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

被引：46

作者：

Aghamohammadi, Asghar ^{[1
]}

Abolhassani, Hassan ^{[1
]}

Kutukculer, Necil ^{[2
]}

Wassilak, Steve G. ^{[3
]}

Pallansch, Mark A. ^{[4
]}

Kluglein, Samantha ^{[5
]}

Quinn, Jessica ^{[6
]}

Sutter, Roland W. ^{[7
]}

Wang, Xiaochuan ^{[8
]}

Sanal, Ozden ^{[9
]}

Latysheva, Tatiana ^{[10
]}

Ikinciogullari, Aydan ^{[11
]}

Bernatowska, Ewa ^{[12
]}

Tuzankina, Irina A. ^{[13
]}

Costa-Carvalho, Beatriz T. ^{[14
]}

Luis Franco, Jose ^{[15
]}

Somech, Raz ^{[16
,17
]}

Karakoc-Aydiner, Elif ^{[18
]}

Singh, Surjit ^{[19
]}

Bezrodnik, Liliana ^{[20
]}

Espinosa-Rosales, Francisco J. ^{[21
]}

Shcherbina, Anna ^{[22
,23
]}

Lau, Yu-Lung ^{[24
,25
]}

Nonoyama, Shigeaki ^{[26
]}

Modell, Fred ^{[6
]}

Modell, Vicki ^{[6
]}

Barbouche, Mohamed-Ridha ^{[27
]}

McKinlay, Mark A. ^{[5
]}

机构：

[1] Univ Tehran Med Sci, Childrens Med Ctr, Res Ctr Immunodeficiencies, Pediat Ctr Excellence, Tehran, Iran

[2] Ege Univ, Dept Pediat Immunol, Fac Med, Izmir, Turkey

[3] Ctr Dis Control & Prevent, Global Immunizat Div, Atlanta, GA USA

[4] Ctr Dis Control & Prevent, Div Viral Dis, Atlanta, GA USA

[5] Ctr Vaccine Equ, Task Force Global Hlth, Atlanta, GA USA

[6] Jeffrey Modell Fdn, New York, NY USA

[7] WHO, Res & Product Dev, Geneva, Switzerland

[8] Fudan Univ, Childrens Hosp, Dept Clin Immunol, Shanghai, Peoples R China

[9] Hacettepe Univ, Fac Med, Dept Pediat, Div Immunol, Ankara, Turkey

[10] Inst Immunol, Dept Allergol & Immunotherapy, Moscow, Russia

[11] Ankara Univ, Sch Med, Dept Pediat Immunol & Allergy, Ankara, Turkey

[12] Childrens Mem Hlth Inst, Dept Clin Immunol, Warsaw, Poland

[13] Russian Acad Sci, Ural Branch, Inst Immunol & Physiol, Ekaterinburg, Russia

[14] Univ Fed Sao Paulo, Dept Pediat, Sao Paulo, Brazil

[15] Univ Antioquia, Dept Microbiol & Parasitol, Fac Med, Grp Inmunodeficiencias Primarias, Medellin, Colombia

[16] Tel Aviv Univ, Pediat Dept A, Tel Aviv, Israel

[17] Tel Aviv Univ, Affiliated Sackler Fac Med, Jeffrey Modell Fdn Ctr, Sheba Med Ctr,Immunol Serv, Tel Aviv, Israel

[18] Marmara Med Fac, Div Pediat Allergy & Immunol, Istanbul, Turkey

[19] PGIMER, Adv Pediat Ctr, Pediat Allergy & Immunol Unit, Chandigarh, India

[20] Ricardo Gutierrez Hosp Ninos, Buenos Aires, DF, Argentina

[21] Inst Nacl Pediatria, Clin Immunol & Allergy Unit, Mexico City, DF, Mexico

[22] Dmitry Rogachev Fed Res, Dept Clin Immunol, Moscow, Russia

[23] Clin Ctr Pediat Hematol Oncol & Immunol, Moscow, Russia

[24] Univ Hong Kong, Queen Mary Hosp, Dept Paediat & Adolescent Med, Hong Kong, Hong Kong, Peoples R China

[25] Univ Hong Kong, Shenzhen Hosp, Shenzhen Primary Immunodeficiency Diagnost & Ther, Shenzhen, Peoples R China

[26] Natl Def Med Coll, Dept Pediat, Saitama, Japan

[27] Univ Tunis El Manar, Inst Pasteur Tunis, Dept Immunol, Tunis, Tunisia

来源：

FRONTIERS IN IMMUNOLOGY | 2017年 / 8卷

基金：

比尔及梅琳达.盖茨基金会;

关键词：

poliovirus eradication; immunodeficiency-associated vaccine-derived polioviruses; oral poliovirus vaccine; humoral immunodeficiency; combined immunodeficiency; primary immunodeficiency; VACCINE-DERIVED POLIOVIRUSES; PRIMARY IMMUNE-DEFICIENCY; ANTIVIRAL AGENTS; WORLDWIDE; EXCRETION; DISEASES; MANAGEMENT; DISORDERS; CHILDREN; PROGRESS;

D O I：

10.3389/fimmu.2017.00685

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

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.

引用

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