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首页> 外文期刊>Vaccine >Prevalence of prolonged and chronic poliovirus excretion among persons with primary immune deficiency disorders in Sri Lanka.
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Prevalence of prolonged and chronic poliovirus excretion among persons with primary immune deficiency disorders in Sri Lanka.

机译：在斯里兰卡患有原发性免疫缺陷疾病的人中长期和慢性脊髓灰质炎病毒排泄的流行。

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Background: The Global Polio Eradication Initiative, established in 1988, has made substantial progress toward achieving this target, with only 3 countries never having eliminated wild poliovirus. Persons with primary immune deficiency disorders (PIDD) exposed to OPV are at increased risk of vaccine-associated paralytic poliomyelitis (VAPP) and of prolonged excretion of Sabin polioviruses. However, the risk for prolonged excretion is not known. Therefore, we studied the prevalence of PIDD with long-term poliovirus excretion in Sri Lanka, a middle income country currently using OPV. Methods: We stimulated the referral of patients under the age of 35 years, with clinical features suggestive of immune deficiency to the single immunology clinic in the country, where these patients were investigated for the presence of PIDD. Stool samples from patients with PIDD were cultured for the presence of poliovirus (PV). Poliovirus isolates were tested for intratypic differentiation (ITD). The VP1 region of all poliovirus isolates was sequenced. Results: Of 942 patients investigated, 51 (5.4%) were diagnosed with PIDD. Five (10.2%) patients excreted poliovirus. A patient with X linked agammaglobulinemia (XLA) excreted a mixture of all three Sabin like (SL) poliovirus serotypes. One patient with severe combined immune deficiency (SCID) excreted SL type 2, and another with SCID excreted SL type 3. One patient with SCID excreted a P2 vaccine-derived poliovirus (VDPV 2), and another with common variable immune deficiency (CVID) excreted a VDPV 3. The 3 patients with SCID died before scheduled collection of subsequent samples one month later, while the patient with XLA had cleared the virus in stool sample collected after 3 and 11 months. The CVID patient with VDPV 3 excreted for 7 months, and has developed a 23 nucleotide divergence in VP1 (~900 nucleotides) from the parental Sabin virus. Conclusions: In our study, several patients with SCID, XLA and CVID excreted poliovirus. With improving health care quality patients with CVID and XLA may survive longer especially with provision of intravenous immune globulin. Regular screening of patients with PIDD for excretion of poliovirus is necessary to identify chronic excretors and make available specific therapies.
机译：背景：1988年建立的全球根除脊髓灰质炎行动在实现这一目标方面取得了实质性进展，只有3个国家从未消除野生脊髓灰质炎病毒。暴露于OPV的原发性免疫缺陷疾病（PIDD）的人与疫苗相关的麻痹性脊髓灰质炎（VAPP）和沙宾脊髓灰质炎病毒长时间排泄的风险增加。但是，长时间排泄的风险尚不清楚。因此，我们研究了斯里兰卡（一个目前正在使用OPV的中等收入国家）中长期脊灰病毒排泄导致的PIDD患病率。方法：我们刺激了35岁以下患者的转诊，其临床特征表明存在免疫缺陷，请转到该国唯一的免疫学诊所，对这些患者的PIDD进行调查。培养来自PIDD患者的粪便样本以发现脊髓灰质炎病毒（PV）。测试脊髓灰质炎病毒分离株的型内分化（ITD）。对所有脊髓灰质炎病毒分离株的VP1区进行测序。结果：在研究的942名患者中，有51名（5.4％）被诊断患有PIDD。五（10.2％）例患者排出脊髓灰质炎病毒。 X连锁性丙种球蛋白血症（XLA）的患者排泄了所有三种Sabin样（SL）脊髓灰质炎病毒血清型的混合物。一名患有严重的联合免疫缺陷（SCID）的患者排泄了2型SL，另一名患有SCID的SL排泄了3型。一名SCID的患者排泄了P2疫苗衍生的脊髓灰质炎病毒（VDPV 2），另一名患有常见的可变免疫缺陷性（CVID）排泄了VDPV3。这3名SCID患者在计划一个月后收集后续样本之前死亡，而XLA患者则在3和11个月后清除了粪便样本中的病毒。患有VDPV 3的CVID患者排泄了7个月，并且已从亲本萨宾病毒中分离出VP1（〜900个核苷酸）中的23个核苷酸差异。结论：在我们的研究中，几例SCID，XLA和CVID的患者排出了脊髓灰质炎病毒。随着医疗质量的改善，尤其是在静脉注射免疫球蛋白的情况下，CVID和XLA的患者可以存活更长的时间。定期筛查PIDD患者脊髓灰质炎病毒的排泄是确定慢性排泄者并提供具体治疗方法所必需的。

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