between the three programs regarding which EVs were found. In 6 sewage samples collected during the measles outbreak in 2013, measles virus RNA was detected in regions where measles cases were identified. In conclusion, we detected PVs, nonpolio EVs, and measles virus in sewage and showed that environmental surveillance is useful for poliovirus detection in the Netherlands, where live oral poliovirus vaccine is not used and communities with lower vaccination coverage exist. EEVS led to the detection of EV types not seen in the CEVS, showing that EEVS is complementary to CEVS. IMPORTANCE We show that environmental enterovirus surveillance complements clinical enterovirus surveillance for poliovirus detection, or exclusion, and for nonpolio enterovirus surveillance. Even in the presence of adequate surveillance, only a very limited number of Sabin-like poliovirus strains were detected in a 10-year period, and no signs of transmission of oral polio vaccine (OPV) strains were found in a country using exclusively inactivated polio vaccine (IPV). Measles viruses can be detected during an outbreak in sewage samples collected and concentrated following procedures used for environmental enterovirus surveillance.

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Transmission of Imported Vaccine‐Derived Poliovirus in an Undervaccinated Community in Minnesota

Abstract: This is the first demonstrated transmission of VDPV in an undervaccinated community in a developed country. Continued vigilance is needed in all countries to identify poliovirus infections in communities at high risk of poliovirus transmission.

Cited by 97 publications

References 25 publications

Emergence and Localized Circulation of a Vaccine-Derived Poliovirus in an Isolated Mountain Community in Guangxi, China

Emergence and Localized Circulation of a Vaccine-Derived Poliovirus in an Isolated Mountain Community in Guangxi, China

A Cluster of Paralytic Poliomyelitis Cases Due to Transmission of Slightly Diverged Sabin 2 Vaccine Poliovirus

Polio and Measles Down the Drain: Environmental Enterovirus Surveillance in the Netherlands, 2005 to 2015

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