The Long and Winding Road to Eradicate Vaccine-Related Polioviruses
Open accessAbstract
As the vaccine of choice for the Global Polio Eradication Initiative (GPEI), oral poliovirus vaccine (OPV) is inexpensive, easy to administer, and can provide good protection against poliomyelitis and poliovirus infection, through durable humoral immunity and induction of intestinal mucosal immunity.Even though trivalent OPV is a safe and effective vaccine and has a remarkable disease elimination record, all 3 strains are live attenuated RNA viruses capable of genetic mutation during replication.This means that polioviruses in OPV can undergo genetic changes in vaccine recipients to reverse attenuation.This inherent in-stability represents a key disadvantage of OPV that is manifest in some of the current polio eradication challenges.It has long been known that sporadic cases of vaccine-associated paralytic polio (VAPP) occur in recently vaccinated individuals (recipient VAPP) and in susceptible persons indirectly exposed to vaccine virus, such as close contacts of persons recently vaccinated or community contacts (contact VAPP).The global burden of VAPP was estimated in 2011 to be approximately 250-500 cases per year [1].In countries using OPV, of the 3 poliovirus vaccine serotypes, type 3 is the predominant serotype isolated from the stool of recipient and contact VAPP cases, followed by type 2 and then type 1 [1,2].The higher frequency of type 2 and type 3 VAPP may be related to the fewer nucleotide substitutions responsible for the attenuated phenotype in types 2 and 3 virus strains, making reversion easier [2].As global eradication progressed in the decade following the World Health Assembly declaration of the global eradication goal in 1988, many countries achieved the elimination of all 3 types of indigenous wild polioviruses, including many in the developing world.However, these newly polio-free countries were now completely dependent on vaccination to maintain immunity against polio in the population.The continued use of OPV with low coverage led to a widening immunity gap and revealed another manifestation of the genetic in-stability of the polioviruses in OPV.In this case, instead of OPV-related polio being restricted to vaccine recipients and contacts, the vaccine virus continues to transmit from
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OPV strains can mutate and evolve into VDPV, which may be neurovirulent in vaccinated individuals due to intrinsic genetic instability.
“However, OPV strains can mutate and evolve into VDPV, which may be neurovirulent in vaccinated individuals due to their intrinsic genetic instability [78,79,80,81].”
From The Fight against Poliovirus Is Not Over (2023) · cites this paper as [81]
In the main text (page unavailable), the paper says OPV strains can mutate because of inherent genetic instability and that continued mutation can produce neurovirulent VDPVs. It separately describes vaccine-associated paralytic polio in recently vaccinated individuals; it does not specifically say that VDPVs are neurovirulent in vaccinated individuals. (LLM, conf=0.87)
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Self-citationBurns, C. C., Diop, O. M., Sutter, R. W., & Kew, O. M. (2014) · The Journal of Infectious Diseases · doi:10.1093/infdis/jiu295 · Cited by 310 · see citing works
Platt, L. R., Estivariz, C. F., & Sutter, R. W. (2014) · Journal of Infectious Diseases · doi:10.1093/infdis/jiu184 · Cited by 267 · see citing works
Van Damme, P., De Coster, I., Bandyopadhyay, A. S., Revets, H., Withanage, K., De Smedt, P., Suykens, L., Oberste, M. S., Weldon, W. C., Costa-Clemens, S. A., et al. (2019) · The Lancet · doi:10.1016/s0140-6736(19)31279-6 · Cited by 141 · see citing works
Update on Vaccine-Derived Poliovirus Outbreaks — Worldwide, July 2019–February 2020
Alleman, M. M., Jorba, J. C., Greene, S. A., Diop, O. M., Iber, J. C., Tallis, G. F., Goel, A., Wiesen, E., Wassilak, S. G. F., & Burns, C. C. (2020) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6916a1 · Cited by 93 · see citing works
Update on Vaccine-Derived Poliovirus Outbreaks-Worldwide, January 2018–June 2019
Jorba, J., Diop, O. M., Iber, J., Henderson, E., Zhao, K., Quddus, A., Sutter, R., Vertefeuille, J. F., Wenger, J., Wassilak, S. G. F., et al. (2019) · MMWR. Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6845a4 · Cited by 83 · see citing works
Self-citationAddressing the Challenges and Opportunities of the Polio Endgame: Lessons for the Future
Patel, M. M., & Cochi, S. L. (2017) · The Journal of Infectious Diseases · doi:10.1093/infdis/jix117 · Cited by 44 · see citing works
Self-citationConsiderations for the Full Global Withdrawal of Oral Polio Vaccine After Eradication of Polio
Hampton, L. M., du Châtellier, G. M., Fournier-Caruana, J., Ottosen, A., Rubin, J., Menning, L., Farrell, M., Shendale, S., & Patel, M. M. (2017) · The Journal of Infectious Diseases · doi:10.1093/infdis/jix105 · Cited by 36 · see citing works
Inactivated Poliovirus Vaccine Supply Shortage: Is There Light at the End of the Tunnel?
Sutter, R. W., & Cochi, S. L. (2018) · The Journal of Infectious Diseases · doi:10.1093/infdis/jiy739 · Cited by 34 · see citing works
Self-citationBandyopadhyay, A. S., Gast, C., Brickley, E. B., Rüttimann, R. W., Clemens, R. L., Oberste, M. S., Weldon, W. C., Ackerman, M. E., Connor, R. I., Wieland‐Alter, W., et al. (2020) · The Journal of Infectious Diseases · doi:10.1093/infdis/jiaa390 · Cited by 19 · see citing works
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Research works printed but not linked: 1
- [2]Sutter RW, Kew OM, Cochi SL, Aylward BA. Poliovirus vaccine-live. In: Plotkin SA, Orenstein WA, eds. Vaccines. 7th ed. Philadelphia, PA: Elsevier, 2018: 866– 916.
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The Fight against Poliovirus Is Not Over
Mbani, C. J., Nekoua, M. P., Moukassa, D., & Hober, D. (2023) · Microorganisms · doi:10.3390/microorganisms11051323 · Cited by 31 · see citing works
Kitamura, K., & Shimizu, H. (2021) · Viruses · doi:10.3390/v13071407 · Cited by 14 · see citing works
- Authors
- Cochi, S. L., & Pallansch, M. A.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Cochi, Stephen L
- ORCID
- Pallansch, Mark A
- Venue
- The Journal of Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-07-05
- Volume
- 223
- Issue
- 1
- Pages
- 7-9
- ISSN
- 0022-1899 (ISSN-L)
- 1537-6613
- PMC
- PMC10546420
- OpenAlex
- W3039863063
- Cited by
- 9
- References
- 11
- Citations by year
- 2025: 2 · 2023: 4 · 2022: 2 · 2021: 1
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- public-domain
- Locations
- The Journal of Infectious Diseases (publishedVersion, public-domain)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Centers for Disease Control and Prevention
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
- Health Sciences › Medicine › Epidemiology › Virology and Viral Diseases
- Life Sciences › Immunology and Microbiology › Virology › Poxvirus research and outbreaks
- Keywords
- oral polio vaccine, vaccine-associated paralytic poliomyelitis, vaccine-derived poliovirus, trivalent oral polio vaccine, Global Polio Eradication Initiative, polio eradication, immunity gaps
- MeSH terms
- Child, Humans, Lithuania, Poliomyelitis, Poliovirus Vaccine, Inactivated, Poliovirus Vaccine, Oral, Poliovirus
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