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Journal of Clinical Microbiology, March 2003, p. 1203-1211, Vol. 41, No. 3
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.3.1203-1211.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Community-Acquired Poliovirus Infection in Children with Primary Immunodeficiencies in Tunisia

Laboratory of Clinical Virology, WHO Regional Reference Laboratory on Poliomyelitis,¹ Laboratory of Immunology, WHO Collaborating Center for Research and Training in Immunology, Institut Pasteur de Tunis ,² Pediatrics Department, Bone Marrow Transplantation Center, Tunis, Tunisia³

Received 11 February 2002/ Returned for modification 29 October 2002/ Accepted 14 December 2002

The global polio eradication program recommends the use of massive vaccination campaigns with live vaccine through National Immunization Days (NIDs) to displace the wild virus from the community. Immunodeficient patients may be indirectly infected and become chronic excretors and potential reservoirs of polioviruses, a concern for the posteradication era. This prospective study aimed to assess the risk of community-acquired infection of immunodeficient patients following NIDs, the dynamics of viral excretion and the genetic variation of excreted viruses. Sixteen children with various primary immunodeficiencies, who did not receive the vaccine during the campaign, were investigated. Stool samples were collected weekly, shortly after the NIDs, during at least 3 months, and were processed for viral isolation. Isolates were characterized by three intratypic differentiation methods and partial sequencing of the VP1/2A region. Polioviruses were detected in 4 out of 16 patients (serotype 1 in 3 patients and serotype 3 in 1 patient). Sequencing revealed more than 99% homology with homotypic Sabin strains, suggesting recent infection. Duration of viral excretion ranged from 1 to 7 weeks. Nine out of eleven isolates from the three poliovirus serotype 1-infected patients disclosed a non-Sabin-like phenotype by enzyme-linked immunosorbent assay and had recurrent mutations within or close to the neutralizing antigenic sites. In summary, the risk of secondary infection in immunodeficient patients is within the range previously reported for the general population. Although none of the four infected patients developed prolonged viral excretion, particular viral variants were selected and may be of epidemiological significance.