Shaghaghi Mohammadreza, Shahmahmoodi Shohreh, Abolhassani Hassan, Soleyman-Jahi Saeed, Parvaneh Leila, Mahmoudi Sussan, Chavoshzadeh Zahra, Yazdani Reza, Zahraei Seyed Mohsen, Ebrahimi Mohsen, Eslamian Mohammad H, Tabatabaie Hamideh, Yousefi Maryam, Kandelousi Yaghoob M, Oujaghlou Aliasghar, Rezaei Nima, Aghamohammadi Asghar
Emerg Infect Dis. 2016 Oct;22(10):1712-9. doi: 10.3201/eid2210.151071.
Widespread use of oral poliovirus vaccine has led to an ≈99.9% decrease in global incidence of poliomyelitis (from ≈350,000 cases in 1988 to 74 cases in 2015) and eradication of wild-type poliovirus serotypes 2 and 3. However, patients with primary immunodeficiency might shed vaccine-derived polioviruses (VDPVs) for an extended period, which could pose a major threat to polio eradication programs. Since 1995, sixteen VDPV populations have been isolated from 14 patients with immunodeficiency in Iran. For these patients, vaccine-associated paralysis, mostly in >1 extremity, was the first manifestation of primary immunodeficiency. Seven patients with humoral immunodeficiency cleared VDPV infection more frequently than did 6 patients with combined immunodeficiencies. Our results raise questions about manifestations of VDPVs in immunodeficient patients and the role of cellular immunity against enterovirus infections. On the basis of an association between VDPVs and immunodeficiency, we advocate screening of patients with primary immunodeficiency for shedding of polioviruses.
口服脊髓灰质炎疫苗的广泛使用已使全球脊髓灰质炎发病率下降了约99.9%（从1988年的约35万例降至2015年的74例），并根除了野生型脊髓灰质炎病毒2型和3型。然而，原发性免疫缺陷患者可能会长期排出疫苗衍生脊髓灰质炎病毒（VDPV），这可能对脊髓灰质炎根除计划构成重大威胁。自1995年以来，已从伊朗14名免疫缺陷患者中分离出16个VDPV种群。对于这些患者，疫苗相关麻痹（大多累及一个以上肢体）是原发性免疫缺陷的首发表现。7名体液免疫缺陷患者比6名联合免疫缺陷患者更频繁地清除VDPV感染。我们的结果引发了关于VDPV在免疫缺陷患者中的表现以及细胞免疫在肠道病毒感染中的作用的问题。基于VDPV与免疫缺陷之间的关联，我们主张对原发性免疫缺陷患者进行脊髓灰质炎病毒排出情况的筛查。
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