1
|
Tegegne AA, Anyuon AN, Legge GA, Ferede MA, Isaac Z, Laku KA, Biadgilign S, Kilo OTD, Ndenzako F, Modjirom N, Olu OO, Maleghemi S. A circulating vaccine-derived poliovirus type 2 outbreak in a chronic conflict setting: a descriptive epidemiological study in South Sudan - 2020 to 2021. BMC Infect Dis 2023; 23:816. [PMID: 37990165 PMCID: PMC10664300 DOI: 10.1186/s12879-023-08758-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/26/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND In this study, we describe the epidemiological profile of an outbreak of the circulating Vaccine Derived Polio Virus type 2 in South Sudan from 2020 to 2021. METHOD We conducted a retrospective descriptive epidemiological study using data from the national polio/AFP surveillance database, the outbreak investigation reports, and the vaccination coverage survey databases stored at the national level. RESULTS Between September 2020 and April 2021, 59 cases of the circulating virus were confirmed in the country, with 50 cases in 2020 and 9 cases in 2021. More cases were males (56%) under five (93%). The median age of the cases was 23.4 ± 11.9 months, ranging from 1 to 84 months. All states, with 28 out of the 80 counties, reported at least one case. Most of the cases (44, 75%) were reported from five states, namely Warrap (31%), Western Bahr el Ghazal (12%), Unity (12%), Central Equatoria (10%), and Jonglei (10%). Four counties accounted for 45.8% of the cases; these are Gogrial West with 12 (20%), Jur River with 5 (8.5%), Tonj North with 5 (8.5%), and Juba with 5 (8.5%) cases. The immunization history of the confirmed cases indicated that 14 (24%) of the affected children had never received any doses of oral polio or injectable vaccines either from routine or during supplemental immunization before the onset of paralysis, 17 (28.8%) had received 1 to 2 doses, while 28 (47.5%) had received 3 or more doses (Fig. 4). Two immunization campaigns and a mop-up were conducted with monovalent Oral Polio Vaccine type 2 in response to the outbreak, with administrative coverage of 91.1%, 99.1%, and 97% for the first, second, and mop-up rounds, respectively. CONCLUSION The emergence of the circulating vaccine-derived poliovirus outbreak in South Sudan was due to low population immunity, highlighting the need to improve the country's routine and polio immunization campaign coverage.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Fabian Ndenzako
- World Health Organization Country Office, Juba, Republic of South Sudan
| | - Ndoutabe Modjirom
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Olushayo Oluseun Olu
- World Health Organization Country Office, Juba, Republic of South Sudan
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | |
Collapse
|
2
|
Manukyan H, Tritama E, Wahid R, Anstadt J, Konz J, Chumakov K, Laassri M. Improvement of the qmosRT-PCR Assay and Its Application for the Detection and Quantitation of the Three Serotypes of the Novel Oral Polio Vaccine in Stool Samples. Vaccines (Basel) 2023; 11:1729. [PMID: 38006061 PMCID: PMC10675353 DOI: 10.3390/vaccines11111729] [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: 10/06/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Recently, genetically stable novel OPVs (nOPV) were developed by modifying the genomes of Sabin viruses of conventional OPVs to reduce the risk of reversion to neurovirulence and therefore the risk of generating circulating vaccine-derived polioviruses. There is a need for specific and sensitive methods for the identification and quantification of nOPV viruses individually and in mixtures for clinical trials and potentially for manufacturing quality control and environmental surveillance. In this communication, we evaluated and improved the quantitative multiplex one-step reverse transcriptase polymerase chain reaction (qmosRT-PCR) assay for the identification and quantification of nOPV viruses in samples with different formulations and virus concentrations and in virus-spiked stool samples. The assay was able to specifically identify at least 1 log10 CCID50/mL of each serotype in the presence of the two other serotypes at high concentrations (6-7 log10 CCID50/mL) in the same sample. In addition, the lowest viral concentration that the assay was able to detect in stool samples was 17 CCID50/mL for nOPV1 and nOPV2 viruses and 6 CCID50/mL for nOPV3. We also found high correlation between the expected and observed (by qmosRT-PCR) concentrations of spiked viruses in stool samples for all three nOPV viruses, with R-squared values above 0.95. The analysis of samples collected from an nOPV2 clinical trial showed that 100% of poliovirus type 2 was detected and few samples showed the presence of type 1 and 3 residuals from previous vaccinations with bOPV (at least 4 weeks prior vaccination with nOPV2), confirming the high sensitivity of the method. The qmosRT-PCR was specific and sensitive for the simultaneous identification and quantification of all three nOPV viruses. It can be used as an identity test during the nOPV manufacturing process and in evaluation of virus excretion in nOPV clinical trials.
Collapse
Affiliation(s)
- Hasmik Manukyan
- Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Erman Tritama
- Research and Development Division, PT. BioFarma, Bandung 40161, Indonesia
| | - Rahnuma Wahid
- Center for Vaccine Innovation and Access, PATH, Seattle, WA 98121, USA (J.A.)
| | - Jennifer Anstadt
- Center for Vaccine Innovation and Access, PATH, Seattle, WA 98121, USA (J.A.)
| | - John Konz
- Center for Vaccine Innovation and Access, PATH, Seattle, WA 98121, USA (J.A.)
| | - Konstantin Chumakov
- Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Majid Laassri
- Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| |
Collapse
|
3
|
Prado NDR, Brilhante-Da-Silva N, Sousa RMO, Morais MSDS, Roberto SA, Luiz MB, Assis LCD, Marinho ACM, Araujo LFLD, Pontes RDS, Stabeli RG, Fernandes CFC, Pereira SDS. Single-domain antibodies applied as antiviral immunotherapeutics. J Virol Methods 2023; 320:114787. [PMID: 37516366 DOI: 10.1016/j.jviromet.2023.114787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 07/31/2023]
Abstract
Viral infections have been the cause of high mortality rates throughout different periods in history. Over the last two decades, outbreaks caused by zoonotic diseases and transmitted by arboviruses have had a significant impact on human health. The emergence of viral infections in different parts of the world encourages the search for new inputs to fight pathologies of viral origin. Antibodies represent the predominant class of new drugs developed in recent years and approved for the treatment of various human diseases, including cancer, autoimmune and infectious diseases. A promising group of antibodies are single-domain antibodies derived from camelid heavy chain immunoglobulins, or VHHs, are biomolecules with nanometric dimensions and unique pharmaceutical and biophysical properties that can be used in the diagnosis and immunotherapy of viral infections. For viral neutralization to occur, VHHs can act in different stages of the viral cycle, including the actual inhibition of infection, to hindering viral replication or assembly. This review article addresses advances involving the use of VHHs in therapeutic propositions aimed to battle different viruses that affect human health.
Collapse
Affiliation(s)
- Nidiane Dantas Reis Prado
- Laboratório de Engenharia de Anticorpos, Fundação Oswaldo Cruz, FIOCRUZ, unidade Rondônia, Porto Velho, RO, Brazil
| | - Nairo Brilhante-Da-Silva
- Laboratório de Engenharia de Anticorpos, Fundação Oswaldo Cruz, FIOCRUZ, unidade Rondônia, Porto Velho, RO, Brazil; Programa de Pós-Graduação em Biologia Celular e Molecular, Instituto Oswaldo Cruz, IOC, Rio de Janeiro, RJ, Brazil
| | - Rosa Maria Oliveira Sousa
- Laboratório de Engenharia de Anticorpos, Fundação Oswaldo Cruz, FIOCRUZ, unidade Rondônia, Porto Velho, RO, Brazil
| | | | - Sibele Andrade Roberto
- Plataforma Bi-institucional de Medicina Translacional, Fundação Oswaldo Cruz-USP, Ribeirão Preto, SP, Brazil
| | - Marcos Barros Luiz
- Instituto Federal de Rondônia Campus Guajará-Mirim, IFRO, Guajará-Mirim, RO, Brazil
| | - Livia Coelho de Assis
- Programa de Pós-Graduação em Biologia Celular e Molecular, Instituto Oswaldo Cruz, IOC, Rio de Janeiro, RJ, Brazil; Laboratório Multiusuário de Pesquisa e Desenvolvimento, Fundação Oswaldo Cruz, Fiocruz unidade Ceará, Eusebio, CE, Brazil
| | - Anna Carolina M Marinho
- Laboratório Multiusuário de Pesquisa e Desenvolvimento, Fundação Oswaldo Cruz, Fiocruz unidade Ceará, Eusebio, CE, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Luiz Felipe Lemes de Araujo
- Plataforma Bi-institucional de Medicina Translacional, Fundação Oswaldo Cruz-USP, Ribeirão Preto, SP, Brazil; Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade de São Paulo, USP, Ribeirão Preto, SP, Brazil
| | - Rafael de Souza Pontes
- Plataforma Bi-institucional de Medicina Translacional, Fundação Oswaldo Cruz-USP, Ribeirão Preto, SP, Brazil; Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade de São Paulo, USP, Ribeirão Preto, SP, Brazil
| | - Rodrigo Guerino Stabeli
- Plataforma Bi-institucional de Medicina Translacional, Fundação Oswaldo Cruz-USP, Ribeirão Preto, SP, Brazil
| | - Carla Freire Celedonio Fernandes
- Programa de Pós-Graduação em Biologia Celular e Molecular, Instituto Oswaldo Cruz, IOC, Rio de Janeiro, RJ, Brazil; Laboratório Multiusuário de Pesquisa e Desenvolvimento, Fundação Oswaldo Cruz, Fiocruz unidade Ceará, Eusebio, CE, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Soraya Dos Santos Pereira
- Laboratório de Engenharia de Anticorpos, Fundação Oswaldo Cruz, FIOCRUZ, unidade Rondônia, Porto Velho, RO, Brazil; Programa de Pós-Graduação em Biologia Celular e Molecular, Instituto Oswaldo Cruz, IOC, Rio de Janeiro, RJ, Brazil; Programa de Pós-graduação em Biologia Experimental, Universidade Federal de Rondônia, UNIR, Porto Velho, RO, Brazil.
| |
Collapse
|
4
|
Walter KS, Altamirano J, Huang C, Carrington YJ, Zhou F, Andrews JR, Maldonado Y. Rapid emergence and transmission of virulence-associated mutations in the oral poliovirus vaccine following vaccination campaigns. NPJ Vaccines 2023; 8:137. [PMID: 37749086 PMCID: PMC10520055 DOI: 10.1038/s41541-023-00740-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/15/2023] [Indexed: 09/27/2023] Open
Abstract
There is an increasing burden of circulating vaccine-derived polioviruses (cVDPVs) due to the continued use of oral poliovirus vaccine (OPV). However, the informativeness of routine OPV VP1 sequencing for the early identification of viruses carrying virulence-associated reversion mutations has not been directly evaluated in a controlled setting. We prospectively collected 15,331 stool samples to track OPV shedding from children receiving OPV and their contacts for ten weeks following an immunization campaign in Veracruz State, Mexico and sequenced VP1 genes from 358 samples. We found that OPV was genetically unstable and evolves at an approximately clocklike rate that varies across serotypes and by vaccination status. Overall, 61% (11/18) of OPV-1, 71% (34/48) OPV-2, and 96% (54/56) OPV-3 samples with available data had evidence of a reversion at the key 5' UTR attenuating position and 28% (13/47) of OPV-1, 12% (14/117) OPV-2, and 91% (157/173) OPV-3 of Sabin-like viruses had ≥1 known reversion mutations in the VP1 gene. Our results are consistent with previous work documenting rapid reversion to virulence of OPV and underscores the need for intensive surveillance following OPV use.
Collapse
Affiliation(s)
- Katharine S Walter
- Division of Epidemiology, University of Utah, Salt Lake City, UT, 84105, USA.
| | - Jonathan Altamirano
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - ChunHong Huang
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Yuan J Carrington
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Frank Zhou
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Yvonne Maldonado
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
5
|
Wong W, Gauld J, Famulare M. From vaccine to pathogen: Modeling Sabin 2 vaccine virus reversion and evolutionary epidemiology in Matlab, Bangladesh. Virus Evol 2023; 9:vead044. [PMID: 37692896 PMCID: PMC10491863 DOI: 10.1093/ve/vead044] [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: 08/08/2022] [Revised: 06/26/2023] [Accepted: 07/07/2023] [Indexed: 09/12/2023] Open
Abstract
The oral poliovirus vaccines (OPVs) are one of the most effective disease eradication tools in public health. However, the OPV strains are genetically unstable and can cause outbreaks of circulating, vaccine-derived Type 2 poliovirus (cVDPV2) that are clinically indistinguishable from wild poliovirus (WPV) outbreaks. Here, we developed a Sabin 2 reversion model that simulates the reversion of Sabin 2 to reacquire a WPV-like phenotype based on the clinical differences in shedding duration and infectiousness between individuals vaccinated with Sabin 2 and those infected with WPV. Genetic reversion is informed by a canonical reversion pathway defined by three gatekeeper mutations (A481G, U2909C, and U398C) and the accumulation of deleterious nonsynonymous mutations. Our model captures essential aspects of both phenotypic and molecular evolution and simulates transmission using a multiscale transmission model that consolidates the relationships among immunity, susceptibility, and transmission risk. Despite rapid Sabin 2 attenuation reversal, we show that the emergence of a revertant virus does not guarantee a cVDPV2 outbreak. When simulating outbreaks in Matlab, Bangladesh, we found that cVDPV2 outbreaks are most likely in areas with low population-level immunity and poor sanitation. In Matlab, our model predicted that declining immunity against Type 2 poliovirus following the cessation of routine OPV vaccination was not enough to promote cVDPV2 emergence. However, cVDPV2 emergencedepended on the average viral exposure dose per contact, which was modeled as a combination of the viral concentration per fecal gram and the average fecal-oral dose per contact. These results suggest that cVDPV2 emergence risk can be mitigated by reducing the amount of infectious fecal material individuals are exposed to. Thus, a combined strategy of assessing and improving sanitation levels in conjunction with high-coverage vaccination campaigns could limit the future cVDPV2 emergence.
Collapse
Affiliation(s)
- Wesley Wong
- Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, SPH 1, Boston, MA 02115, USA
| | - Jillian Gauld
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, 500 5th Ave N, Seattle, WA 98109, USA
| | - Michael Famulare
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, 500 5th Ave N, Seattle, WA 98109, USA
| |
Collapse
|
6
|
Mbani CJ, Nekoua MP, Moukassa D, Hober D. The Fight against Poliovirus Is Not Over. Microorganisms 2023; 11:1323. [PMID: 37317297 DOI: 10.3390/microorganisms11051323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/13/2023] [Accepted: 05/14/2023] [Indexed: 06/16/2023] Open
Abstract
Poliovirus (PV), the virus that causes both acute poliomyelitis and post-polio syndrome, is classified within the Enterovirus C species, and there are three wild PV serotypes: WPV1, WPV2 and WPV3. The launch of the Global Polio Eradication Initiative (GPEI) in 1988 eradicated two of the three serotypes of WPV (WPV2 and WPV3). However, the endemic transmission of WPV1 persists in Afghanistan and Pakistan in 2022. There are cases of paralytic polio due to the loss of viral attenuation in the oral poliovirus vaccine (OPV), known as vaccine-derived poliovirus (VDPV). Between January 2021 and May 2023, a total of 2141 circulating VDPV (cVDPV) cases were reported in 36 countries worldwide. Because of this risk, inactivated poliovirus (IPV) is being used more widely, and attenuated PV2 has been removed from OPV formulations to obtain bivalent OPV (containing only types 1 and 3). In order to avoid the reversion of attenuated OPV strains, the new OPV, which is more stable due to genome-wide modifications, as well as sabin IPV and virus-like particle (VLP) vaccines, is being developed and offers promising solutions for eradicating WP1 and VDPV.
Collapse
Affiliation(s)
- Chaldam Jespère Mbani
- Laboratoire de Virologie URL3610, Université de Lille, CHU Lille, 59000 Lille, France
- Laboratoire de Biologie Cellulaire et Moléculaire, Faculté des Sciences et Technique, Université Marien Ngouabi, Brazzaville BP 69, Congo
| | | | - Donatien Moukassa
- Laboratoire de Biologie Cellulaire et Moléculaire, Faculté des Sciences et Technique, Université Marien Ngouabi, Brazzaville BP 69, Congo
| | - Didier Hober
- Laboratoire de Virologie URL3610, Université de Lille, CHU Lille, 59000 Lille, France
| |
Collapse
|
7
|
Weil M, Sofer D, Shulman LM, Weiss L, Levi N, Aguvaev I, Cohen Z, Kestin K, Vasserman R, Elul M, Fratty IS, Zuckerman NS, Erster O, Yishai R, Hecht L, Alroy-Preis S, Mendelson E, Bar-Or I. Environmental surveillance detected type 3 vaccine-derived polioviruses in increasing frequency at multiple sites prior to detection of a poliomyelitis case. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 871:161985. [PMID: 36739034 DOI: 10.1016/j.scitotenv.2023.161985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
Israel conducts routine environmental (15 sites) and acute flaccid paralysis (AFP) surveillance for poliovirus. During September 2021, increasing numbers of wastewater samples collected from more than one site in the Jerusalem region proved positive for ambiguous type 3 vaccine-derived poliovirus (aVDPV3), while environmental samples from remaining sampling sites were negative. In late February 2022, a VDPV3, genetically related to the Jerusalem environmental surveillance samples, was isolated from a stool sample collected from a non-immunodeficient, non-immunized child from Jerusalem who developed AFP, indicating that the aVDPV3s were circulating (cVDPV3s) rather than immunodeficiency-related VDPV3s (iVDPVs). In response to these isolations, the Israel Ministry of Health launched a catch-up immunization program.
Collapse
Affiliation(s)
- Merav Weil
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel.
| | - Danit Sofer
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Lester M Shulman
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel; School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Leah Weiss
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Nofar Levi
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Irina Aguvaev
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Zvi Cohen
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Klil Kestin
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Rinat Vasserman
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Michal Elul
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Ilana S Fratty
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel; The Israel Center for Disease Control, Israel Ministry of Health, Ramat-Gan, Israel
| | - Neta S Zuckerman
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Oran Erster
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Ruth Yishai
- Department of Laboratories, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Lior Hecht
- Public Health Services, Ministry of Health, Jerusalem, Israel
| | | | - Ella Mendelson
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel; School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Itay Bar-Or
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel.
| |
Collapse
|
8
|
Morais A, Morais J, Felix M, Neto Z, Madaleno V, Umar AS, Panda N, Lemma F, Chivale JAL, Cavalcante DG, Davlantes E, Ghiselli M, Espinosa C, Whiteman A, Iber J, Henderson E, Bullard K, Jorba J, Burns CC, Diop O, Gumede N, Seakamela L, Howard W, Frawley A. Genetic and epidemiological description of an outbreak of circulating vaccine-derived polio-virus type 2 (cVDPV2) in Angola, 2019-2020. Vaccine 2023; 41 Suppl 1:A48-A57. [PMID: 36803869 PMCID: PMC10823914 DOI: 10.1016/j.vaccine.2023.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/19/2023]
Abstract
After six years without any detection of poliomyelitis cases, Angola reported a case of circulating vaccine-derived poliovirus type 2 (cVDPV2) with paralysis onset date of 27 March 2019. Ultimately, 141 cVDPV2 polio cases were reported in all 18 provinces in 2019-2020, with particularly large hotspots in the south-central provinces of Luanda, Cuanza Sul, and Huambo. Most cases were reported from August to December 2019, with a peak of 15 cases in October 2019. These cases were classified into five distinct genetic emergences (emergence groups) and have ties with cases identified in 2017-2018 in the Democratic Republic of Congo. From June 2019 to July 2020, the Angola Ministry of Health and partners conducted 30 supplementary immunization activity (SIA) rounds as part of 10 campaign groups, using monovalent OPV type 2 (mOPV2). There were Sabin 2 vaccine strain detections in the environmental (sewage) samples taken after mOPV2 SIAs in each province. Following the initial response, additional cVDPV2 polio cases occurred in other provinces. However, the national surveillance system did not detect any new cVDPV2 polio cases after 9 February 2020. While reporting subpar indicator performance in epidemiological surveillance, the laboratory and environmental data as of May 2021 strongly suggest that Angola successfully interrupted transmission of cVDPV2 early in 2020. Additionally, the COVID-19 pandemic did not allow a formal Outbreak Response Assessment (OBRA). Improving the sensitivity of the surveillance system and the completeness of AFP case investigations will be vital to promptly detect and interrupt viral transmission if a new case or sewage isolate are identified in Angola or central Africa.
Collapse
Affiliation(s)
- Alda Morais
- Angola Ministry of Health. R. 17 de Setembro, Luanda, Angola
| | - Joana Morais
- Angola Ministry of Health. R. 17 de Setembro, Luanda, Angola
| | - Miguel Felix
- Angola Ministry of Health. R. 17 de Setembro, Luanda, Angola
| | - Zoraima Neto
- Angola Ministry of Health. R. 17 de Setembro, Luanda, Angola
| | | | - Abubakar Sadiq Umar
- World Health Organization, Angola Country Office. Condomínio Rosalinda, Edifício da ONU, Estrada Direita da Samba, Futungo de Belas, Luanda, Angola
| | - Nirakar Panda
- World Health Organization, Angola Country Office. Condomínio Rosalinda, Edifício da ONU, Estrada Direita da Samba, Futungo de Belas, Luanda, Angola
| | - Fekadu Lemma
- World Health Organization, Angola Country Office. Condomínio Rosalinda, Edifício da ONU, Estrada Direita da Samba, Futungo de Belas, Luanda, Angola
| | - José Alexandre Lifande Chivale
- World Health Organization, Angola Country Office. Condomínio Rosalinda, Edifício da ONU, Estrada Direita da Samba, Futungo de Belas, Luanda, Angola
| | - Danielle Graça Cavalcante
- World Health Organization, Angola Country Office. Condomínio Rosalinda, Edifício da ONU, Estrada Direita da Samba, Futungo de Belas, Luanda, Angola
| | - Elizabeth Davlantes
- Global Immunization Division, US Centers for Disease Control and Prevention. 1600 Clifton Road, Atlanta, GA, USA.
| | - Margherita Ghiselli
- Global Immunization Division, US Centers for Disease Control and Prevention. 1600 Clifton Road, Atlanta, GA, USA
| | - Catherine Espinosa
- Global Immunization Division, US Centers for Disease Control and Prevention. 1600 Clifton Road, Atlanta, GA, USA
| | - Ari Whiteman
- Geospatial Research, Analysis, and Services Program, US Agency for Toxic Substances and Disease Registry. 4770, Buford Hwy Northeast, Atlanta, GA, USA
| | - Jane Iber
- Division of Viral Diseases, US Centers for Disease Control and Prevention. 1600 Clifton Road, Atlanta, GA, USA
| | - Elizabeth Henderson
- Division of Viral Diseases, US Centers for Disease Control and Prevention. 1600 Clifton Road, Atlanta, GA, USA
| | - Kelley Bullard
- Division of Viral Diseases, US Centers for Disease Control and Prevention. 1600 Clifton Road, Atlanta, GA, USA
| | - Jaume Jorba
- Division of Viral Diseases, US Centers for Disease Control and Prevention. 1600 Clifton Road, Atlanta, GA, USA
| | - Cara C Burns
- Division of Viral Diseases, US Centers for Disease Control and Prevention. 1600 Clifton Road, Atlanta, GA, USA
| | - Ousmane Diop
- Polio Eradication Department, World Health Organization, Avenue Appia, 20, 1211, Geneva 27, Switzerland
| | - Nicksy Gumede
- World Health Organization Regional Office for Africa. Cité du Djoué, P.O. Box 06, Brazzaville, Republic of Congo
| | - Lerato Seakamela
- National Institute for Communicable Diseases, 1, Modderfontein Road, Sandringham, Johannesburg 2192, South Africa
| | - Wayne Howard
- National Institute for Communicable Diseases, 1, Modderfontein Road, Sandringham, Johannesburg 2192, South Africa
| | - Alean Frawley
- US Centers for Disease Control and Prevention, Angola Country Office, R. Houari Boumediene 32, Luanda, Angola
| |
Collapse
|
9
|
Alleman MM, Jorba J, Riziki Y, Henderson E, Mwehu A, Seakamela L, Howard W, Kadiobo Mbule A, Nsamba RN, Djawe K, Yapi MD, Mengouo MN, Gumede N, Ndoutabe M, Kfutwah AKW, Senouci K, Burns CC. Vaccine-derived poliovirus serotype 2 outbreaks and response in the Democratic Republic of the Congo, 2017-2021. Vaccine 2023; 41 Suppl 1:A35-A47. [PMID: 36907733 PMCID: PMC10427717 DOI: 10.1016/j.vaccine.2023.02.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 02/01/2023] [Accepted: 02/13/2023] [Indexed: 03/13/2023]
Abstract
Vaccine-derived polioviruses (VDPVs) can emerge from Sabin strain poliovirus serotypes 1, 2, and 3 contained in oral poliovirus vaccine (OPV) after prolonged person-to-person transmission where population vaccination immunity against polioviruses is suboptimal. VDPVs can cause paralysis indistinguishable from wild polioviruses and outbreaks when community circulation ensues. VDPV serotype 2 outbreaks (cVDPV2) have been documented in The Democratic Republic of the Congo (DRC) since 2005. The nine cVDPV2 outbreaks detected during 2005-2012 were geographically-limited and resulted in 73 paralysis cases. No outbreaks were detected during 2013-2016. During January 1, 2017-December 31, 2021, 19 cVDPV2 outbreaks were detected in DRC. Seventeen of the 19 (including two first detected in Angola) resulted in 235 paralysis cases notified in 84 health zones in 18 of DRC's 26 provinces; no notified paralysis cases were associated with the remaining two outbreaks. The DRC-KAS-3 cVDPV2 outbreak that circulated during 2019-2021, and resulted in 101 paralysis cases in 10 provinces, was the largest recorded in DRC during the reporting period in terms of numbers of paralysis cases and geographic expanse. The 15 outbreaks occurring during 2017-early 2021 were successfully controlled with numerous supplemental immunization activities (SIAs) using monovalent OPV Sabin-strain serotype 2 (mOPV2); however, suboptimal mOPV2 vaccination coverage appears to have seeded the cVDPV2 emergences detected during semester 2, 2018 through 2021. Use of the novel OPV serotype 2 (nOPV2), designed to have greater genetic stability than mOPV2, should help DRC's efforts in controlling the more recent cVDPV2 outbreaks with a much lower risk of further seeding VDPV2 emergence. Improving nOPV2 SIA coverage should decrease the number of SIAs needed to interrupt transmission. DRC needs the support of polio eradication and Essential Immunization (EI) partners to accelerate the country's ongoing initiatives for EI strengthening, introduction of a second dose of inactivated poliovirus vaccine (IPV) to increase protection against paralysis, and improving nOPV2 SIA coverage.
Collapse
Affiliation(s)
- Mary M Alleman
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, USA.
| | - Jaume Jorba
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Yogolelo Riziki
- Institut National de Recherche Biomédicale, Ministry of Public Health, Hygiene and Prevention, Democratic Republic of the Congo
| | - Elizabeth Henderson
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Anicet Mwehu
- Emergency Operations Center for Polio, Ministry of Public Health, Hygiene and Prevention, Democratic Republic of the Congo
| | - Lerato Seakamela
- National Institute for Communicable Diseases, National Health Laboratory Services, South Africa
| | - Wayne Howard
- National Institute for Communicable Diseases, National Health Laboratory Services, South Africa
| | - Albert Kadiobo Mbule
- Polio, Office of the Regional Director, World Health Organization, Democratic Republic of the Congo Country Office, Democratic Republic of the Congo
| | - Renee Ntumbannji Nsamba
- Polio, Office of the Regional Director, World Health Organization, Democratic Republic of the Congo Country Office, Democratic Republic of the Congo
| | - Kpandja Djawe
- Polio, Office of the Regional Director, World Health Organization, Democratic Republic of the Congo Country Office, Democratic Republic of the Congo
| | - Moïse Désiré Yapi
- Polio, Office of the Regional Director, World Health Organization, Democratic Republic of the Congo Country Office, Democratic Republic of the Congo
| | - Marcellin Nimpa Mengouo
- Polio, Office of the Regional Director, World Health Organization, Democratic Republic of the Congo Country Office, Democratic Republic of the Congo
| | - Nicksy Gumede
- Polio, Office of the Regional Director, World Health Organization, Regional Office for Africa, Republic of the Congo
| | - Modjirom Ndoutabe
- Polio, Office of the Regional Director, World Health Organization, Regional Office for Africa, Republic of the Congo
| | - Anfumbom K W Kfutwah
- Polio, Office of the Regional Director, World Health Organization, Regional Office for Africa, Republic of the Congo
| | | | - Cara C Burns
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| |
Collapse
|
10
|
Tan J, Zhao Y, Burns CC, Tian D, Zhao K. Novel Network Method Major Minor Variation Clustering Enables Identification of Poliovirus Clusters with High-Resolution Linkages. J Comput Biol 2023; 30:409-419. [PMID: 36112351 PMCID: PMC11299649 DOI: 10.1089/cmb.2022.0292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Global Polio Eradication Initiative uses an outbreak response protocol that defines type 2 Sabin or Sabin-like virus as those with 0-5 nucleotides diverging from their parental strain in the complete VP1 genomic region. Sabin or Sabin-like viruses share highly similar genome sequences, regardless of their origin. Thus, it is challenging to distinguish viruses at a higher resolution to detect polio clusters or trace sources for local transmissions of viruses at an early stage. To identify type 2 Sabin or Sabin-like sources and improve our ability to map viral sources to campaigns during the polio endgame, we investigated the feasibility of a new method for genetic sequence analysis. We named the method Major Minor Variation Clustering (MMVC), which uses a network model to simultaneously incorporate sequence similarity in major and minor variants in addition to onset dates to detect fine-scale polio clusters. Each identified cluster represents a collection of sequences that are highly similar in both major and minor variants, enabling the discovery of new links between viruses. By applying the method to a published data set collected in Nigeria during 2009-2012, we found that clusters identified using this method have several improvements over clusters derived from a phylogenetic tree approach. Integrative data analysis reveals that sequences in the same cluster have greater genomic similarities and better agreement with onset dates. As a complement to current phylogenetic tree approaches, MMVC has the potential to improve epidemiological surveillance and investigation precision to guide polio eradication.
Collapse
Affiliation(s)
- Jiahui Tan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yutong Zhao
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Cara C Burns
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dechao Tian
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Kun Zhao
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
11
|
Walter KS, Altamirano J, Huang C, Carrington YJ, Zhou F, Andrews JR, Maldonado Y. Rapid emergence and transmission of virulence-associated mutations in the oral poliovirus vaccine following vaccination campaigns. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.16.23287381. [PMID: 36993386 PMCID: PMC10055580 DOI: 10.1101/2023.03.16.23287381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
There is an increasing burden of circulating vaccine-derived polioviruses (cVDPVs) due to the continued use of oral poliovirus vaccine (OPV). However, the informativeness of routine OPV VP1 sequencing for the early identification of viruses carrying virulence-associated reversion mutations has not been directly evaluated in a controlled setting. We prospectively collected 15,331 stool samples to track OPV shedding from vaccinated children and their contacts for ten weeks following an immunization campaign in Veracruz State, Mexico and sequenced VP1 genes from 358 samples. We found that OPV was genetically unstable and evolves at an approximately clocklike rate that varies across serotypes and by vaccination status. Alarmingly, 28% (13/47) of OPV-1, 12% (14/117) OPV-2, and 91% (157/173) OPV-3 of Sabin-like viruses had ≥1 known reversion mutation. Our results suggest that current definitions of cVDPVs may exclude circulating virulent viruses that pose a public health risk and underscore the need for intensive surveillance following OPV use.
Collapse
Affiliation(s)
| | - Jonathan Altamirano
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - ChunHong Huang
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Yuan J. Carrington
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Frank Zhou
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Jason R. Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Yvonne Maldonado
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| |
Collapse
|
12
|
Darwar R, Biya O, Greene SA, Jorba J, Al Safadi M, Franka R, Wiesen E, Durry E, Pallansch MA. Assessing country compliance with circulating vaccine-derived poliovirus type 2 outbreak response standard operating procedures: April 2016 to December 2020. Vaccine 2023; 41 Suppl 1:A25-A34. [PMID: 36863925 DOI: 10.1016/j.vaccine.2023.02.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Trivalent oral poliovirus vaccine (tOPV) was globally replaced with bivalent oral poliovirus vaccine (bOPV) in April 2016 ("the switch"). Many outbreaks of paralytic poliomyelitis associated with type 2 circulating vaccine-derived poliovirus (cVDPV2) have been reported since this time. The Global Polio Eradication Initiative (GPEI) developed standard operating procedures (SOPs) to guide countries experiencing cVDPV2 outbreaks to implement timely and effective outbreak response (OBR). To assess the possible role of compliance with SOPs in successfully stopping cVDPV2 outbreaks, we analyzed data on critical timelines in the OBR process. METHODS Data were collected on all cVDPV2 outbreaks detected for the period April 1, 2016 and December 31, 2020 and all outbreak responses to those outbreaks between April 1, 2016 and December 31, 2021. We conducted secondary data analysis using the GPEI Polio Information System database, records from the Anonymized Institution Poliovirus Laboratory, and meeting minutes of the monovalent OPV2 (mOPV2) Advisory Group. Date of notification of circulating virus was defined as Day 0 for this analysis. Extracted process variables were compared with indicators in the GPEI SOP version 3.1. RESULTS One hundred and eleven cVDPV2 outbreaks resulting from 67 distinct cVDPV2 emergences were reported during April 1, 2016-December 31, 2020, affecting 34 countries across four World Health Organization Regions. Out of 65 OBRs with the first large-scale campaign (R1) conducted after Day 0, only 12 (18.5%) R1s were conducted by the target of 28 days after Day 0. Of the 89 OBRs with the second large-scale campaign (R2) conducted after Day 0, 30 (33.7%) R2s were conducted by the target of 56 days after Day 0. Twenty-three (31.9%) of the 72 outbreaks with isolates dated after Day 0 were stopped within the 120-day target. CONCLUSION Since "the switch", delays in OBR implementation were evident in many countries, which may be related to the persistence of cVDPV2 outbreaks >120 days. To achieve timely and effective response, countries should follow GPEI OBR guidelines.
Collapse
Affiliation(s)
- Roopa Darwar
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Oladayo Biya
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Sharon A Greene
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Jaume Jorba
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Mohammad Al Safadi
- Polio Eradication Department, World Health Organization, Geneva, Switzerland.
| | - Richard Franka
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Eric Wiesen
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Elias Durry
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Mark A Pallansch
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| |
Collapse
|
13
|
Nearly Complete Genome Sequences of Type 2 Sabin-Like Polioviruses from Northern Nigerian Poliovirus Surveillance, 2016 to 2018. Microbiol Resour Announc 2023; 12:e0073522. [PMID: 36507631 PMCID: PMC9872618 DOI: 10.1128/mra.00735-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We sequenced 109 type 2 Sabin-like poliovirus isolates that had been collected from acute flaccid paralysis patients or healthy children in Nigeria. Understanding the genetic makeup of these viruses may contribute to polio eradication efforts.
Collapse
|
14
|
Nanque LM, Fisker AB. Maximising the lessons learned from trial data after emergency use listing of a novel oral polio vaccine. Lancet 2023; 401:83-85. [PMID: 36495877 DOI: 10.1016/s0140-6736(22)02455-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Line M Nanque
- Bandim Health Project, OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Copenhagen, Denmark; Bandim Health Project, INDEPTH network, 1004 Bissau Codex, Guinea-Bissau
| | - Ane Bærent Fisker
- Bandim Health Project, OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Copenhagen, Denmark; Bandim Health Project, INDEPTH network, 1004 Bissau Codex, Guinea-Bissau.
| |
Collapse
|
15
|
Immunogenicity of Catch-Up Immunization with Conventional Inactivated Polio Vaccine among Japanese Adults. Vaccines (Basel) 2022; 10:vaccines10122160. [PMID: 36560570 PMCID: PMC9785821 DOI: 10.3390/vaccines10122160] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Most Japanese adults are vaccinated twice with the Sabin trivalent oral polio vaccine. Booster vaccination is recommended for Japanese travelers to polio-endemic/high-risk countries. We assessed the catch-up immunization of healthy Japanese adults aged ≥20 years with two doses of standalone conventional inactivated polio vaccine (cIPV). Immunogenicity was evaluated by serum neutralization titers (pre-booster vaccination, 4-6 weeks after each vaccination) against type 1, 2, and 3 poliovirus strains. The participants were 61 healthy Japanese adults (26 men/35 women; mean age ± standard deviation age 35.8 ± 8.0 years). Seropositivity rates (percentage of participants with anti-poliovirus antibody titers ≥1:8) pre-vaccination were 88.5%, 95.1%, and 52.5% for Sabin strains (type 1, 2, and 3); 72.1%, 93.4%, and 31.1% for virulent poliovirus strains (type 1: Mahoney; type 2: MEF-1; and type 3: Saukett); and 93.4%, 93.4%, 93.4%, and 88.5% for type 2 vaccine-derived poliovirus strains (SV3128, SV3130, 11,196, and 11,198). After one cIPV dose, all seropositivity rates increased to 98.4-100.0%. After two cIPV doses, the seropositivity rates reached 100% for all strains. cIPV was well tolerated, with no safety concerns. Catch-up immunization with standalone cIPV induced robust immune responses in Japanese adults, indicating that one booster dose boosted serum-neutralizing antibodies to many strains.
Collapse
|
16
|
Wahid R, Mercer LD, De Leon T, DeAntonio R, Sáez-Llorens X, Macadam A, Chumakov K, Strating J, Koel B, Konopka-Anstadt JL, Oberste MS, Burns CC, Andino R, Tritama E, Bandyopadhyay AS, Aguirre G, Rüttimann R, Gast C, Konz JO. Genetic and phenotypic stability of poliovirus shed from infants who received novel type 2 or Sabin type 2 oral poliovirus vaccines in Panama: an analysis of two clinical trials. THE LANCET. MICROBE 2022; 3:e912-e921. [PMID: 36332645 PMCID: PMC9712124 DOI: 10.1016/s2666-5247(22)00254-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 07/29/2022] [Accepted: 08/26/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Sabin strains used in oral poliovirus vaccines (OPV) can revert to virulence and, in rare instances, cause disease or generate vaccine-derived strains leading to outbreaks in areas of low immunisation coverage. A novel OPV2 (nOPV2) was designed to stabilise the viral genome against reversion and reduce recombination events that might lead to virulent strains. In this study, we evaluated the genetic and phenotypic stability of shed poliovirus following administration of one dose of monovalent OPV2 (mOPV2) or nOPV2 to infants aged 18-22 weeks. METHODS In two similarly designed clinical trials (NCT02521974 and NCT03554798) conducted in Panama, infants aged 18-22-weeks, after immunisation with three doses of bivalent OPV (types 1 and 3) and one dose of inactivated poliovirus vaccine, were administered one or two doses of mOPV2 or nOPV2. In this analysis of two clinical trials, faecally shed polioviruses following one dose of mOPV2 or nOPV2 were isolated from stools meeting predetermined criteria related to sample timing and viral presence and quantity and assessed for nucleotide polymorphisms using next-generation sequencing. A transgenic mouse neurovirulence test was adapted to assess the effect of the possible phenotypic reversion of shed mOPV2 and nOPV2 with a logistic regression model. FINDINGS Of the 91 eligible samples, 86 were able to be sequenced, with 72 evaluated in the transgenic mouse assay. Sabin-2 poliovirus reverts rapidly at nucleotide 481, the primary attenuation site in domain V of the 5' untranslated region of the genome. There was no evidence of neurovirulence-increasing polymorphisms in domain V of shed nOPV2. Reversion of shed Sabin-2 virus corresponded with unadjusted paralysis rates of 47·6% at the 4 log10 50% cell culture infectious dose (CCID50) and 76·7% at the 5 log10 CCID50 inoculum levels, with rates of 2·8% for 4 log10 CCID50 and 11·8% for 5 log10 CCID50 observed for shed nOPV2 samples. The estimated adjusted odds ratio at 4·5 log10 of 0·007 (95% CI 0·002-0·023; p<0·0001) indicates significantly reduced odds of mouse paralysis from virus obtained from nOPV2 recipients compared with mOPV2 recipients. INTERPRETATION The data indicate increased genetic stability of domain V of nOPV2 relative to mOPV2, with significantly lower neurovirulence of shed nOPV2 virus compared with shed mOPV2. While this vaccine is currently being deployed under an emergency use listing, the data on the genetic stability of nOPV2 will support further regulatory and policy decision-making regarding use of nOPV2 in outbreak responses. FUNDING Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Rahnuma Wahid
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - Laina D Mercer
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - Tirza De Leon
- Hospital Materno Infantil José Domingo De Obaldía, David, Panama,CEVAXIN, Centro de Vacunación e Investigación, Panama City, Panama
| | | | - Xavier Sáez-Llorens
- CEVAXIN, Centro de Vacunación e Investigación, Panama City, Panama,Department of Infectious Diseases, Hospital del Niño Dr José Renán Esquivel and Sistema Nacional de Investigación at Secretaria Nacional de Ciencia y Tecnologia, Panama City, Panama
| | - Andrew Macadam
- Division of Virology, National Institute for Biological Standards and Control, South Mimms, UK
| | - Konstantin Chumakov
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA,Global Virus Network Center of Excellence, Baltimore, MD, USA
| | | | - Björn Koel
- Viroclinics Xplore, Viroclinics Biosciences, Rotterdam, Netherlands
| | | | - M Steven Oberste
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cara C Burns
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Raul Andino
- Department of Microbiology and Immunology, University of California, San Francisco, CA, USA
| | - Erman Tritama
- Research and Development Division, PT Bio Farma, Bandung, West Java, Indonesia
| | | | - Gabriela Aguirre
- Fighting Infectious Diseases in Emerging Countries, Miami, FL, USA
| | | | - Chris Gast
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - John O Konz
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA,Correspondence to: Dr John O Konz, Center for Vaccine Innovation and Access, PATH, Seattle, WA 98121, USA
| |
Collapse
|
17
|
Polio outbreak: An ongoing but ignored public health emergency of international concern - Correspondence. Int J Surg 2022; 108:106975. [PMID: 36332784 DOI: 10.1016/j.ijsu.2022.106975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/28/2022] [Indexed: 11/05/2022]
|
18
|
Ong-Lim AL, Shukarev G, Trinidad-Aseron M, Caparas-Yu D, Greijer A, Duchene M, Scheper G, van Paassen V, Le Gars M, Cahill CP, Schuitemaker H, Douoguih M, Jacquet JM. Safety and immunogenicity of 3 formulations of a Sabin inactivated poliovirus vaccine produced on the PER.C6® cell line: A phase 2, double-blind, randomized, controlled study in infants vaccinated at 6, 10 and 14 weeks of age. Hum Vaccin Immunother 2022; 18:2044255. [PMID: 35344464 PMCID: PMC9196784 DOI: 10.1080/21645515.2022.2044255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An inactivated poliovirus vaccine candidate using Sabin strains (sIPV) grown on the PER.C6® cell line was assessed in infants after demonstrated immunogenicity and safety in adults. The study recruited 300 infants who were randomized (1:1:1:1) to receive one of 3 dose levels of sIPV or a conventional IPV based on Salk strains (cIPV). Poliovirus-neutralizing antibodies were measured before the first dose and 28 days after the third dose. Reactogenicity was assessed for 7 days and unsolicited adverse events (AEs) for 28 days after each vaccination. Serious AEs (SAEs) were recorded throughout the study. Solicited AEs were mostly mild to moderate. None of the SAEs reported in the study were judged vaccine related, including one fatal SAE due to aspiration of vomitus that occurred 26 days after the third dose of low-dose sIPV. After 3 sIPV vaccinations and across all dose levels, seroconversion (SC) rates were at least 92% against Sabin poliovirus types and at least 80% against Salk types, with a dose-response in neutralizing antibody geometric mean titers (GMTs) observed across the 3 sIPV groups. Compared to cIPV, the 3 sIPV groups displayed similar or higher SC rates and GMTs against the 3 Sabin types but showed a lower response against Salk types 1 and 2; this was most visible for Salk type 1. While the PER.C6® cell line-based sIPV showed an acceptable safety profile and immunogenicity in infants, lower seroprotection against type 1 warrants optimization of dose level and additional clinical evaluation.
Collapse
Affiliation(s)
- Anna Lisa Ong-Lim
- Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | | | | | - Delia Caparas-Yu
- De La Salle Medical and Health Sciences Institute, Cavite, Philippines
| | - Astrid Greijer
- Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
| | - Michel Duchene
- Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
| | - Gert Scheper
- Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
| | | | | | - Conor P Cahill
- Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
| | | | | | | |
Collapse
|
19
|
Quarleri J. Poliomyelitis is a current challenge: long-term sequelae and circulating vaccine-derived poliovirus. GeroScience 2022; 45:707-717. [PMID: 36260265 PMCID: PMC9886775 DOI: 10.1007/s11357-022-00672-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/12/2022] [Indexed: 02/03/2023] Open
Abstract
For more than 20 years, the World Health Organization Western Pacific Region (WPR) has been polio-free. However, two current challenges are still polio-related. First, around half of poliomyelitis elderly survivors suffer late poliomyelitis sequelae with a substantial impact on daily activities and quality of life, experiencing varying degrees of residual weakness as they age. The post-polio syndrome as well as accelerated aging may be involved. Second, after the worldwide Sabin oral poliovirus (OPV) vaccination, the recent reappearance of strains of vaccine-derived poliovirus (VDPV) circulating in the environment is worrisome and able to persistent person-to-person transmission. Such VDPV strains exhibit atypical genetic characteristics and reversed neurovirulence that can cause paralysis similarly to wild poliovirus, posing a significant obstacle to the elimination of polio. Immunization is essential for preventing paralysis in those who are exposed to the poliovirus. Stress the necessity of maintaining high vaccination rates because declining immunity increases the likelihood of reemergence. If mankind wants to eradicate polio in the near future, measures to raise immunization rates and living conditions in poorer nations are needed, along with strict observation. New oral polio vaccine candidates offer a promissory tool for this goal.
Collapse
Affiliation(s)
- Jorge Quarleri
- Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina. .,Consejo de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
| |
Collapse
|
20
|
O'Leary A. Overcoming challenges en route to polio eradication. Lancet 2022; 400:1191. [PMID: 36183702 DOI: 10.1016/s0140-6736(22)01880-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/26/2022] [Indexed: 10/14/2022]
|
21
|
Faye M, Kébé O, Diop B, Ndiaye ND, Dosseh A, Sam A, Diallo A, Dia H, Diallo JP, Dia N, Kiori DE, Diop OM, Sall AA, Faye O. Importation and Circulation of Vaccine-Derived Poliovirus Serotype 2, Senegal, 2020-2021. Emerg Infect Dis 2022; 28:2027-2034. [PMID: 36148906 PMCID: PMC9514370 DOI: 10.3201/eid2810.220847] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Environmental surveillance for poliovirus is increasingly used in poliovirus eradication efforts as a supplement to acute flaccid paralysis (AFP) surveillance. Environmental surveillance was officially established in 2017 in Senegal, where no poliovirus had been detected since 2010. We tested sewage samples from 2 sites in Dakar monthly for polioviruses. We identified a vaccine-derived poliovirus serotype 2 on January 19, 2021, from a sample collected on December 24, 2020; by December 31, 2021, we had detected 70 vaccine-derived poliovirus serotype 2 isolates circulating in 7 of 14 regions in Senegal. Sources included 18 AFP cases, 20 direct contacts, 17 contacts in the community, and 15 sewage samples. Phylogenetic analysis revealed the circulation of 2 clusters and provided evidence on the virus introduction from Guinea. Because novel oral polio vaccine serotype 2 was used for response activities throughout Senegal, we recommend expanding environmental surveillance into other regions.
Collapse
|
22
|
Manukyan H, Wahid R, Ansari A, Tritama E, Macadam A, Konz J, Chumakov K, Laassri M. Quantitative RT-PCR Assays for Quantification of Undesirable Mutants in the Novel Type 2 Oral Poliovirus Vaccine. Vaccines (Basel) 2022; 10:vaccines10091394. [PMID: 36146473 PMCID: PMC9502871 DOI: 10.3390/vaccines10091394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 01/09/2023] Open
Abstract
Emergence of mutations is an inherent property of RNA viruses with several implications for their replication, pathogenesis, and evolutionary adaptation. Oral poliovirus vaccine (OPV), developed by Albert Sabin, is composed of live attenuated polioviruses of three serotypes that can revert to neurovirulence during replication in cell culture and in vaccine recipients. Recently, a new modified variant of Sabin 2 virus was developed by introducing changes in its genome, making it more genetically stable to prevent the reversion. The new strain was used to manufacture novel OPV2 (nOPV2), which was approved by the World Health Organization for emergency use to stop outbreaks caused by circulating vaccine-derived poliovirus (cVDPV2). Manufacture of this improved vaccine requires close attention to the genetic heterogenicity to ensure that the levels of the undesirable mutations are limited. Preliminary studies using whole-genome Illumina sequencing (NGS) identified several genomic sites where mutations tend to occur with regularity. They include VP1-I143T amino acid change at the secondary attenuation site; VP1-N171D, a substitution that modestly increases neurovirulence in mice; and VP1-E295K, which may reduce the immunogenicity of the nOPV2. Therefore, to ensure the molecular consistency of vaccine batches, the content of these mutants must be quantified and kept within specifications. To do this, we have developed quantitative, multiplex, one-step reverse-transcriptase polymerase chain reactions (qmosRT-PCRs) as simple methods for quantification of these mutations. Each method uses specific short TaqMan probes with different dyes for the analysis of both mutants and non-mutants in the same sample. The quantification is done using calibration curves developed using validated reference materials. To evaluate the sensitivity and the linearity of the qmosRT-PCR method, the mutant viruses were spiked in non-mutant viruses, and nOPV2 batches were used to validate the method. The spiked samples and the nOPV2 batches were analyzed by qmosRT-PCR and NGS assays. The results showed that qmosRT-PCR is sensitive enough to detect around 1% of mutants. The percentages of mutants determined by qmosRT-PCR correlate well with the results of the NGS. Further, the analysis of the nOPV2 batches showed that the results of qmosRT-PCR correlated well with the results of NGS. In conclusion, the qmosRT-PCR is a specific, sensitive, and linear method. It could be used for quality control of the nOPV2 batches.
Collapse
Affiliation(s)
- Hasmik Manukyan
- Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Rahnuma Wahid
- Center for Vaccine Innovation and Access, PATH, Seattle, WA 98121, USA
| | - Azeem Ansari
- Center for Vaccine Innovation and Access, PATH, Seattle, WA 98121, USA
| | - Erman Tritama
- Research and Development Division, PT. Bio Farma, Bandung, West Java 40161, Indonesia
| | - Andrew Macadam
- National Institute for Biological Standards and Control (NIBSC), Hertfordshire EN6 3QG, UK
| | - John Konz
- Center for Vaccine Innovation and Access, PATH, Seattle, WA 98121, USA
| | - Konstantin Chumakov
- Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Majid Laassri
- Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
- Correspondence: ; Tel.: +1-(240)-402-9656; Fax: +1-3015951440
| |
Collapse
|
23
|
Al-Qassimi MA, Al Amad M, Anam L, Almoayed K, Al-Dar A, Ezzadeen F. Circulating vaccine derived polio virus type 1 outbreak, Saadah governorate, Yemen, 2020. BMC Infect Dis 2022; 22:414. [PMID: 35488227 PMCID: PMC9052627 DOI: 10.1186/s12879-022-07397-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background Yemen has faced one of the worst humanitarian crises in the world since the start of the war in 2015. In 2020; 30 Vaccine Derived Polio Virus type 1 (VDPV1) isolates were detected in Saadah governorate. The aims are to characterize the outbreak and address the gaps predisposing the emergence and circulation of VDPV1 in Saadah governorate, Yemen. Method A retrospective descriptive study of confirmed cases of VDPV1 between January and December 2020 was performed. Surveillance staff collected data from patient cases, contacts, as well as stool specimens that shipped to WHO accredited polio labs. Data of population immunity was also reviewed. The difference in days between the date of sample collection, shipment, and receiving lab result was used to calculate the average of delayed days for lab confirmation. Results From January to December 2020, a total of 114 cases of acute flaccid paralysis (AFP) were reported from 87% (13/15) districts, and cVDPV1 was confirmed among 26% (30) AFP cases. 75% (21) were < 5 years, 73% (20) had zero doses of Oral Polio Vaccine (OPV). The first confirmed case (3%) was from Saadah city, with paralysis onset at the end of January 2020 followed by 5 cases (17%) in March from another four districts, 8 cases (27%) in April, and 13 (43%) up to December 2020 were from the same five districts in addition to 3 (10%) form three new districts. The lab confirmation was received after an average of 126 days (71–196) from sample collection. The isolates differ from the Sabin 1 type by 17- 30 VP1 nucleotides (nt) and were linked to VDPV1 with 13 (nt) divergence that isolated in July 2020 from stool specimens collected before one year from contacts of an inadequate AFP case reported from Sahar district. Conclusion The new emerging VDPV1 was retrospectively confirmed after one year of sample collection from Sahar district. Delayed lab confirmation, as well as the response and low immunization profile of children against polio, were the main predisposing factors for cVDPV1 outbreak. This outbreak highlights the need to maintain regular biweekly shipments to referral polio labs in the short-term, and the exploration of other options in the longer-term to enable the Yemen National Lab to fully process national samples itself. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07397-0.
Collapse
Affiliation(s)
| | - Mohammed Al Amad
- Field Epidemiology Training Program, Yemen Ministry of Public Health and Population, Sana'a, Yemen
| | - Labiba Anam
- Field Epidemiology Training Program, Yemen Ministry of Public Health and Population, Sana'a, Yemen
| | - Khaled Almoayed
- General Directorate for Diseases Control and Surveillance, Yemen Ministry of Public Health and Population, Sana'a, Yemen
| | - Ahmed Al-Dar
- National Polio Surveillance, Yemen Ministry of Public Health and Population, Sana'a, Yemen
| | - Faten Ezzadeen
- National Polio Surveillance, Yemen Ministry of Public Health and Population, Sana'a, Yemen
| |
Collapse
|
24
|
Crothers JW, Ross Colgate E, Cowan KJ, Dickson DM, Walsh M, Carmolli M, Wright PF, Norton EB, Kirkpatrick BD. Intradermal fractional-dose inactivated polio vaccine (fIPV) adjuvanted with double mutant Enterotoxigenic Escherichia coli heat labile toxin (dmLT) is well-tolerated and augments a systemic immune response to all three poliovirus serotypes in a randomized placebo-controlled trial. Vaccine 2022; 40:2705-2713. [PMID: 35367069 PMCID: PMC9024222 DOI: 10.1016/j.vaccine.2022.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/25/2022] [Accepted: 03/22/2022] [Indexed: 11/19/2022]
Abstract
Eradication of poliomyelitis globally is constrained by fecal shedding of live polioviruses, both wild-type and vaccine-derived strains, into the environment. Although inactivated polio vaccines (IPV) effectively protect the recipient from clinical poliomyelitis, fecal shedding of live virus still occurs following infection with either wildtype or vaccine-derived strains of poliovirus. In the drive to eliminate the last cases of polio globally, improvements in both oral polio vaccines (OPV) (to prevent reversion to virulence) and injectable polio vaccines (to improve mucosal immunity and prevent viral shedding) are underway. The E. coli labile toxin with two or "double" attenuating mutations (dmLT) may boost immunologic responses to IPV, including at mucosal sites. We performed a double-blinded phase I controlled clinical trial to evaluate safety, tolerability, as well as systemic and mucosal immunogenicity of IPV adjuvanted with dmLT, given as a fractional (1/5th) dose intradermally (fIPV-dmLT). Twenty-nine volunteers with no past exposure to OPV were randomized to a single dose of fIPV-dmLT or fIPV alone. fIPV-dmLT was well tolerated, although three subjects had mild but persistent induration and hyperpigmentation at the injection site. A ≥ 4-fold rise in serotype-specific neutralizing antibody (SNA) titers to all three serotypes was seen in 84% of subjects receiving fIPV-dmLT vs. 50% of volunteers receiving IPV alone. SNA titers were higher in the dmLT-adjuvanted group, but only differences in serotype 1 were significant. Mucosal immune responses, as measured by polio serotype specific fecal IgA were minimal in both groups and differences were not seen. fIPV-dmLT may offer a benefit over IPV alone. Beyond NAB responses protecting the individual, studies demonstrating the ability of fIPV-dmLT to prevent viral shedding are necessary. Studies employing controlled human infection models, using monovalent OPV post-vaccine are ongoing. Studies specifically in children may also be necessary and additional biomarkers of mucosal immune responses in this population are needed. Clinicaltrials.gov Identifer: NCT03922061.
Collapse
Affiliation(s)
- Jessica W Crothers
- Department of Pathology and Laboratory Medicine, Vaccine Testing Center, University of Vermont Larner College of Medicine, Burlington, VT, USA.
| | - Elizabeth Ross Colgate
- Microbiology and Molecular Genetics, Vaccine Testing Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Kelly J Cowan
- Department of Pediatrics, Vaccine Testing Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Dorothy M Dickson
- Microbiology and Molecular Genetics, Vaccine Testing Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - MaryClaire Walsh
- Microbiology and Molecular Genetics, Vaccine Testing Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Marya Carmolli
- Microbiology and Molecular Genetics, Vaccine Testing Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Peter F Wright
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Elizabeth B Norton
- Department of Immunology and Microbiology, Tulane University, New Orleans, LA, USA
| | - Beth D Kirkpatrick
- Microbiology and Molecular Genetics, Vaccine Testing Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| |
Collapse
|
25
|
Evaluating stability of attenuated Sabin and two novel type 2 oral poliovirus vaccines in children. NPJ Vaccines 2022; 7:19. [PMID: 35149714 PMCID: PMC8837630 DOI: 10.1038/s41541-022-00437-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
Novel oral poliovirus vaccine type 2 (nOPV2) is being developed to reduce the rare occurrence of disease and outbreaks associated with the genetic instability of the Sabin vaccine strains. Children aged 1 to 5 years were enrolled in two related clinical studies to assess safety, immunogenicity, shedding rates and properties of the shed virus following vaccination with nOPV2 (two candidates) versus traditional Sabin OPV type 2 (mOPV2). The anticipated pattern of reversion and increased virulence was observed for shed Sabin-2 virus, as assessed using a mouse model of poliovirus neurovirulence. In contrast, there were significantly reduced odds of mouse paralysis for shed virus for both nOPV2 candidates when compared to shed Sabin-2 virus. Next-generation sequencing of shed viral genomes was consistent with and further supportive of the observed neurovirulence associated with shed Sabin-2 virus, as well as the reduced reversion to virulence of shed candidate viruses. While shed Sabin-2 showed anticipated A481G reversion in the primary attenuation site in domain V in the 5’ untranslated region to be associated with increased mouse paralysis, the stabilized domain V in the candidate viruses did not show polymorphisms consistent with reversion to neurovirulence. The available data from a key target age group for outbreak response confirm the superior genetic and phenotypic stability of shed nOPV2 strains compared to shed Sabin-2 and suggest that nOPV2 should be associated with less paralytic disease and potentially a lower risk of seeding new outbreaks.
Collapse
|
26
|
Current view on novel vaccine technologies to combat human infectious diseases. Appl Microbiol Biotechnol 2022; 106:25-56. [PMID: 34889981 PMCID: PMC8661323 DOI: 10.1007/s00253-021-11713-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 02/06/2023]
Abstract
Inactivated and live attenuated vaccines have improved human life and significantly reduced morbidity and mortality of several human infectious diseases. However, these vaccines have faults, such as reactivity or suboptimal efficacy and expensive and time-consuming development and production. Additionally, despite the enormous efforts to develop vaccines against some infectious diseases, the traditional technologies have not been successful in achieving this. At the same time, the concerns about emerging and re-emerging diseases urge the need to develop technologies that can be rapidly applied to combat the new challenges. Within the last two decades, the research of vaccine technologies has taken several directions to achieve safe, efficient, and economic platforms or technologies for novel vaccines. This review will give a brief overview of the current state of the novel vaccine technologies, new vaccine candidates in clinical trial phases 1-3 (listed by European Medicines Agency (EMA) and Food and Drug Administration (FDA)), and vaccines based on the novel technologies which have already been commercially available (approved by EMA and FDA) with the special reference to pandemic COVID-19 vaccines. KEY POINTS: • Vaccines of the new generation follow the minimalist strategy. • Some infectious diseases remain a challenge for the vaccine development. • The number of new vaccine candidates in the late phase clinical trials remains low.
Collapse
|
27
|
Zhao H, Ma X, Tang H, Zhang Y, Chen N, Kaisaier W, Wang Q, Wang C, Zhu S, Qi Q, Liu Y, Ma Q, Yang Q, Li J, Wang D, Li X, Xiao J, Zhu H, Xu W, Tong W, Yan D. Circulation of Type 2 Vaccine-Derived Poliovirus in China in 2018-2019. Open Forum Infect Dis 2021; 8:ofab535. [PMID: 34926714 PMCID: PMC8677525 DOI: 10.1093/ofid/ofab535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/14/2021] [Indexed: 11/14/2022] Open
Abstract
Background China implemented the globally synchronized switch from trivalent oral poliovirus vaccine (tOPV) to bivalent OPV (bOPV) on May 1, 2016. During April 2018 to May 2019, the first outbreak caused by type 2 circulating vaccine-derived poliovirus (cVDPV2) after the switch occurred in Xinjiang and Sichuan, China. Methods. We performed sequence analysis of VP1 and the whole genome to determine the genomic characteristics of type 2 cVDPVs, and carried out coverage surveys to assess the risk of viral propagation. Surveillance for environment and acute flaccid paralysis was intensified to enhance case ascertainment. Results. Comparison of the complete genomes between early (Xinjiang strain) and late strains (Sichuan strains) revealed that recombination pattern and reverse mutation of attenuation sites had been fixed early, but the mutations of the neutralizing antigenic sites were introduced over the circulation. The Markov Chain Monte Carlo tree showed that the cVDPV2 initial infection was April 2016, earlier than the switch. So, we speculated that the cVDPV2 was originated from tOPV recipients and spread among children with a low level of immunity against the type 2. Conclusions The detection of this outbreak combined acute flaccid paralysis (AFP) surveillance with environmental surveillance (ES) indicates that ES should be expanded geographically to further complement AFP surveillance.
Collapse
Affiliation(s)
- Hehe Zhao
- WHO WPRO Regional Polio Reference Laboratory, NHC Key Laboratory of Biosafety and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Xiaozhen Ma
- Sichuan Center for Disease Control and Prevention, Chengdu, People's Republic of China
| | - Haishu Tang
- Xinjiang Uygur Autonomous Region Center for Disease Control and Prevention, Urumqi, People's Republic of China
| | - Yong Zhang
- WHO WPRO Regional Polio Reference Laboratory, NHC Key Laboratory of Biosafety and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China.,Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, People's Republic of China
| | - Na Chen
- Sichuan Center for Disease Control and Prevention, Chengdu, People's Republic of China
| | - Wusiman Kaisaier
- Xinjiang Uygur Autonomous Region Center for Disease Control and Prevention, Urumqi, People's Republic of China
| | - Qi Wang
- Xinjiang Uygur Autonomous Region Center for Disease Control and Prevention, Urumqi, People's Republic of China
| | - Cheng Wang
- Sichuan Center for Disease Control and Prevention, Chengdu, People's Republic of China
| | - Shuangli Zhu
- WHO WPRO Regional Polio Reference Laboratory, NHC Key Laboratory of Biosafety and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Qi Qi
- Sichuan Center for Disease Control and Prevention, Chengdu, People's Republic of China
| | - Yu Liu
- Sichuan Center for Disease Control and Prevention, Chengdu, People's Republic of China
| | - Qianli Ma
- Sichuan Center for Disease Control and Prevention, Chengdu, People's Republic of China
| | - Qing Yang
- Sichuan Center for Disease Control and Prevention, Chengdu, People's Republic of China
| | - Junhan Li
- WHO WPRO Regional Polio Reference Laboratory, NHC Key Laboratory of Biosafety and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Dongyan Wang
- WHO WPRO Regional Polio Reference Laboratory, NHC Key Laboratory of Biosafety and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Xiaolei Li
- WHO WPRO Regional Polio Reference Laboratory, NHC Key Laboratory of Biosafety and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Jinbo Xiao
- WHO WPRO Regional Polio Reference Laboratory, NHC Key Laboratory of Biosafety and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Hui Zhu
- WHO WPRO Regional Polio Reference Laboratory, NHC Key Laboratory of Biosafety and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Wenbo Xu
- WHO WPRO Regional Polio Reference Laboratory, NHC Key Laboratory of Biosafety and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China.,Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, People's Republic of China
| | - Wenbin Tong
- Sichuan Center for Disease Control and Prevention, Chengdu, People's Republic of China
| | - Dongmei Yan
- WHO WPRO Regional Polio Reference Laboratory, NHC Key Laboratory of Biosafety and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| |
Collapse
|
28
|
Alleman MM, Jorba J, Henderson E, Diop OM, Shaukat S, Traoré MA, Wiesen E, Wassilak SG, Burns CC. Update on Vaccine-Derived Poliovirus Outbreaks - Worldwide, January 2020-June 2021. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:1691-1699. [PMID: 34882653 PMCID: PMC8659190 DOI: 10.15585/mmwr.mm7049a1] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
29
|
Gamougam K, Jeyaseelan V, Jones KAV, Mainou BA, Palmer T, Diaha A, Wiesen E, Ntezayabo B, Ayangma R, Soke NG, Samba D, Okiror S, Mach O. A Survey to Assess Serological Prevalence of Poliovirus Antibodies in Areas With High-Risk for Vaccine-Derived Poliovirus Transmission in Chad. J Pediatric Infect Dis Soc 2021; 11:55-59. [PMID: 34791366 PMCID: PMC8865003 DOI: 10.1093/jpids/piab103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/14/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND World Health Organization African region is wild poliovirus-free; however, outbreaks of vaccine-derived poliovirus type 2 (VDPV2) continue to expand across the continent including in Chad. We conducted a serological survey of polio antibodies in polio high-risk areas of Chad to assess population immunity against poliovirus and estimate the risk of future outbreaks. METHODS This was a community-based, cross-sectional survey carried out in September 2019. Children between 12 and 59 months were randomly selected using GIS enumeration of structures. Informed consent, demographic and anthropometric data, vaccination history, and blood spots were collected. Seropositivity against all 3 poliovirus serotypes was assessed using a microneutralization assay at Centers for Disease Control and Prevention, Atlanta, GA, USA. RESULTS Analyzable data were obtained from 236 out of 285 (82.8%) enrolled children. Seroprevalence of polio antibodies for serotypes 1, 2, and 3 was 214/236 (90.7%); 145/236 (61.4%); and 196/236 (86.2%), respectively. For serotype 2, the seroprevalence significantly increased with age (P = .004); chronic malnutrition was a significant risk factor for being type 2-seronegative. INTERPRETATION Poliovirus type 2 seroprevalence in young children was considered insufficient to protect against the spread of paralytic diseases caused by VDPV2. Indeed, VDPV2 outbreaks were reported from Chad in 2019 and 2020. High-quality immunization response to these outbreaks is needed to prevent further spread.
Collapse
Affiliation(s)
- Kadidja Gamougam
- Department of Virology Laboratory, Hôpital General, N’Djamena, Chad
| | - Visalakshi Jeyaseelan
- Polio Eradication Department, Research Unit, World Health Organization, Geneva, Switzerland
| | - Kathryn A V Jones
- Division of Viral Diseases, Office of Science Quality, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bernardo A Mainou
- Division of Viral Diseases, Office of Science Quality, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tess Palmer
- Geospatial Research Analysis and Services Program, Office of Innovation and Analytics, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, USA
| | - Aissata Diaha
- Global Immunization Division, Office of Science Quality, Centers for Disease Control and Prevention, Atlanta, Georgia, USAand
| | - Eric Wiesen
- Global Immunization Division, Office of Science Quality, Centers for Disease Control and Prevention, Atlanta, Georgia, USAand
| | - Benoit Ntezayabo
- Regional Office for Africa, Immunization Unit, World Health Organization, Cite du Djoue, Brazzaville, Republic of Congo
| | - Richelot Ayangma
- Regional Office for Africa, Immunization Unit, World Health Organization, Cite du Djoue, Brazzaville, Republic of Congo
| | - Norbert Gnakub Soke
- Global Immunization Division, Office of Science Quality, Centers for Disease Control and Prevention, Atlanta, Georgia, USAand
| | - Dhoud Samba
- Global Immunization Division, Office of Science Quality, Centers for Disease Control and Prevention, Atlanta, Georgia, USAand
| | - Samuel Okiror
- Regional Office for Africa, Immunization Unit, World Health Organization, Cite du Djoue, Brazzaville, Republic of Congo
| | - Ondrej Mach
- Polio Eradication Department, Research Unit, World Health Organization, Geneva, Switzerland,Corresponding Author: Ondrej Mach, MD, MPH, Polio Department, World Health Organization, Avenue Appia 20, CH-1211, Genève 27, Switzerland. E-mail:
| |
Collapse
|
30
|
Estimation of oral poliovirus vaccine effectiveness in Afghanistan, 2010-2020. Vaccine 2021; 39:6250-6255. [PMID: 34538696 DOI: 10.1016/j.vaccine.2021.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/13/2021] [Accepted: 09/05/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Afghanistan is one of two countries with endemic wild poliovirus type 1 (WPV1). The oral poliovirus vaccine (OPV) is the predominant vaccine used for polio eradication. Although OPV has been administered in routine childhood immunization and during frequent supplementary immunization activities, WPV1 continues to circulate in Afghanistan and case incidence has been increasing since 2017. We estimated the effectiveness of OPV in Afghanistan during 2010-2020. METHODS We conducted a matched case-control analysis using acute flaccid paralysis (AFP) surveillance data from 29,370 children < 15 years with AFP onset between January 1, 2010 and December 31, 2020. We matched children with confirmed WPV1 (cases) with children with non-polio AFP (controls) by age at onset of paralysis (+/- 3 months), date of onset of paralysis (+/- 3 months), and province of residence, and compared their reported OPV vaccination history to estimate the effectiveness of OPV in preventing paralysis by WPV1 using conditional logistic regression. To account for changes in OPV formulations provided over the analysis period, we stratified the analysis based on dates of the global switch from trivalent OPV (tOPV) to bivalent OPV (bOPV) in April 2016. RESULTS Between January 1, 2010 and December 31, 2020, there were 329 WPV1 cases in Afghanistan. The per-dose estimated effectiveness of OPV against WPV1 was 19% (95% CI: 15%-22%) and of ≥ 7 doses was 94% (95% CI: 90%-97%). Before the global switch from tOPV to bOPV, the per-dose estimated effectiveness of OPV was 14% (95% CI: 11%-18%) and of ≥ 7 doses was 92% (95% CI: 85%-96%). After the switch, the per-dose estimated effectiveness of OPV against WPV1 was 32% (24%-39%) and of ≥ 7 doses was 96% (95% CI: 90%-99%). DISCUSSION OPV is highly effective in preventing paralysis by WPV1; these results indicate that continued WPV1 transmission in Afghanistan is due to failure to vaccinate, not failure of the vaccine. Although difficult to implement in parts of country, improving the administration of OPV in routine immunization and supplementary immunization activities will be critical for achieving polio eradication in Afghanistan.
Collapse
|
31
|
Wahid R, Mercer L, Macadam A, Carlyle S, Stephens L, Martin J, Chumakov K, Laassri M, Petrovskaya S, Smits SL, Stittelaar KJ, Gast C, Weldon WC, Konopka-Anstadt JL, Steven Oberste M, Van Damme P, De Coster I, Rüttimann R, Bandyopadhyay A, Konz J. Assessment of genetic changes and neurovirulence of shed Sabin and novel type 2 oral polio vaccine viruses. NPJ Vaccines 2021; 6:94. [PMID: 34326330 PMCID: PMC8322168 DOI: 10.1038/s41541-021-00355-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 07/06/2021] [Indexed: 11/09/2022] Open
Abstract
Sabin-strain oral polio vaccines (OPV) can, in rare instances, cause disease in recipients and susceptible contacts or evolve to become circulating vaccine-derived strains with the potential to cause outbreaks. Two novel type 2 OPV (nOPV2) candidates were designed to stabilize the genome against the rapid reversion that is observed following vaccination with Sabin OPV type 2 (mOPV2). Next-generation sequencing and a modified transgenic mouse neurovirulence test were applied to shed nOPV2 viruses from phase 1 and 2 studies and shed mOPV2 from a phase 4 study. The shed mOPV2 rapidly reverted in the primary attenuation site (domain V) and increased in virulence. In contrast, the shed nOPV2 viruses showed no evidence of reversion in domain V and limited or no increase in neurovirulence in mice. Based on these results and prior published data on safety, immunogenicity, and shedding, the nOPV2 viruses are promising alternatives to mOPV2 for outbreak responses.
Collapse
Affiliation(s)
- Rahnuma Wahid
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA.
| | - Laina Mercer
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - Andrew Macadam
- National Institute for Biological Standards and Control (NIBSC), Hertfordshire, UK
| | - Sarah Carlyle
- National Institute for Biological Standards and Control (NIBSC), Hertfordshire, UK
| | - Laura Stephens
- National Institute for Biological Standards and Control (NIBSC), Hertfordshire, UK
| | - Javier Martin
- National Institute for Biological Standards and Control (NIBSC), Hertfordshire, UK
| | - Konstantin Chumakov
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
- Global Virus Network Center of Excellence, Baltimore, MD, USA
| | - Majid Laassri
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Svetlana Petrovskaya
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Saskia L Smits
- Viroclinics Biosciences B.V., Rotterdam, the Netherlands
| | - Koert J Stittelaar
- Viroclinics Xplore, Viroclinics Biosciences B.V., Rotterdam, the Netherlands
| | - Chris Gast
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - William C Weldon
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - M Steven Oberste
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Ilse De Coster
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Ricardo Rüttimann
- Fighting Infectious Diseases in Emerging Countries (FIDEC), Miami, FL, USA
| | | | - John Konz
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| |
Collapse
|
32
|
Joffret ML, Doté JW, Gumede N, Vignuzzi M, Bessaud M, Gouandjika-Vasilache I. Vaccine-Derived Polioviruses, Central African Republic, 2019. Emerg Infect Dis 2021; 27:620-623. [PMID: 33496226 PMCID: PMC7853572 DOI: 10.3201/eid2702.203173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Since May 2019, the Central African Republic has experienced a poliomyelitis outbreak caused by type 2 vaccine-derived polioviruses (VDPV-2s). The outbreak affected Bangui, the capital city, and 10 districts across the country. The outbreak resulted from several independent emergence events of VDPV-2s featuring recombinant genomes with complex mosaic genomes. The low number of mutations (<20) in the viral capsid protein 1–encoding region compared with the vaccine strain suggests that VDPV-2 had been circulating for a relatively short time (probably <3 years) before being isolated. Environmental surveillance, which relies on a limited number of sampling sites in the Central African Republic and does not cover the whole country, failed to detect the circulation of VDPV-2s before some had induced poliomyelitis in children.
Collapse
|
33
|
Yan D, Wang D, Zhang Y, Li X, Tang H, Guan J, Song Y, Zhu S, Xu W. Implication of a High Risk for Type 2 Vaccine-Derived Poliovirus Emergence and Transmission After the Switch From Trivalent to Bivalent Oral Poliovirus Vaccine. J Infect Dis 2021; 223:113-118. [PMID: 32621746 DOI: 10.1093/infdis/jiaa386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/03/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND China implemented the globally synchronized switch from trivalent oral poliovirus vaccine (tOPV) to bivalent OPV (bOPV) and introduced 1 dose of inactivated poliovirus vaccine on 1 May 2016. We assessed the impact of the switch on the immunity level against poliovirus, especially type 2. METHODS Children born between 2014 and 2017, who were brought to the hospitals in Urumqi city, Xinjiang Province in 2017, were enrolled and blood samples were collected to test for antibody titers against poliovirus. A comparison of seroprevalence between the children born before (preswitch group) and after the switch (postswitch group) was performed to assess the impact of the switch on the immunity level against polio. RESULTS A total of 172 subjects were enrolled. The overall seroprevalences were 98.8%, 79.1%, and 98.3% for types 1, 2, and 3, respectively. Seroprevalence for type 2 significantly decreased from 91.6% in the preswitch group to 67.4% in the postswitch group, but no statistically significant change was observed for both types 1 and 3. CONCLUSIONS The switch from tOPV to bOPV can provide high-level immunity against types 1 and 3 but not against type 2, indicating a high risk of type 2 vaccine-derived poliovirus emergence and transmission.
Collapse
Affiliation(s)
- Dongmei Yan
- World Health Organization Western Pacific Regional Office Regional Reference Poliomyelitis Laboratory and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dongyan Wang
- World Health Organization Western Pacific Regional Office Regional Reference Poliomyelitis Laboratory and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yong Zhang
- World Health Organization Western Pacific Regional Office Regional Reference Poliomyelitis Laboratory and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaolei Li
- World Health Organization Western Pacific Regional Office Regional Reference Poliomyelitis Laboratory and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Haishu Tang
- Xinjiang Uyghur Autonomous Region Center for Disease Control and Prevention, Urumqi, China
| | - Jing Guan
- Xinjiang Uyghur Autonomous Region Center for Disease Control and Prevention, Urumqi, China
| | - Yang Song
- World Health Organization Western Pacific Regional Office Regional Reference Poliomyelitis Laboratory and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shuangli Zhu
- World Health Organization Western Pacific Regional Office Regional Reference Poliomyelitis Laboratory and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenbo Xu
- World Health Organization Western Pacific Regional Office Regional Reference Poliomyelitis Laboratory and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| |
Collapse
|
34
|
Mbaeyi C, Moran T, Wadood Z, Ather F, Sykes E, Nikulin J, Al Safadi M, Stehling-Ariza T, Zomahoun L, Ismaili A, Abourshaid N, Asghar H, Korukluoglu G, Duizer E, Ehrhardt D, Burns CC, Sharaf M. Stopping a polio outbreak in the midst of war: Lessons from Syria. Vaccine 2021; 39:3717-3723. [PMID: 34053791 DOI: 10.1016/j.vaccine.2021.05.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/05/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Outbreaks of circulating vaccine-derived polioviruses (cVDPVs) pose a threat to the eventual eradication of all polioviruses. In 2017, an outbreak of cVDPV type 2 (cVDPV2) occurred in the midst of a war in Syria. We describe vaccination-based risk factors for and the successful response to the outbreak. METHODS We performed a descriptive analysis of cVDPV2 cases and key indicators of poliovirus surveillance and vaccination activities during 2016-2018. In the absence of reliable subnational coverage data, we used the caregiver-reported vaccination status of children with non-polio acute flaccid paralysis (AFP) as a proxy for vaccination coverage. We then estimated the relative odds of being unvaccinated against polio, comparing children in areas affected by the outbreak to children in other parts of Syria in order to establish the presence of poliovirus immunity gaps in outbreak affected areas. FINDINGS A total of 74 cVDPV2 cases were reported, with paralysis onset ranging from 3 March to 21 September 2017. All but three cases were reported from Deir-ez-Zor governorate and 84% had received < 3 doses of oral poliovirus vaccine (OPV). After adjusting for age and sex, non-polio AFP case-patients aged 6-59 months in outbreak-affected areas had 2.5 (95% CI: 1.1-5.7) increased odds of being unvaccinated with OPV compared with non-polio AFP case-patients in the same age group in other parts of Syria. Three outbreak response rounds of monovalent OPV type 2 (mOPV2) vaccination were conducted, with governorate-level coverage mostly exceeding 80%. INTERPRETATION Significant declines in both national and subnational polio vaccination coverage, precipitated by war and a humanitarian crisis, led to a cVDPV2 outbreak in Syria that was successfully contained following three rounds of mOPV2 vaccination.
Collapse
Affiliation(s)
- Chukwuma Mbaeyi
- United States Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA 30329, USA.
| | - Thomas Moran
- World Health Organization Headquarters, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Zubair Wadood
- World Health Organization Headquarters, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Fazal Ather
- Middle East and North Africa Office, United Nations Children's Fund, Abdulqader Al-Abed Street, Building No. 15, Tla'a Al-Ali, Amman, Jordan
| | - Emma Sykes
- World Health Organization, Regional Office for the Eastern Mediterranean, Mohammad Jamjoum Street, Ministry of Interior Circle Building No. 5, P.O. Box 811547, Amman 11181, Jordan
| | - Joanna Nikulin
- World Health Organization, Regional Office for the Eastern Mediterranean, Mohammad Jamjoum Street, Ministry of Interior Circle Building No. 5, P.O. Box 811547, Amman 11181, Jordan
| | - Mohammad Al Safadi
- World Health Organization Headquarters, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Tasha Stehling-Ariza
- United States Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA 30329, USA
| | - Laurel Zomahoun
- World Health Organization Headquarters, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Abdelkarim Ismaili
- World Health Organization, Regional Office for the Eastern Mediterranean, Mohammad Jamjoum Street, Ministry of Interior Circle Building No. 5, P.O. Box 811547, Amman 11181, Jordan
| | - Nidal Abourshaid
- Syria Country Office, United Nations Children's Fund, East Mazzeh, Al Shafiee St., Damascus, Syria
| | - Humayun Asghar
- World Health Organization, Regional Office for the Eastern Mediterranean, Mohammad Jamjoum Street, Ministry of Interior Circle Building No. 5, P.O. Box 811547, Amman 11181, Jordan
| | - Gulay Korukluoglu
- Public Health Institutions of Turkey, Adnan Saygun Cad. No. 55, F Blok 06100 Sihhiye, Ankara, Turkey
| | - Erwin Duizer
- National Polio Laboratory, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA, Bilthoven, the Netherlands
| | - Derek Ehrhardt
- United States Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA 30329, USA
| | - Cara C Burns
- United States Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA 30329, USA
| | - Magdi Sharaf
- World Health Organization, Regional Office for the Eastern Mediterranean, Mohammad Jamjoum Street, Ministry of Interior Circle Building No. 5, P.O. Box 811547, Amman 11181, Jordan
| |
Collapse
|
35
|
Abstract
Acute flaccid myelitis (AFM) is an incompletely understood neurologic disorder occurring in epidemic fashion causing weakness ranging from mild paresis to devastating paralysis in children and some adults. This article reviews the case definition of AFM as well as its epidemiology and association with enteroviral infection. The clinical presentation, diagnostic investigation with particular attention to electrodiagnostics, acute management, and surgical options are described. Clinical outcomes and considerations for acute and long-term rehabilitation management are discussed extensively based on review of current literature, highlighting avenues for further study.
Collapse
Affiliation(s)
- William Ide
- Department of Pediatric Rehabilitation, Kennedy Krieger Institute, 707 North Broadway, Ste. 232, Baltimore, MD 21205, USA; Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine
| | - Michelle Melicosta
- Department of Pediatric Rehabilitation, Kennedy Krieger Institute, 707 North Broadway, Ste. 232, Baltimore, MD 21205, USA; Department of Pediatrics, Johns Hopkins University School of Medicine
| | - Melissa K Trovato
- Department of Pediatric Rehabilitation, Kennedy Krieger Institute, 707 North Broadway, Ste. 232, Baltimore, MD 21205, USA; Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine.
| |
Collapse
|
36
|
Bandyopadhyay AS, Gast C, Rivera L, Sáez-Llorens X, Oberste MS, Weldon WC, Modlin J, Clemens R, Costa Clemens SA, Jimeno J, Rüttimann R. Safety and immunogenicity of inactivated poliovirus vaccine schedules for the post-eradication era: a randomised open-label, multicentre, phase 3, non-inferiority trial. THE LANCET. INFECTIOUS DISEASES 2021; 21:559-568. [PMID: 33284114 PMCID: PMC7992032 DOI: 10.1016/s1473-3099(20)30555-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/11/2020] [Accepted: 06/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Following the global eradication of wild poliovirus, countries using live attenuated oral poliovirus vaccines will transition to exclusive use of inactivated poliovirus vaccine (IPV) or fractional doses of IPV (f-IPV; a f-IPV dose is one-fifth of a normal IPV dose), but IPV supply and cost constraints will necessitate dose-sparing strategies. We compared immunisation schedules of f-IPV and IPV to inform the choice of optimal post-eradication schedule. METHODS This randomised open-label, multicentre, phase 3, non-inferiority trial was done at two centres in Panama and one in the Dominican Republic. Eligible participants were healthy 6-week-old infants with no signs of febrile illness or known allergy to vaccine components. Infants were randomly assigned (1:1:1:1, 1:1:1:2, 2:1:1:1), using computer-generated blocks of four or five until the groups were full, to one of four groups and received: two doses of intradermal f-IPV (administered at 14 and 36 weeks; two f-IPV group); or three doses of intradermal f-IPV (administered at 10, 14, and 36 weeks; three f-IPV group); or two doses of intramuscular IPV (administered at 14 and 36 weeks; two IPV group); or three doses of intramuscular IPV (administered at 10, 14, and 36 weeks; three IPV group). The primary outcome was seroconversion rates based on neutralising antibodies for poliovirus type 1 and type 2 at baseline and at 40 weeks (4 weeks after the second or third vaccinations) in the per-protocol population to allow non-inferiority and eventually superiority comparisons between vaccines and regimens. Three co-primary outcomes concerning poliovirus types 1 and 2 were to determine if seroconversion rates at 40 weeks of age after a two-dose regimen (administered at weeks 14 and 36) of intradermally administered f-IPV were non-inferior to a corresponding two-dose regimen of intramuscular IPV; if seroconversion rates at 40 weeks of age after a two-dose IPV regimen (weeks 14 and 36) were non-inferior to those after a three-dose IPV regimen (weeks 10, 14, and 36); and if seroconversion rates after a two-dose f-IPV regimen (weeks 14 and 36) were non-inferior to those after a three-dose f-IPV regimen (weeks 10, 14, and 36). The non-inferiority boundary was set at -10% for the lower bound of the two-sided 95% CI for the seroconversion rate difference.. Safety was assessed as serious adverse events and important medical events. This study is registered on ClinicalTrials.gov, NCT03239496. FINDINGS From Oct 23, 2017, to Nov 13, 2018, we enrolled 773 infants (372 [48%] girls) in Panama and the Dominican Republic (two f-IPV group n=217, three f-IPV group n=178, two IPV group n=178, and three IPV group n=200). 686 infants received all scheduled vaccine doses and were included in the per-protocol analysis. We observed non-inferiority for poliovirus type 1 seroconversion rate at 40 weeks for the two f-IPV dose schedule (95·9% [95% CI 92·0-98·2]) versus the two IPV dose schedule (98·7% [95·4-99·8]), and for the three f-IPV dose schedule (98·8% [95·6-99·8]) versus the three IPV dose schedule (100% [97·9-100]). Similarly, poliovirus type 2 seroconversion rate at 40 weeks for the two f-IPV dose schedule (97·9% [94·8-99·4]) versus the two IPV dose schedule (99·4% [96·4-100]), and for the three f-IPV dose schedule (100% [97·7-100]) versus the three IPV dose schedule (100% [97·9-100]) were non-inferior. Seroconversion rate for the two f-IPV regimen was statistically superior 4 weeks after the last vaccine dose in the 14 and 36 week schedule (95·9% [92·0-98·2]) compared with the 10 and 14 week schedule (83·2% [76·5-88·6]; p=0·0062) for poliovirus type 1. Statistical superiority of the 14 and 36 week schedule was also found for poliovirus type 2 (14 and 36 week schedule 97·9% [94·8-99·4] vs 10 and 14 week schedule 83·9% [77·2-89·2]; p=0·0062), and poliovirus type 3 (14 and 36 week schedule 84·5% [78·7-89·3] vs 10 and 14 week schedule 73·3% [65·8-79·9]; p=0·0062). For IPV, a two dose regimen administered at 14 and 36 weeks (99·4% [96·4-100]) was superior a 10 and 14 week schedule (88·9% [83·4-93·1]; p<0·0001) for poliovirus type 2, but not for type 1 (14 and 36 week schedule 98·7% [95·4-99·8] vs 10 and 14 week schedule 95·6% [91·4-98·1]), or type 3 (14 and 36 week schedule 97·4% [93·5-99·3] vs 10 and 14 week schedule 93·9% [89·3-96·9]). There were no related serious adverse events or important medical events reported in any group showing safety was unaffected by administration route or schedule. INTERPRETATION Our observations suggest that adequate immunity against poliovirus type 1 and type 2 is provided by two doses of either IPV or f-IPV at 14 and 36 weeks of age, and broad immunity is provided with three doses of f-IPV, enabling substantial savings in cost and supply. These novel clinical data will inform global polio immunisation policy for the post-eradication era. FUNDING Bill & Melinda Gates Foundation.
Collapse
MESH Headings
- Antibodies, Viral/blood
- Antibodies, Viral/immunology
- Dominican Republic
- Female
- Humans
- Immunization Schedule
- Immunogenicity, Vaccine
- Infant
- Infant, Newborn
- Male
- Panama
- Poliomyelitis/immunology
- Poliomyelitis/prevention & control
- Poliomyelitis/virology
- Poliovirus/immunology
- Poliovirus Vaccine, Inactivated/administration & dosage
- Poliovirus Vaccine, Inactivated/adverse effects
- Poliovirus Vaccine, Inactivated/immunology
- Poliovirus Vaccine, Oral/administration & dosage
- Poliovirus Vaccine, Oral/adverse effects
- Poliovirus Vaccine, Oral/immunology
- Seroconversion
Collapse
Affiliation(s)
| | - Chris Gast
- Biostatistics Consultant, Seattle, Washington, USA
| | - Luis Rivera
- Hospital Maternidad Nuestra Señora de la Altagracia, Santo Domingo, Dominican Republic
| | - Xavier Sáez-Llorens
- Department of Infectious Disease, Hospital del Niño Dr José Renán Esquivel, Panama City, Panama
| | - M Steven Oberste
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | - William C Weldon
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | - John Modlin
- Polio, Global Development, Bill & Melinda Gates Foundation, Seattle, USA
| | - Ralf Clemens
- Global Research in Infectious Diseases, Rio de Janeiro, Brazil
| | | | - Jose Jimeno
- Department of Infectious Disease, Hospital del Niño Dr José Renán Esquivel, Panama City, Panama
| | | |
Collapse
|
37
|
Elastic Bioresorbable Polymeric Capsules for Osmosis-Driven Delayed Burst Delivery of Vaccines. Pharmaceutics 2021; 13:pharmaceutics13030434. [PMID: 33807062 PMCID: PMC8004877 DOI: 10.3390/pharmaceutics13030434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 11/24/2022] Open
Abstract
Single-administration vaccine delivery systems are intended to improve the efficiency and efficacy of immunisation programs in both human and veterinary medicine. In this work, an osmotically triggered delayed delivery device was developed that was able to release a payload after a delay of approximately 21 days, in a consistent and reproducible manner. The device was constructed out of a flexible poly(ε-caprolactone) photo-cured network fabricated into a hollow tubular shape, which expelled approximately 10% of its total payload within 2 days after bursting. Characterisation of the factors that control the delay of release demonstrated that it was advantageous to adjust material permeability and device wall thickness over manipulation of the osmogent concentration in order to maintain reproducibility in burst delay times. The photo-cured poly(ε-caprolactone) network was shown to be fully degradable in vitro, and there was no evidence of cytotoxicity after 11 days of direct contact with primary dermal fibroblasts. This study provides strong evidence to support further development of flexible biomaterials with the aim of continuing improvement of the device burst characteristics in order to provide the greatest chance of the devices succeeding with in vivo vaccine booster delivery.
Collapse
|
38
|
Alleman MM, Coulliette-Salmond AD, Wilnique P, Belgasmi-Wright H, Sayyad L, Wong K, Gue E, Barrais R, Rey-Benito G, Burns CC, Vega E. Environmental Surveillance for Polioviruses in Haïti (2017-2019): The Dynamic Process for the Establishment and Monitoring of Sampling Sites. Viruses 2021; 13:v13030505. [PMID: 33803868 PMCID: PMC8003210 DOI: 10.3390/v13030505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023] Open
Abstract
Haïti is at risk for wild poliovirus (WPV) importation and circulation, as well as vaccine-derived poliovirus (VDPV) emergence. Environmental surveillance (ES) for polioviruses was established in Port au Prince and Gonaïves in 2016. During 2017–2019, initial ES sites were re-evaluated, and ES was expanded into Cap Haïtien and Saint Marc. Wastewater samples and data on weather, hour of collection, and sample temperature and pH were collected every 4 weeks during March 2017–December 2019 (272 sampling events) from 21 sites in Cap Haïtien, Gonaïves, Port au Prince, and Saint Marc. Samples were processed for the detection of polio and non-polio enteroviruses using the two-phase and “Concentration and Filter Elution” methodologies. Polioviruses were serotyped and underwent intra-typic characterization. No WPV or VDPVs were isolated. Sabin-like polioviruses (oral vaccine strain) of serotypes 1 and 3 were sporadically detected. Five of six (83%), one of six (17%), five of six (83%), and two of three (67%) sites evaluated in Cap Haïtien, Gonaïves, Port au Prince, and Saint Marc, respectively, had enterovirus isolation from >50% of sampling events; these results and considerations, such as watershed population size and overlap, influence of sea water, and excessive particulates in samples, were factors in site retention or termination. The evaluation of 21 ES sampling sites in four Haïtian cities led to the termination of 11 sites. Every-four-weekly sampling continues at the remaining 10 sites across the four cities as a core Global Polio Eradication Initiative activity.
Collapse
Affiliation(s)
- Mary M. Alleman
- Polio Eradication Branch, Centers for Disease Control and Prevention, Global Immunization Division, Atlanta, GA 30329, USA
- Correspondence: ; Tel.: +1-404-639-8703
| | - Angela D. Coulliette-Salmond
- Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA 30329, USA; (A.D.C.-S.); (C.C.B.); (E.V.)
- United States Public Health Service, Rockville, MD 20852, USA
| | - Pierre Wilnique
- Laboratory and Research, Division of Epidemiology, Ministère de la Santé Publique et de la Population (Ministry of Public Health and Population (MSPP)), Port au Prince HT6110, Haiti; (P.W.); (R.B.)
| | | | | | - Kimberly Wong
- IHRC, Inc., Atlanta, GA 30346, USA; (H.B.-W.); (K.W.)
- Cherokee Nation Assurance, Catoosa, OK 74015, USA;
| | - Edmund Gue
- Pan American Health Organization, World Health Organization, Region of the Americas, Port au Prince HT6110, Haiti;
| | - Robert Barrais
- Laboratory and Research, Division of Epidemiology, Ministère de la Santé Publique et de la Population (Ministry of Public Health and Population (MSPP)), Port au Prince HT6110, Haiti; (P.W.); (R.B.)
| | - Gloria Rey-Benito
- Pan American Health Organization, World Health Organization, Washington, DC 20037, USA;
| | - Cara C. Burns
- Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA 30329, USA; (A.D.C.-S.); (C.C.B.); (E.V.)
| | - Everardo Vega
- Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA 30329, USA; (A.D.C.-S.); (C.C.B.); (E.V.)
| |
Collapse
|
39
|
Cochi SL, Pallansch MA. The Long and Winding Road to Eradicate Vaccine-Related Polioviruses. J Infect Dis 2021; 223:7-9. [PMID: 32621744 PMCID: PMC10546420 DOI: 10.1093/infdis/jiaa393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stephen L. Cochi
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark A. Pallansch
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
40
|
Lee B. Update on rotavirus vaccine underperformance in low- to middle-income countries and next-generation vaccines. Hum Vaccin Immunother 2020; 17:1787-1802. [PMID: 33327868 PMCID: PMC8115752 DOI: 10.1080/21645515.2020.1844525] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In the decade since oral rotavirus vaccines (ORV) were recommended by the World Health Organization for universal inclusion in all national immunization programs, significant yet incomplete progress has been made toward reducing the burden of rotavirus in low- to middle-income countries (LMIC). ORVs continue to demonstrate effectiveness and impact in LMIC, yet numerous factors hinder optimal performance and evaluation of these vaccines. This review will provide an update on ORV performance in LMIC, the increasing body of literature regarding factors that affect ORV response, and the status of newer and next-generation rotavirus vaccines as of early 2020. Fully closing the gap in rotavirus prevention between LMIC and high-income countries will likely require a multifaceted approach accounting for biological and methodological challenges and evaluation and roll-out of newer and next-generation vaccines.
Collapse
Affiliation(s)
- Benjamin Lee
- Vaccine Testing Center and Translational Global Infectious Diseases Research Center, University of Vermont College of Medicine, Burlington, VT, USA
| |
Collapse
|
41
|
Zhao C, Lin X, Ji F, Xiong P, Liu Y, Wang S, Chen P, Xu Q, Zhang L, Tao Z, Xu A. Prevalence and Bayesian Phylogenetics of Enteroviruses Derived From Environmental Surveillance Around Polio Vaccine Switch Period in Shandong Province, China. FOOD AND ENVIRONMENTAL VIROLOGY 2020; 12:321-332. [PMID: 33108600 DOI: 10.1007/s12560-020-09449-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/22/2020] [Indexed: 06/11/2023]
Abstract
We present the results of environmental surveillance for poliovirus (PV) and non-poliovirus (NPEV) around the switch from trivalent to bivalent oral polio-vaccine (OPV) which occurred in China in May 2016. Sewage samples were collected in Jinan and Linyi city from 2015 to 2017. Enterovirus (EV) isolation, VP1 amplification, Sanger sequencing, and phylogenetic analyses were performed. Among105 sewage samples (36 in Jinan and 69 in Linyi), 101 were positive for EV, with 74.3% (78/105) PV-positive samples and 90.5% (95/105) NPEV-positive samples. A total of 893 EV isolates were obtained, including 326 (36.5%) PVs and 567 (63.5%) NPEVs. Echovirus (E) -11 was the most common serotype out of 18 detected NPEV types (120/567), followed by E-3 (75/567) and E-6 (74/567). PV2 vanished and PV3 came to be the ascendant PV type in sewage after May 2016. Eight PV isolates were judged as pre-vaccine-derived poliovirus (pre-VDPV) and no VDPV or wild PV isolates were monitored. Bayesian phylogenetics demonstrated global E-11 originated in 1876 and evolved with the estimated rate of 4.63 × 10-3 nucleotide substitutions per site per year (s/s/y). Multiple circulating clusters that originated at different times were coexisting in Shandong province. The most recently common ancestor of global coxsackievirus B5 could date back to 1867, at the evolutionary rate of 3.95 × 10-3 s/s/y. In conclusion, our study described the changes of PVs and NPEVs around the polio vaccine switch period and provided meaningful global molecular epidemiological data for further studies of EV-related diseases among the population.
Collapse
Affiliation(s)
- Chenxu Zhao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Xiaojuan Lin
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, 16992 Jingshi Road, Jinan, 250014, Shandong, China
| | - Feng Ji
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, 16992 Jingshi Road, Jinan, 250014, Shandong, China
| | - Ping Xiong
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, 16992 Jingshi Road, Jinan, 250014, Shandong, China
| | - Yao Liu
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, 16992 Jingshi Road, Jinan, 250014, Shandong, China
| | - Suting Wang
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, 16992 Jingshi Road, Jinan, 250014, Shandong, China
| | - Peng Chen
- Hospital of Stomatology, Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Cheeloo College of Medicine, Shandong University, 44-1 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Qing Xu
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, 16992 Jingshi Road, Jinan, 250014, Shandong, China
| | - Li Zhang
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, 16992 Jingshi Road, Jinan, 250014, Shandong, China
| | - Zexin Tao
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, 16992 Jingshi Road, Jinan, 250014, Shandong, China.
| | - Aiqiang Xu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, Shandong, China.
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, 16992 Jingshi Road, Jinan, 250014, Shandong, China.
| |
Collapse
|
42
|
Hobday LK, Ibrahim A, Kaye ME, Bruggink L, Chanthalavanh P, Garcia-Clapes A, Roberts JA, Thorley BR. Australian National Enterovirus Reference Laboratory annual report, 2019. Commun Dis Intell (2018) 2020; 44. [PMID: 33349203 DOI: 10.33321/cdi.2020.44.94] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Australia monitors its polio-free status by conducting surveillance for cases of acute flaccid paralysis (AFP) in children less than 15 years of age, as recommended by the World Health Organization. Cases of AFP in children are notified to the Australian Paediatric Surveillance Unit or the Paediatric Active Enhanced Disease Surveillance System and faecal specimens are referred for virological investigation to the National Enterovirus Reference Laboratory. In 2019, no cases of poliomyelitis were reported from clinical surveillance and Australia reported 1.34 non-polio AFP cases per 100,000 children, meeting the World Health Organization’s performance criterion for a sensitive surveillance system. The non-polio enteroviruses coxsackievirus A2, coxsackievirus A16, echovirus 9, and enterovirus A71 were identified from clinical specimens collected from AFP cases. Australia also performs enterovirus and environmental surveillance to complement the clinical system focussed on children. In 2019, 175 cases of wild polio were reported, with three countries remaining endemic: Afghanistan, Nigeria and Pakistan.
Collapse
Affiliation(s)
- Linda K Hobday
- National Enterovirus Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, 792 Elizabeth St, Melbourne 3000, Victoria, Australia
| | - Aishah Ibrahim
- National Enterovirus Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, 792 Elizabeth St, Melbourne 3000, Victoria, Australia
| | - Matthew E Kaye
- National Enterovirus Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, 792 Elizabeth St, Melbourne 3000, Victoria, Australia
| | - Leesa Bruggink
- National Enterovirus Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, 792 Elizabeth St, Melbourne 3000, Victoria, Australia
| | - Presa Chanthalavanh
- National Enterovirus Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, 792 Elizabeth St, Melbourne 3000, Victoria, Australia
| | - Arnau Garcia-Clapes
- National Enterovirus Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, 792 Elizabeth St, Melbourne 3000, Victoria, Australia
| | - Jason A Roberts
- Electron Microscopy Laboratory, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, 792 Elizabeth St, Melbourne 3000, Victoria, Australia
| | - Bruce R Thorley
- National Enterovirus Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, 792 Elizabeth St, Melbourne 3000, Victoria, Australia
| |
Collapse
|
43
|
Moffett DB, Llewellyn A, Singh H, Saxentoff E, Partridge J, Boualam L, Pallansch M, Wassilak S, Asghar H, Roesel S, Grabovac V, Rey-Benito G, Barnor J, Theo A, Swan J, Iakovenko M, Baig N, Gurung S, Pandel E, Zaffran M. Progress Toward Poliovirus Containment Implementation - Worldwide, 2019-2020. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:1330-1333. [PMID: 32941411 PMCID: PMC7498175 DOI: 10.15585/mmwr.mm6937a7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
44
|
Investigation Report of cVDPV2 Outbreak in Bokh Woreda of Dollo Zone, Somali Regional State, Ethiopia. Case Rep Infect Dis 2020; 2020:6917313. [PMID: 32908734 PMCID: PMC7471813 DOI: 10.1155/2020/6917313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 07/27/2020] [Accepted: 08/20/2020] [Indexed: 11/29/2022] Open
Abstract
Background Poliovirus isolates detected in persons or in the environment can fall into three major categories: wild, Sabin and Sabin-like, or vaccine-derived. Detection of wild or vaccine-derived poliovirus may constitute an emergency, which can be categorized as an event that can lead to an outbreak, depending on characteristics of the isolate and the context in which it appears. The aim of the study was investigation report of cVDPV2 outbreak in Bokh woreda of Dollo Zone, Somali regional state, Ethiopia. Methods A team of experts drawn from different organizations was deployed to Bokh woreda to make detailed field investigation from May 25 to June 17, 2019. By using standard World Health Organization polio outbreak investigation checklist, document review of surveillance, immunization, and clinical data related to the case was made. Key informant's interview was made to health professionals, managers, parents of case, woreda and kebele leaders, religious leaders, and HEWs related to acute flaccid paralysis outbreak. Result The notified AFP case was a 39-month-old female from Angalo kebele of Bokh woreda, Dollo Zone. On 19th May 2019, the patient developed high grade fever and was taken to Angalo Health Post on 20th May 2019. As per the examination by a health extension worker, the child had high grade fever and neck stiffness with preliminary diagnosis of meningitis for which ceftriaxone injection was prescribed. Contact sample was taken from three children on 28th May 2019 and 29th May 2019 and was sent to Addis Ababa National Polio Laboratory. All contact stool samples were found to be positive for poliovirus type 2 and referred for sequencing in National Institute of Communicable Diseases (NICD), South Africa, the Regional Polio Reference Laboratory. Conclusion and Recommendation. The clinical presentation of the cases is compatible with poliovirus infection, improving the quality and coverage of supplementary polio immunization activities through proper planning; strict supervision and follow-up can reduce the occurrence of acute flaccid paralysis.
Collapse
|
45
|
Korotkova EA, Prostova MA, Gmyl AP, Kozlovskaya LI, Eremeeva TP, Baikova OY, Krasota AY, Morozova NS, Ivanova OE. Case of Poliomyelitis Caused by Significantly Diverged Derivative of the Poliovirus Type 3 Vaccine Sabin Strain Circulating in the Orphanage. Viruses 2020; 12:E970. [PMID: 32883046 PMCID: PMC7552002 DOI: 10.3390/v12090970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 12/26/2022] Open
Abstract
Significantly divergent polioviruses (VDPV) derived from the oral poliovirus vaccine (OPV) from Sabin strains, like wild polioviruses, are capable of prolonged transmission and neuropathology. This is mainly shown for VDPV type 2. Here we describe a molecular-epidemiological investigation of a case of VDPV type 3 circulation leading to paralytic poliomyelitis in a child in an orphanage, where OPV has not been used. Samples of feces and blood serum from the patient and 52 contacts from the same orphanage were collected twice and investigated. The complete genome sequencing was performed for five polioviruses isolated from the patient and three contact children. The level of divergence of the genomes of the isolates corresponded to approximately 9-10 months of evolution. The presence of 61 common substitutions in all isolates indicated a common intermediate progenitor. The possibility of VDPV3 transmission from the excretor to susceptible recipients (unvaccinated against polio or vaccinated with inactivated poliovirus vaccine, IPV) with subsequent circulation in a closed children's group was demonstrated. The study of the blood sera of orphanage residents at least twice vaccinated with IPV revealed the absence of neutralizing antibodies against at least two poliovirus serotypes in almost 20% of children. Therefore, a complete rejection of OPV vaccination can lead to a critical decrease in collective immunity level. The development of new poliovirus vaccines that create mucosal immunity for the adequate replacement of OPV from Sabin strains is necessary.
Collapse
Affiliation(s)
- Ekaterina A. Korotkova
- Belozersky Institute of Physical-Chemical Biology, Lomonosov Moscow State University, 119899 Moscow, Russia;
| | - Maria A. Prostova
- Federal State Budgetary Scientific Institution “Chumakov Federal Scientific Centre for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (FSBSI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia; (M.A.P.); (L.I.K.); (T.P.E.); (O.Y.B.)
| | - Anatoly P. Gmyl
- Federal State Budgetary Scientific Institution “Chumakov Federal Scientific Centre for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (FSBSI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia; (M.A.P.); (L.I.K.); (T.P.E.); (O.Y.B.)
- Institute for Bionic Technologies and Engineering, Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Liubov I. Kozlovskaya
- Federal State Budgetary Scientific Institution “Chumakov Federal Scientific Centre for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (FSBSI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia; (M.A.P.); (L.I.K.); (T.P.E.); (O.Y.B.)
- Institute for Bionic Technologies and Engineering, Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Tatiana P. Eremeeva
- Federal State Budgetary Scientific Institution “Chumakov Federal Scientific Centre for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (FSBSI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia; (M.A.P.); (L.I.K.); (T.P.E.); (O.Y.B.)
| | - Olga Y. Baikova
- Federal State Budgetary Scientific Institution “Chumakov Federal Scientific Centre for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (FSBSI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia; (M.A.P.); (L.I.K.); (T.P.E.); (O.Y.B.)
| | - Alexandr Y. Krasota
- Belozersky Institute of Physical-Chemical Biology, Lomonosov Moscow State University, 119899 Moscow, Russia;
- Federal State Budgetary Scientific Institution “Chumakov Federal Scientific Centre for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (FSBSI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia; (M.A.P.); (L.I.K.); (T.P.E.); (O.Y.B.)
| | - Nadezhda S. Morozova
- Federal Centre of Hygiene and Epidemiology, Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, 117105 Moscow, Russia;
| | - Olga E. Ivanova
- Federal State Budgetary Scientific Institution “Chumakov Federal Scientific Centre for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (FSBSI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia; (M.A.P.); (L.I.K.); (T.P.E.); (O.Y.B.)
- Institute for Bionic Technologies and Engineering, Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| |
Collapse
|
46
|
Enteric Viral Co-Infections: Pathogenesis and Perspective. Viruses 2020; 12:v12080904. [PMID: 32824880 PMCID: PMC7472086 DOI: 10.3390/v12080904] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/10/2020] [Accepted: 08/14/2020] [Indexed: 02/06/2023] Open
Abstract
Enteric viral co-infections, infections involving more than one virus, have been reported for a diverse group of etiological agents, including rotavirus, norovirus, astrovirus, adenovirus, and enteroviruses. These pathogens are causative agents for acute gastroenteritis and diarrheal disease in immunocompetent and immunocompromised individuals of all ages globally. Despite virus–virus co-infection events in the intestine being increasingly detected, little is known about their impact on disease outcomes or human health. Here, we review what is currently known about the clinical prevalence of virus–virus co-infections and how co-infections may influence vaccine responses. While experimental investigations into enteric virus co-infections have been limited, we highlight in vivo and in vitro models with exciting potential to investigate viral co-infections. Many features of virus–virus co-infection mechanisms in the intestine remain unclear, and further research will be critical.
Collapse
|
47
|
Alonge O. What can over 30 years of efforts to eradicate polio teach us about global health? BMC Public Health 2020; 20:1177. [PMID: 32787897 PMCID: PMC7419726 DOI: 10.1186/s12889-020-09198-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Olakunle Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
| |
Collapse
|
48
|
Chard AN, Datta SD, Tallis G, Burns CC, Wassilak SG, Vertefeuille JF, Zaffran M. Progress Toward Polio Eradication - Worldwide, January 2018-March 2020. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:784-789. [PMID: 32584798 PMCID: PMC7316320 DOI: 10.15585/mmwr.mm6925a4] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Since the Global Polio Eradication Initiative (GPEI) was established in 1988, two of the three wild poliovirus (WPV) serotypes (types 2 and 3) have been eradicated.* Transmission of WPV type 1 (WPV1) remains uninterrupted only in Afghanistan and Pakistan. This report summarizes progress toward global polio eradication during January 1, 2018-March 31, 2020 and updates previous reports (1,2). In 2019, Afghanistan and Pakistan reported the highest number of WPV1 cases (176) since 2014. During January 1-March 31, 2020 (as of June 19), 54 WPV1 cases were reported, an approximate fourfold increase from 12 cases during the corresponding period in 2019. Paralytic poliomyelitis can also be caused by circulating vaccine-derived poliovirus (cVDPV), which emerges when attenuated oral poliovirus vaccine (OPV) virus reverts to neurovirulence following prolonged circulation in underimmunized populations (3). Since the global withdrawal of type 2-containing OPV (OPV2) in April 2016, cVDPV type 2 (cVDPV2) outbreaks have increased in number and geographic extent (4). During January 2018-March 2020, 21 countries reported 547 cVDPV2 cases. Complicating increased poliovirus transmission during 2020, the coronavirus disease 2019 (COVID-19) pandemic and mitigation efforts have resulted in suspension of immunization activities and disruptions to poliovirus surveillance. When the COVID-19 emergency subsides, enhanced support will be needed to resume polio eradication field activities.
Collapse
|
49
|
Jorgensen D, Pons-Salort M, Shaw AG, Grassly NC. The role of genetic sequencing and analysis in the polio eradication programme. Virus Evol 2020; 6:veaa040. [PMID: 32782825 PMCID: PMC7409915 DOI: 10.1093/ve/veaa040] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Genetic sequencing of polioviruses detected through clinical and environmental surveillance is used to confirm detection, identify their likely origin, track geographic patterns of spread, and determine the appropriate vaccination response. The critical importance of genetic sequencing and analysis to the Global Polio Eradication Initiative has grown with the increasing incidence of vaccine-derived poliovirus (VDPV) infections in Africa specifically (470 reported cases in 2019), and globally, alongside persistent transmission of serotype 1 wild-type poliovirus in Pakistan and Afghanistan (197 reported cases in 2019). Adapting what has been learned about the virus genetics and evolution to address these threats has been a major focus of recent work. Here, we review how phylogenetic and phylogeographic methods have been used to trace the spread of wild-type polioviruses and identify the likely origins of VDPVs. We highlight the analysis methods and sequencing technology currently used and the potential for new technologies to speed up poliovirus detection and the interpretation of genetic data. At a pivotal point in the eradication campaign with the threat of anti-vaccine sentiment and donor and public fatigue, innovation is critical to maintain drive and overcome the last remaining circulating virus.
Collapse
Affiliation(s)
- David Jorgensen
- Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| | - Margarita Pons-Salort
- Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| | - Alexander G Shaw
- Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| | - Nicholas C Grassly
- Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| |
Collapse
|
50
|
Alleman MM, Jorba J, Greene SA, Diop OM, Iber J, Tallis G, Goel A, Wiesen E, Wassilak SG, Burns CC. Update on Vaccine-Derived Poliovirus Outbreaks - Worldwide, July 2019-February 2020. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:489-495. [PMID: 32324719 PMCID: PMC7188410 DOI: 10.15585/mmwr.mm6916a1] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|