Galal Nermeen M, Meshaal Safaa, ElHawary Rabab, Nasr Eman, Bassiouni Laila, Ashghar Humayun, Farag Noha H, Mach Ondrej, Burns Cara, Iber Jane, Chen Qi, ElMarsafy Aisha
Department of Pediatrics, Cairo University, Cairo University Specialized Pediatric Hospital, 1 Ali Ibrahim Street, Mounira, Cairo, Egypt.
Department of Clinical and Chemical Pathology, Cairo University, 2 Ali Ibrahim Street, Kasr Alainy, Cairo, 11956, Egypt.
BMC Res Notes. 2018 Oct 11;11(1):717. doi: 10.1186/s13104-018-3822-7.
Primary immunodeficiency (PID) patients are prone to developing viral infections and should not be vaccinated with live vaccines. In such patients, prolonged excretion and viral divergence may occur and they may subsequently act as reservoirs in the community introducing mutated virus and jeopardizing polio eradication. One hundred and thirty PID cases were included for poliovirus detection in stool with assessment of divergence of detected polioviruses from oral polio vaccine (OPV) virus. Clinical presentations of PID patients with detectable poliovirus in stool specimens are described.
Six PID patients (4.5%) had detectable vaccine-derived poliovirus (VDPV) excretion in stool specimens; of these, five patients had severe combined immunodeficiency (two with acute flaccid paralysis, one with meningoencephalitis and two without neurological manifestations), and one patient had X-linked agammaglobulinemia (paralysis developed shortly after diagnosis of immunodeficiency). All six case-patients received trivalent OPV. Five case-patients had type 2 immunodeficiency-related vaccine-derived polioviruses (iVDPV2) excretion; one had concomitant excretion of Sabin like type 3 virus and one was identified as iVDPV1 excretor. Surveillance for poliovirus excretion among PID patients is critical as these patients represent a potential source to reseed polioviruses into populations.
原发性免疫缺陷（PID）患者易于发生病毒感染，不应接种活疫苗。在此类患者中，可能会出现病毒长期排泄和病毒分化，随后他们可能会成为社区中的病毒储存宿主，引入变异病毒并危及脊髓灰质炎的根除。纳入130例PID病例进行粪便脊髓灰质炎病毒检测，并评估检测到的脊髓灰质炎病毒与口服脊髓灰质炎疫苗（OPV）病毒的差异。描述了粪便标本中可检测到脊髓灰质炎病毒的PID患者的临床表现。
6例PID患者（4.5%）粪便标本中可检测到疫苗衍生脊髓灰质炎病毒（VDPV）排泄；其中，5例患者患有严重联合免疫缺陷（2例急性弛缓性麻痹，1例脑膜脑炎，2例无神经学表现），1例患者患有X连锁无丙种球蛋白血症（免疫缺陷诊断后不久出现麻痹）。所有6例病例患者均接种了三价OPV。5例病例患者排泄2型免疫缺陷相关疫苗衍生脊髓灰质炎病毒（iVDPV2）；1例同时排泄萨宾3型病毒，1例被确定为iVDPV1排泄者。对PID患者的脊髓灰质炎病毒排泄进行监测至关重要，因为这些患者是脊髓灰质炎病毒重新传播到人群中的潜在来源。
