Apropos ‘Monitoring of poliovirus neutralizing antibodies in São Paulo State, Brazil’

We admire Luchs et al.1 for their monitoring of poliovirus neutralizing antibody status in São Paulo State, Brazil; this study would be valuable to formulate future plans to address a poliovirus-susceptible population. Nevertheless, such a pursuit for poliovirus-susceptible Brazilians should incorporate those persons in the seventh or higher decades of life and a number of susceptible children and adults after organ transplants or cancer chemotherapy. In all probability there were few elderly in the seventh or higher decades of life who were screened for poliovirus neutralizing antibody.1 It is probable they were never immunized against poliomyelitis: inactivated or live poliovirus vaccines were not available when they were infants and children. They could catch polioviruses in Brazil or while on travel abroad. Two healthy adult males, aged 62 and 65 years, were afflicted with acute flaccid paralysis while they were on a holiday trip to Morocco.2 In the Brazilian São Paulo State, there might be several children and adults who received chemotherapy of malignancy or underwent organ transplantations. They might have emerged as a cohort of these lacking poliovirus neutralizing antibody. Serologic evaluation of post chemotherapy pediatric patients with osteosarcoma, rhabdomyosarcoma and Ewing sarcoma in Piscataway, New Jersey pointed towards poliovirus 2 and 3 susceptibility requiring revaccination.3