Division of Allergy Clinical Immunology and Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil.
Division of Allergy Immunology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
J Clin Immunol. 2018 Jul;38(5):628-634. doi: 10.1007/s10875-018-0531-x. Epub 2018 Jul 14.
Poliovirus has been nearly eliminated as part of a world-wide effort to immunize and contain circulating wild-type polio. Nevertheless, poliovirus has been detected in water supplies and represents a threat to patients with humoral immunodeficiencies where infection can be fatal. To define the risk, we analyzed antibodies to poliovirus 1, 2, and 3 in serum samples collected over a year from patients with primary immunodeficiency diseases (PID) on regular intravenous immunoglobulin (IVIG) replacement.
Twenty-one patients on regular IVIG replacement therapy were evaluated: Twelve patients with common variable immune deficiency (CVID), six with X-linked agammaglobulinemia (XLA), and three with hyper IgM syndrome (HIGM). Over 1 year, four blood samples were collected from each of these patients immediately before immunoglobulin infusion. One sample of IVIG administered to each patient in the month before blood collection was also evaluated. Poliovirus antibodies were quantified by seroneutralization assay.
All IVIG samples had detectable antibodies to the three poliovirus serotypes. Despite that, only 52.4, 61.9, and 19.0% of patients showed protective antibody titers for poliovirus 1, 2, and 3, respectively. Only two patients (9.5%) had protective antibodies for the three poliovirus serotypes on all samples. Most patients were therefore susceptible to all three poliovirus serotypes.
This study demonstrates the need for ongoing vigilance regarding exposure of patients with PID to poliovirus in the community.
作为全球免疫和控制循环野生型脊髓灰质炎病毒努力的一部分，脊髓灰质炎病毒已几乎被消灭。然而，脊髓灰质炎病毒已在供水系统中被检测到，这对具有体液免疫缺陷的患者构成了威胁，因为感染可能是致命的。为了确定风险，我们分析了在接受常规静脉注射免疫球蛋白 (IVIG) 替代治疗的原发性免疫缺陷病 (PID) 患者的血清样本中，1 型、2 型和 3 型脊髓灰质炎病毒的抗体。
评估了 21 名接受常规 IVIG 替代治疗的患者：12 名患有普通可变免疫缺陷 (CVID)、6 名患有 X 连锁无丙种球蛋白血症 (XLA) 和 3 名患有高 IgM 综合征 (HIGM)。在这一年中，从每个患者中采集了四次血样，每次均在免疫球蛋白输注前采集。还评估了在采血前一个月给予每位患者的 IVIG 的一个样本。通过血清中和测定法来定量脊髓灰质炎病毒抗体。
所有 IVIG 样本均具有针对三种脊髓灰质炎病毒血清型的可检测抗体。尽管如此，只有 52.4%、61.9%和 19.0%的患者分别对脊髓灰质炎病毒 1 型、2 型和 3 型具有保护性抗体滴度。只有两名患者 (9.5%) 在所有样本中对三种脊髓灰质炎病毒血清型均具有保护性抗体。因此，大多数患者容易受到三种脊髓灰质炎病毒血清型的影响。
本研究表明，需要持续关注 PID 患者在社区中接触脊髓灰质炎病毒的情况。
