Toscana Virus and Acute Meningitis, France

sequencing results showed vaccine-derived poliovirus; the decision was made to launch an outbreak response immunization for 175,000 children <5 years of age living in Loei, Khonkaen, and Nongbualampoo provinces (visited by the patient from March to August 2003).Two-round campaigns were conducted in August and September.The estimated vaccine coverage was >95%.Considering the rate of 1% genomic diversity per year and the immunodeficient status of the patient (2), he should have harbored the vaccine strain virus since he received the first dose of routine oral polio vaccine immunization at 2 months of age, and the virus was replicated in his gut.However, why the virus disappeared in subsequent stool specimens is unknown.Circulating vaccinederived poliovirus is unlikely in this event, as we found no evidence of recombination with other nonpolio enterovirus, high oral polio vaccine coverage in the community, and no vaccine-derived poliovirus in other children.Although immunoglobulin levels in this case were low but still detectable, whether the patient's illness was agammaglobulinemia or hypogammaglobulinemia is uncertain.The detected immunoglobulin levels, as well as the antibody level to poliovirus, may be due to intravenous immunoglobulin (IVIG) the patient received while hospitalized 4 months before testing.Since August 2003, the patient has been on IVIG replacement therapy after prolonged and repeated respiratory tract infections.In retrospect, problems surrounded this event.First, because of several attempts to confirm the result, identification of strain differentiation was delayed.Second, genetic sequencing was delayed because of a communication gap associated with new bioterrorism regulations in the United States during specimen transfer.Third, knowledge of a possible immune defi-ciency in the previously healthy child was lacking, testing for the patient's immune status was delayed.