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

Abstract

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.

Assessing the individual risk of fecal poliovirus shedding among vaccinated and non-vaccinated subjects following national health weeks in Mexico

“…Both laboratories have the necessary conditions to handle these types of samples according to the third Global Action Plan to minimize the risk associated with laboratories (GAP III) [8]. At Stanford and EVMS stool underwent RNA extraction, reverse transcription and real-time polymerase chain reaction (rRT-PCR) to look for vaccine poliovirus serotypes 1, 2 and 3 according to previously published methods [9]. …”

British HIV Association Guidelines on the Use of Vaccines in HIV‐Positive Adults 2015

“…No specific data are available on wild‐type poliomyelitis in HIV‐positive persons. HIV‐positive children – including those who are mildly to moderately symptomatic – retain the ability to clear enteroviruses, including vaccine‐related poliovirus, and do not appear to be at increased risk of prolonged OPV shedding relative to HIV‐negative children .…”

Identification of genes and pathways in human antigen‐presenting cell subsets in response to polio vaccine by bioinformatical analysis

“…The oral poliovirus vaccine (OPV) contains the live‐attenuated poliovirus that induces immunity but can paralyze vaccinated recipients and generate an outbreak of vaccine‐derived poliovirus . The OPV replicates and activates the adaptive immune system by antigen‐presenting cells (APCs), which migrate to lymphoid organs to present the antigen to T and B cells . The IPV does not replicate and is safer than the OPV; however, the IPV activates innate responses only at their site of injection …”

“…2 The OPV replicates and activates the adaptive immune system by antigen-presenting cells (APCs), which migrate to lymphoid organs to present the antigen to T and B cells. [3][4][5] The IPV does not replicate and is safer than the OPV; however, the IPV activates innate responses only at their site of injection. 5,6 Although the acquisition of immunity to polio vaccination is an important role, the accurate molecular pathways and functional networks are still a challenge.…”