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Mohanty MC, Govindaraj G, Ahmad M, Varose SY, Tatkare M, Shete A, Yadav S, Joshi Y, Yadav P, Sharma D, Kumar A, Verma H, Patil AP, Edavazhipurath A, Dhanasooraj D, Othayoth Kandy S, Puthenpurayil JM, Chakyar K, Melarcode Ramanan K, Madkaikar M. Immunodeficiency-Related Vaccine-Derived Poliovirus (iVDPV) Excretion in an Infant with Severe Combined Immune Deficiency with Spillover to a Parent. Vaccines (Basel) 2024; 12:759. [PMID: 39066397 PMCID: PMC11281642 DOI: 10.3390/vaccines12070759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 07/28/2024] Open
Abstract
In order to maintain the polio eradication status, it has become evident that the surveillance of cases with acute flaccid paralysis and of environmental samples must be urgently supplemented with the surveillance of poliovirus excretions among individuals with inborn errors of immunity (IEI). All children with IEI were screened for the excretion of poliovirus during a collaborative study conducted by the ICMR-National Institute of Virology, Mumbai Unit, ICMR-National Institute of Immunohaematology, and World Health Organization, India. A seven-month -old male baby who presented with persistent pneumonia and lymphopenia was found to have severe combined immune deficiency (SCID) due to a missense variant in the RAG1 gene. He had received OPV at birth and at 20 weeks. Four stool samples collected at 4 weekly intervals yielded iVDPV type 1. The child's father, an asymptomatic 32-year-old male, was also found to be excreting iVDPV. A haploidentical hematopoietic stem cell transplant was performed, but the child succumbed due to severe myocarditis and pneumonia three weeks later. We report a rare case of transmission of iVDPV from an individual with IEI to a healthy household contact, demonstrating the threat of the spread of iVDPV from persons with IEI and the necessity to develop effective antivirals.
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Affiliation(s)
- Madhu Chhanda Mohanty
- Mumbai Unit, ICMR-National Institute of Virology, Haffkine Institute Campus, Acharya Donde Marg, Parel, Mumbai 400012, India; (S.Y.V.); (M.T.); (A.P.P.)
| | - Geeta Govindaraj
- Government Medical College, Kozhikode 673008, India; (G.G.); (A.E.); (D.D.); (S.O.K.); (J.M.P.); (K.C.)
| | - Mohammad Ahmad
- Country Office, World Health Organization, New Delhi 110011, India; (M.A.); (D.S.); (A.K.)
| | - Swapnil Y. Varose
- Mumbai Unit, ICMR-National Institute of Virology, Haffkine Institute Campus, Acharya Donde Marg, Parel, Mumbai 400012, India; (S.Y.V.); (M.T.); (A.P.P.)
| | - Manogat Tatkare
- Mumbai Unit, ICMR-National Institute of Virology, Haffkine Institute Campus, Acharya Donde Marg, Parel, Mumbai 400012, India; (S.Y.V.); (M.T.); (A.P.P.)
| | - Anita Shete
- Microbial Containment Laboratory, ICMR-National Institute of Virology, Pune 411021, India; (A.S.); (S.Y.); (Y.J.); (P.Y.)
| | - Savita Yadav
- Microbial Containment Laboratory, ICMR-National Institute of Virology, Pune 411021, India; (A.S.); (S.Y.); (Y.J.); (P.Y.)
| | - Yash Joshi
- Microbial Containment Laboratory, ICMR-National Institute of Virology, Pune 411021, India; (A.S.); (S.Y.); (Y.J.); (P.Y.)
| | - Pragya Yadav
- Microbial Containment Laboratory, ICMR-National Institute of Virology, Pune 411021, India; (A.S.); (S.Y.); (Y.J.); (P.Y.)
| | - Deepa Sharma
- Country Office, World Health Organization, New Delhi 110011, India; (M.A.); (D.S.); (A.K.)
| | - Arun Kumar
- Country Office, World Health Organization, New Delhi 110011, India; (M.A.); (D.S.); (A.K.)
| | - Harish Verma
- World Health Organization, 1209 Geneva, Switzerland;
| | - Ankita P. Patil
- Mumbai Unit, ICMR-National Institute of Virology, Haffkine Institute Campus, Acharya Donde Marg, Parel, Mumbai 400012, India; (S.Y.V.); (M.T.); (A.P.P.)
| | - Athulya Edavazhipurath
- Government Medical College, Kozhikode 673008, India; (G.G.); (A.E.); (D.D.); (S.O.K.); (J.M.P.); (K.C.)
| | - Dhananjayan Dhanasooraj
- Government Medical College, Kozhikode 673008, India; (G.G.); (A.E.); (D.D.); (S.O.K.); (J.M.P.); (K.C.)
| | - Sheena Othayoth Kandy
- Government Medical College, Kozhikode 673008, India; (G.G.); (A.E.); (D.D.); (S.O.K.); (J.M.P.); (K.C.)
| | | | - Krishnan Chakyar
- Government Medical College, Kozhikode 673008, India; (G.G.); (A.E.); (D.D.); (S.O.K.); (J.M.P.); (K.C.)
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Ranchod H, Howard W, Roux A, van Zyl W, Ekermans P, van den Berg S, Seakamela L, Makua K, Yousif M, Sibiya R, Du Plessis H, Phalane E, McCarthy K, Moonsamy S, Reynders D, Hincks J, Suchard MS, du Plessis NM. Stem Cell Transplant in Immune-deficiency-associated Vaccine-derived Poliovirus. Open Forum Infect Dis 2024; 11:ofad678. [PMID: 38328499 PMCID: PMC10849832 DOI: 10.1093/ofid/ofad678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/15/2024] [Indexed: 02/09/2024] Open
Abstract
Patients with severe primary immunodeficiency are at risk for complications from live-attenuated vaccines. Here, we report a case of a vaccine-associated paralytic polio and Bacille Calmette-Guérin disease in a 6-month-old girl with severe combined immunodeficiency resulting from homozygous recombinant activating gene 1 deficiency. The patient was successfully treated with intravenous immunoglobulins and oral pocapavir for poliovirus, and antimycobacterial therapy for regional Bacille Calmette-Guérin disease, allowing stem cell transplant. Following transplantation, poliovirus type 3 with 13 mutations was detected from cerebrospinal fluid but not from stool, indicating ongoing viral evolution in the central nervous system despite pocapavir treatment. Clinical improvement and immune reconstitution allowed the patient to be successfully discharged with no further detection of poliovirus.
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Affiliation(s)
- Heena Ranchod
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, Johannesburg, South Africa
- Department of Chemical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wayne Howard
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, Johannesburg, South Africa
- Department of Chemical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adele Roux
- Dr Adéle Roux Practice, Life Groenkloof Hospital, Pretoria, South Africa
| | - Walda van Zyl
- Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, National Health Laboratory Services—Tshwane Academic Division, Pretoria, South Africa
| | - Pieter Ekermans
- Department of Medical Microbiology, Ampath Laboratories, Pretoria, South Africa
| | | | - Lerato Seakamela
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Koketso Makua
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Mukhlid Yousif
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, Johannesburg, South Africa
- Department of Virology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rosinah Sibiya
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Heleen Du Plessis
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Emmanuel Phalane
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, Johannesburg, South Africa
- Department of Virology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kerrigan McCarthy
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Shelina Moonsamy
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - David Reynders
- Department of Paediatrics, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Melinda S Suchard
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, Johannesburg, South Africa
- Department of Chemical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicolette M du Plessis
- Department of Paediatrics, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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