Asymptomatic immunodeficiency-associated vaccine-derived poliovirus infections in two UK children

Anika Singanayagam (), Dimitra Klapsa, Shirelle Burton-Fanning, Julian Hand, Thomas Wilton, Laura Stephens, Ryan Mate, Benjamin Shillitoe, Cristina Celma, Mary Slatter, Terry Flood, Robin Gopal, Javier Martin and Maria Zambon ()
Additional contact information
Anika Singanayagam: UK Health Security Agency, Colindale
Dimitra Klapsa: Medicines and Healthcare products Regulatory Agency, Potters Bar
Shirelle Burton-Fanning: Newcastle upon Tyne Hospitals NHS Foundation Trust
Julian Hand: UK Health Security Agency, Colindale
Thomas Wilton: Medicines and Healthcare products Regulatory Agency, Potters Bar
Laura Stephens: Medicines and Healthcare products Regulatory Agency, Potters Bar
Ryan Mate: Medicines and Healthcare products Regulatory Agency, Potters Bar
Benjamin Shillitoe: Great North Children’s Hospital
Cristina Celma: UK Health Security Agency, Colindale
Mary Slatter: Great North Children’s Hospital
Terry Flood: Great North Children’s Hospital
Robin Gopal: UK Health Security Agency, Colindale
Javier Martin: Medicines and Healthcare products Regulatory Agency, Potters Bar
Maria Zambon: UK Health Security Agency, Colindale

Nature Communications, 2023, vol. 14, issue 1, 1-9

Abstract: Abstract Increasing detections of vaccine-derived poliovirus (VDPV) globally, including in countries previously declared polio free, is a public health emergency of international concern. Individuals with primary immunodeficiency (PID) can excrete polioviruses for prolonged periods, which could act as a source of cryptic transmission of viruses with potential to cause neurological disease. Here, we report on the detection of immunodeficiency-associated VDPVs (iVDPV) from two asymptomatic male PID children in the UK in 2019. The first child cleared poliovirus with increased doses of intravenous immunoglobulin, the second child following haematopoetic stem cell transplantation. We perform genetic and phenotypic characterisation of the infecting strains, demonstrating intra-host evolution and a neurovirulent phenotype in transgenic mice. Our findings highlight a pressing need to strengthen polio surveillance. Systematic collection of stool from asymptomatic PID patients who are at high risk for poliovirus excretion could improve the ability to detect and contain iVDPVs.

Date: 2023
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DOI: 10.1038/s41467-023-39094-0

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