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Costa Clemens SA, Santos GML, Gonzalez I, Clemens R. The role of a genetically stable, novel oral type 2 poliovirus vaccine in the poliomyelitis endgame. Rev Panam Salud Publica 2023; 47:e99. [PMID: 37405121 PMCID: PMC10317245 DOI: 10.26633/rpsp.2023.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/10/2023] [Indexed: 07/06/2023] Open
Abstract
Poliovirus infection causes paralysis in up to 1 in 200 infected persons. The use of safe and effective inactivated poliovirus vaccines and live attenuated oral poliovirus vaccines (OPVs) means that only two pockets of wild-type poliovirus type 1 remain, in Afghanistan and Pakistan. However, OPVs can revert to virulence, causing outbreaks of circulating vaccine-derived poliovirus (cVDPV). During 2020-2022, cVDPV type 2 (cVDPV2) was responsible for 97-99% of poliomyelitis cases, mainly in Africa. Between January and August 2022, cVDPV2 was detected in sewage samples in Israel, the United Kingdom and the United States of America, where a case of acute flaccid paralysis caused by cVDPV2 also occurred. The Pan American Health Organization has warned that Brazil, the Dominican Republic, Haiti and Peru are at very high risk for the reintroduction of poliovirus and an additional eight countries in Latin America are at high risk, following dropping vaccination rates (average 80% coverage in 2022). Sabin type 2 monovalent OPV has been used to control VDPV2 outbreaks, but its use could also lead to outbreaks. To address this issue, a more genetically stable, novel OPV2 (nOPV2) was developed against cVDPV2 and in 2020 was granted World Health Organization Emergency Use Listing. Rolling out a novel vaccine under the Emergency Use Listing in mass settings to contain outbreaks requires unique local regulatory and operational preparedness.
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Affiliation(s)
- Sue Ann Costa Clemens
- Department of PaediatricsOxford UniversityOxfordUnited KingdomDepartment of Paediatrics, Oxford University, Oxford, United Kingdom
| | - Gustavo Mendes Lima Santos
- International Vaccine InstituteSeoulRepublic of KoreaInternational Vaccine Institute, Seoul, Republic of Korea
| | - Isabela Gonzalez
- Institute for Global HealthUniversity of SienaSienaItalyInstitute for Global Health, University of Siena, Siena, Italy
| | - Ralf Clemens
- International Vaccine InstituteSeoulRepublic of KoreaInternational Vaccine Institute, Seoul, Republic of Korea
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Gast C, Bandyopadhyay AS, Sáez-Llorens X, De Leon T, DeAntonio R, Jimeno J, Aguirre G, McDuffie LM, Coffee E, Mathis DL, Oberste MS, Weldon WC, Konopka-Anstadt JL, Modlin J, Bachtiar NS, Fix A, Konz J, Clemens R, Clemens SAC, Rüttimann R. Fecal shedding of two novel live attenuated oral poliovirus type 2 vaccines candidates by healthy bOPV/IPV-vaccinated infants: two randomized clinical trials. J Infect Dis 2021; 226:852-861. [PMID: 34610135 PMCID: PMC9470102 DOI: 10.1093/infdis/jiab507] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background Primary intestinal immunity through viral replication of live oral vaccine is key to interrupt poliovirus transmission. We assessed viral fecal shedding from infants administered Sabin monovalent poliovirus type 2 vaccine (mOPV2) or low and high doses of 2 novel OPV2 (nOPV2) vaccine candidates. Methods In 2 randomized clinical trials in Panama, a control mOPV2 study (October 2015 to April 2016) and nOPV2 study (September 2018 to October 2019), 18-week-old infants vaccinated with bivalent oral poliovirus vaccine/inactivated poliovirus vaccine received 1 or 2 study vaccinations 28 days apart. Stools were assessed for poliovirus RNA by polymerase chain reaction (PCR) and live virus by culture for 28 days postvaccination. Results Shedding data were available from 621 initially reverse-transcription PCR–negative infants (91 mOPV2, 265 nOPV2-c1, 265 nOPV2-c2 recipients). Seven days after dose 1, 64.3% of mOPV2 recipients and 31.3%–48.5% of nOPV2 recipients across groups shed infectious type 2 virus. Respective rates 7 days after dose 2 decreased to 33.3% and 12.9%–22.7%, showing induction of intestinal immunity. Shedding of both nOPV2 candidates ceased at similar or faster rates than mOPV2. Conclusions Viral shedding of either nOPV candidate was similar or decreased relative to mOPV2, and all vaccines showed indications that the vaccine virus was replicating sufficiently to induce primary intestinal mucosal immunity.
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Affiliation(s)
| | | | - Xavier Sáez-Llorens
- Infectious Disease Department, Hospital del Niño "Dr. José Renán Esquivel", Panama City, Panama.,Sistema Nacional de Investigación, Senacyt, Panama
| | | | | | | | - Gabriela Aguirre
- Fighting Infectious Diseases in Emerging Countries (FIDEC), Miami, USA
| | - Larin M McDuffie
- Cherokee Nation Assurance, contracting agency to the Division of Viral Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Elizabeth Coffee
- Cherokee Nation Assurance, contracting agency to the Division of Viral Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Demetrius L Mathis
- Cherokee Nation Assurance, contracting agency to the Division of Viral Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | | | | | | | - John Modlin
- Bill & Melinda Gates Foundation, Seattle, USA
| | | | | | | | - Ralf Clemens
- Global Research in Infectious Diseases (GRID), Rio de Janeiro, Brazil
| | | | - Ricardo Rüttimann
- Fighting Infectious Diseases in Emerging Countries (FIDEC), Miami, USA
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