AUTHOR=Aghamohammadi Asghar , Abolhassani Hassan , Kutukculer Necil , Wassilak Steve G. , Pallansch Mark A. , Kluglein Samantha , Quinn Jessica , Sutter Roland W. , Wang Xiaochuan , Sanal Ozden , Latysheva Tatiana , Ikinciogullari Aydan , Bernatowska Ewa , Tuzankina Irina A. , Costa-Carvalho Beatriz T. , Franco Jose Luis , Somech Raz , Karakoc-Aydiner Elif , Singh Surjit , Bezrodnik Liliana , Espinosa-Rosales Francisco J. , Shcherbina Anna , Lau Yu-Lung , Nonoyama Shigeaki , Modell Fred , Modell Vicki , The JMF Centers Network Investigators and Study Collaborators , Barbouche Mohamed-Ridha , McKinlay Mark A. , Ozen Ahmet , Berlin Andrea , Chouikha Anissa , Partida-Gaytán Armando , Kiykim Ayca , Prakash Charu , Suri Deepti , Cagdas Ayvaz Deniz , Peláez Dioselina , da Silva Edson Elias , Deordieva Ekaterina , Pérez-Sánchez Elda Edith , Ulusoy Ezgi , Dogu Figen , Seminario Gisela , Cuzcanci Hacer , Triki Hinda , Shimizu Hiroyuki , Tezcan Ilhan , Ben-Mustapha Imen , Sun Jinqiao , Mazzucchelli Juliana T. Lessa , Orrego Julio César , Pac Małgorzata , Bolkov Mikhail , Giraldo Mónica , Belhaj-Hmida Nabil , Mekki Najla , Kuzmenko Natalia , Karaca Neslihan E. , Rezaei Nima , Diop Ousmane Madiagne , Baris Safa , Chan Sau Man , Shahmahmoodi Shohreh , Haskologlu Sule , Ying Wenjing , Wang Ying TITLE=Patients with Primary Immunodeficiencies Are a Reservoir of Poliovirus and a Risk to Polio Eradication JOURNAL=Frontiers in Immunology VOLUME=8 YEAR=2017 URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2017.00685 DOI=10.3389/fimmu.2017.00685 ISSN=1664-3224 ABSTRACT=

Immunodeficiency-associated vaccine-derived polioviruses (iVDPVs) have been isolated from primary immunodeficiency (PID) patients exposed to oral poliovirus vaccine (OPV). Patients may excrete poliovirus strains for months or years; the excreted viruses are frequently highly divergent from the parental OPV and have been shown to be as neurovirulent as wild virus. Thus, these patients represent a potential reservoir for transmission of neurovirulent polioviruses in the post-eradication era. In support of WHO recommendations to better estimate the prevalence of poliovirus excreters among PIDs and characterize genetic evolution of these strains, 635 patients including 570 with primary antibody deficiencies and 65 combined immunodeficiencies were studied from 13 OPV-using countries. Two stool samples were collected over 4 days, tested for enterovirus, and the poliovirus positive samples were sequenced. Thirteen patients (2%) excreted polioviruses, most for less than 2 months following identification of infection. Five (0.8%) were classified as iVDPVs (only in combined immunodeficiencies and mostly poliovirus serotype 2). Non-polio enteroviruses were detected in 30 patients (4.7%). Patients with combined immunodeficiencies had increased risk of delayed poliovirus clearance compared to primary antibody deficiencies. Usually, iVDPV was detected in subjects with combined immunodeficiencies in a short period of time after OPV exposure, most for less than 6 months. Surveillance for poliovirus excretion among PID patients should be reinforced until polio eradication is certified and the use of OPV is stopped. Survival rates among PID patients are improving in lower and middle income countries, and iVDPV excreters are identified more frequently. Antivirals or enhanced immunotherapies presently in development represent the only potential means to manage the treatment of prolonged excreters and the risk they present to the polio endgame.