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New insights into physiopathology of immunodeficiency-associated vaccine-derived poliovirus infection; systematic review of over 5 decades of data
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New insights into physiopathology of immunodeficiency-associated vaccine-derived poliovirus infection; systematic review of over 5 decades of data
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Journal Article
New insights into physiopathology of immunodeficiency-associated vaccine-derived poliovirus infection; systematic review of over 5 decades of data
2018
Overview
•Inherent features of PID contribute to manifestations and outcome of polio infection.•Cytotoxic cellular mechanisms may contribute to the development of vaccine paralysis.•T-cell interactions with poliovirus infected cells play a role in infection clearance.•Paralysis, PID type, and income level independently influence patients’ survival.•We explained the trend of vaccine-derived poliovirus genomic evolution.
Widespread administration of oral poliovirus vaccine (OPV) has decreased global incidence of poliomyelitis by ≈99.9%. However, the emergence of vaccine-derived polioviruses (VDPVs) is threatening polio-eradication program. Primary immunodeficiency (PID) patients are at higher risks of vaccine-associated paralytic poliomyelitis (VAPP) and prolonged excretion of immunodeficiency-associated VDPV (iVDPV).
We searched Embase, Medline, Science direct, Scopus, Web of Science, and CDC and WHO databases by 30 September 2016, for all reports of iVDPV cases. Patient-level data were extracted form eligible studies. Data on immunization coverage and income-level of countries were extracted from WHO/UNICEF and the WORLD BANK databases, respectively. We assessed bivariate associations between immunological, clinical, and virological parameters, and exploited multivariable modeling to identify independent determinants of poliovirus evolution and patients’ outcomes. Study protocol was registered with PROSPERO (CRD42016052931).
4329 duplicate-removed titles were screened. A total of 107 iVDPV cases were identified from 68 eligible articles. The majority of cases were from higher income countries with high polio-immunization coverage. 74 (69.81%) patients developed VAPP. Combined immunodeficiency patients showed lower rates of VAPP (p < .001) and infection clearance (p = .02), compared to humoral immunodeficiency patients. The rate of poliovirus genomic evolution was higher at early stages of replication, decreasing over time until reaching a steady state. Independent of replication duration, higher extent (p = .04) and rates (p = .03) of genome divergence contributed to a less likelihood of virus clearance. PID type (p < .001), VAPP occurrence (p = .008), and income-level of country (p = .04) independently influenced patients’ survival.
With the use of OPV, new iVDPVs will emerge independent of the rate of immunization coverage. Inherent features of PIDs contribute to the clinical course of iVDPV infection and virus evolution. This finding could shed further light on poliomyelitis pathogenesis and iVDPV evolution pattern. It also has implications for public health, the polio eradication effort and the development of effective antiviral interventions.
Publisher
Elsevier Ltd,Elsevier Limited,Elsevier
Subject
/ Animals
/ Female
/ genome
/ Genomes
/ genomics
/ Humans
/ Immunologic Deficiency Syndromes - complications
/ Immunologic Deficiency Syndromes - diagnosis
/ Income
/ Infant
/ Male
/ Microbiology and Parasitology
/ Mutation
/ Patients
/ Poliomyelitis - epidemiology
/ Poliomyelitis - prevention & control
/ Poliovirus Vaccine, Oral - adverse effects
/ Poliovirus Vaccines - adverse effects
/ risk
/ Vaccination - adverse effects
/ Vaccine-associated paralytic poliomyelitis
/ Vaccines
/ Virology
/ Viruses
