Key result
Type 2 iVDPV causes ~53% of cases but drops sharply after the 2016 vaccine switch.
Why the study?
Individuals with certain primary immunodeficiencies exposed to oral poliovirus vaccine may excrete neurovirulent vaccine-derived polioviruses capable of causing paralysis and spreading in communities.
Patients with primary immunodeficiency disorders remain at risk for prolonged vaccine-derived poliovirus infections, predominantly type 2, highlighting the need for surveillance and antiviral treatments in the post-eradication era.
Sustained iVDPV surveillance in PID patients remains essential; leaves open optimal antiviral strategies after the 2016 bivalent OPV switch.
Individuals with certain primary immunodeficiency disorders (PID) may be unable to clear poliovirus infection after exposure to oral poliovirus vaccine (OPV). Over time, vaccine-related strains can revert to immunodeficiency-associated vaccine-derived poliovirus (iVDPVs) that can cause paralysis in the patient and potentially spread in communities with low immunity. We reviewed the efforts for detection and management of PID patients with iVDPV infections and the epidemiology through an analysis of 184 cases reported to the World Health Organization (WHO) during 1962-2024 and a review of polio program and literature reports. Most iVDPV patients (79%) reported in the WHO Registry were residents in middle-income countries and almost half (48%) in the Eastern Mediterranean Region. Type 2 iVDPV was most frequently isolated (53%), but a sharp decline was observed after the switch to bivalent OPV in 2016, with only six cases reported during 2017-2024 compared to 63 during 2009-2016. Patients with common variable immunodeficiency have longer excretion of iVDPV than with other PID types. Implementation of sensitive sentinel surveillance to detect cases of iVDPV infection in high-risk countries and offer antiviral treatment to patients is challenged by competition with other health priorities and regulatory hurdles to the compassionate use of investigational antiviral drugs.
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Estívariz et al. (2024) conducted a review in Primary immunodeficiency disorders (PID) with vaccine-derived poliovirus infection (n=184). Oral poliovirus vaccine (OPV) was evaluated on Epidemiology and clinical characteristics of iVDPV infection. Type 2 iVDPV was most frequently isolated (53% of 184 reported cases), but experienced a sharp decline following the global switch from trivalent to bivalent oral poliovirus vaccine in 2016.
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