Vaccine-Derived Poliovirus Infection among Patients with Primary Immunodeficiency and Effect of Patient Screening on Disease Outcomes, Iran

• Main Authors: Mohammadreza Shaghaghi, Shohreh Shahmahmoodi, Ali Nili, Hassan Abolhassani, Seyedeh Panid Madani, Ahmad Nejati, Maryam Yousefi, Yaghoob M. Kandelousi, Mona Irannejad, Shiva Shaghaghi, Seyed Mohsen Zahraei, Sussan Mahmoudi, Mohammad Mehdi Gouya, Reza Yazdani, Gholamreza Azizi, Nima Parvaneh, Asghar Aghamohammadi
• Format: Article
• Language: English
• Published: Centers for Disease Control and Prevention 2019-11-01
• Series: Emerging Infectious Diseases
• Subjects: poliomyelitis; vaccine; paralysis; primary immunodeficiency; stem cell transplantation; vaccine-derived poliovirus
• Online Access: https://wwwnc.cdc.gov/eid/article/25/11/19-0540_article

Patients with immunodeficiency-associated vaccine-derived poliovirus (iVDPV) are potential poliovirus reservoirs in the posteradication era that might reintroduce polioviruses into the community. We update the iVDPV registry in Iran by reporting 9 new patients. In addition to national acute flaccid paralysis surveillance, cases were identified by screening nonparalyzed primary immunodeficiency (PID) patients. Overall, 23 iVDPV patients have been identified since 1995. Seven patients (30%) never had paralysis. Poliovirus screening accelerated the iVDPV detection rate in Iran after 2014.The iVDPV infection rate among nonparalyzed patients with adaptive PID was 3.1% (7/224), several folds higher than previous estimates. Severe combined immunodeficiency patients had the highest risk for asymptomatic infection (28.6%) compared with other PIDs. iVDPV2 emergence has decreased after the switch from trivalent to bivalent oral poliovirus vaccine in 2016. However, emergence of iVDPV1 and iVDPV3 continued. Poliovirus screening in PID patients is an essential step in the endgame of polio eradication.