Key result
Primary immunodeficiency patients had higher detection rates of nonpolio enteroviruses and Sabin-origin polioviruses than acute flaccid paralysis cases and healthy contacts.
Why the study?
What are the detection rates and molecular epidemiological patterns of polioviruses and nonpolio enteroviruses in patients with primary immunodeficiencies compared with acute flaccid paralysis cases and healthy contacts in Tunisia?
Observational (n=1,722)
Yes
What are the detection rates and molecular epidemiological patterns of polioviruses and nonpolio enteroviruses in patients with primary immunodeficiencies compared with acute flaccid paralysis cases and healthy contacts in Tunisia?
Answers are grounded in this paper and cite their sources.
This 11-year national surveillance study confirms Tunisia's wild-polio-free status while demonstrating that patients with primary immunodeficiencies have elevated excretion rates of Sabin-derived polioviruses and iVDPVs, supporting continuous PID enterovirus monitoring alongside AFP surveillance.
This report is an overview of enterovirus (EV) detection in Tunisian polio-suspected paralytic cases (acute flaccid paralysis (AFP) cases), healthy contacts and patients with primary immunodeficiencies (PID) during an 11-year period. A total of 2735 clinical samples were analyzed for EV isolation and type identification, according to the recommended protocols of the World Health Organization. Three poliovirus (PV) serotypes and 28 different nonpolio enteroviruses (NPEVs) were detected. The NPEV detection rate was 4.3%, 2.8% and 12.4% in AFP cases, healthy contacts and PID patients, respectively. The predominant species was EV-B, and the circulation of viruses from species EV-A was noted since 2011. All PVs detected were of Sabin origin. The PV detection rate was higher in PID patients compared to AFP cases and contacts (6.8%, 1.5% and 1.3% respectively). PV2 was not detected since 2015. Using nucleotide sequencing of the entire VP1 region, 61 strains were characterized as Sabin-like. Among them, six strains of types 1 and 3 PV were identified as pre-vaccine-derived polioviruses (VDPVs). Five type 2 PV, four strains belonging to type 1 PV and two strains belonging to type 3 PV, were classified as iVDPVs. The data presented provide a comprehensive picture of EVs circulating in Tunisia over an 11-year period, reveal changes in their epidemiology as compared to previous studies and highlight the need to set up a warning system to avoid unnoticed PVs.
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Chouikha et al. (2021) conducted an observational in Enterovirus surveillance in acute flaccid paralysis (AFP), primary immunodeficiency (PID), and healthy contacts (n=1,722). Primary immunodeficiency (PID) status vs acute flaccid paralysis (AFP) or healthy contact status vs. Polio-suspected acute flaccid paralysis (AFP) cases and healthy contacts was evaluated on Enterovirus (poliovirus and nonpolio enterovirus) detection rate in stool samples. Primary immunodeficiency patients had higher detection rates of nonpolio enteroviruses and Sabin-origin polioviruses than acute flaccid paralysis cases and healthy contacts.
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