Problems of live virus vaccine-associated poliomyelitis a paralytic case with isolation of all three poliovirus types

Vaccine-associated paralytic poliomyelitis in oral polio vaccine recipients: disproportionality analysis using VAERS and systematic review

BACKGROUND

Vaccine-associated paralytic poliomyelitis (VAPP) is a rare adverse event of oral poliovirus vaccines (OPV), particularly affecting immunodeficient individuals.

RESEARCH DESIGN AND METHODS

This study aimed to (1) Assess the association between OPV and VAPP using Vaccine Adverse Event Reporting System (VAERS) database (2) Outline patient characteristics and risk factors associated with the occurrence of VAPP in OPV recipients through a systematic review of case reports and case series. A disproportionality analysis was conducted using the data from VAERS, encompassing adverse events reported from 1990 till February 2023. Additionally, we conducted a systematic review of case reports and case series using PubMed, Scopus, and Embase databases.

RESULTS

The VAERS data revealed 130 VAPP reports among 1,739,903 OPV linked adverse events, with year 2010 reporting the strongest association. The systematic review of 37 studies highlighted VAPP occurrence within 2 months to 4 years post-vaccination, typically with acute flaccid paralysis. Immunodeficiency and perianal abscess emerged as major risk factors. Out of the 37 included studies, 27 showed consistent causal association of VAPP with OPV using WHO-AEFI causality assessment tool.

CONCLUSION

The study emphasized the seriousness of VAPP and highlights its association with OPV, identifying immunodeficiency as a prominent contributor to VAPP manifestation.

[Vaccine-associated paralytic poliomyelitis showing biphasic motor paresis]

We report a 38-year-old man with vaccine associated paralytic poliomyelitis (VAPP) which showed unusual biphasic worsening. The patient developed mild paresis of left upper and right lower extremities, five weeks after the oral poliovirus vaccination of patient's son and two weeks after the intramuscular injection of mumps/varicella vaccine in the left triceps muscle for himself. Needle electromyography (EMG) of his left arm and right leg was not remarkable, and the weakness recovered almost completely in three weeks. However, four weeks after the needle EMG, severe weakness and muscle atrophy of the four extremities, accentuated at the left arm and right leg, developed again. Cervical MRI showed gadolinium-enhanced, T(2) high-signal intensity area in the left C4-C6 anterior horn, most prominent at the height of C5 spine. Significant elevation of serum anti-poliomyelitis type 2 neutralizing antibody confirmed the diagnosis of VAPP. Immunomodulatory treatment, intravenous immunoglobulin (IVIg), did not improve weakness. We consider that the second clinical worsening of this patient was provoked by the needle EMG performed just after the first exacerbation, which injured the skeletal muscles and might have enhanced the retrograde transport of poliovirus via neural pathway.

Accomplishments and challenges in picornavirology as observed by a medical doctor

BACKGROUND

The family of picornaviridae has been studied extensively: the structure of the virion and its replication strategy are known in molecular detail. Nevertheless, infections with the multitude of enteroviruses still cause widespread epidemics, serious disease and a diversity of clinical syndromes ranging from central nervous system involvement to light febrile illness. Infections with more than 100 human rhinovirus types are an important economic factor.

OBJECTIVE

In order to treat and control picornavirus infections with their great diversity of manifestations the pathogenesis of diseases must be better understood, e.g. concerning virus spread in the organism or molecular detail of the disease processes, such as cell tropism of the virus or cytokine and immunologic actions. Elucidation of mechanisms of virus transmission in the population is also needed.

STUDY DESIGN

This review discusses aspects of our present knowledge of the pathogenesis, transmission, prophylaxis and treatment of picornavirus infections.

CONCLUSIONS

The need for further development of selective antiviral substances, safe vaccines and basic research in picornavirology is stressed.

Role of provocation poliomyelitis in vaccine-associated poliomyelitis

The impact of different vaccine administrations in the Federal Republic of Germany, in relation to vaccine-associated paralytic poliomyelitis (VAPP) was studied. (This only means that on the basis of the temporal relation of vaccination and onset, the vaccine cannot be ruled out as possible cause). Oral polio vaccine (OPV) was given between 1963 and 1977 only and recommended simultaneously with inactivated vaccines (DT/DPT) between 1980 and 1985. In the first period 10 VAPP cases occurred among 9.96 million estimated vaccinees aged under 2 years. In the second period 6 cases of provocation poliomyelitis (PRP) were found among 2.9 million estimated OPV/DT/DPT vaccinees of the same age group. Statistically the VAPP/PRP frequencies in the two periods studied did not achieve significance.

Immunity of hospital personnel against polio virus

Sera from 275 employees of three hospitals were tested for the presence of antibodies to polio virus. Immunity was found to increase with age, and was higher in personnel directly involved in patient care than in the others. Previous exposure to poliomyelitis as well as a history of previous immunization did not correlate with the immunological status of the employee. When antibodies against one of the three polio types or more could not be demonstrated, the employee was vaccinated by an inactivated polio virus vaccine.