Clearing Vaccine-Derived Poliovirus Infection Following Hematopoietic Stem Cell Transplantation: a Case Report and Review of Literature
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The use of oral poliovirus vaccine in a worldwide scale has led to a 99.9% decrease in annual incidence of wild-type poliomyelitis and the eradication of serotype 2 poliovirus. However, the emergence of vaccine-derived polioviruses (VDPVs) is endangering the eradication program. Patients with combined immunodeficiencies are at increased risk of both vaccine-associated poliomyelitis and prolonged asymptomatic infection with immunodeficiency-associated VDPVs (iVDPVs). Herein, we present a severe combined immunodeficiency patient with prolonged and asymptomatic iVDPV infection. He continued to shed poliovirus during immunoglobulin replacement therapy and cleared the infection following successful hematopoietic stem cell transplantation (HSCT). To explain the efficiency of HSCT in clearing the infection, we reviewed the literature for all reports of HSCT in iVDPV-excreting patients and discussed novel ideas about the role of different immune mechanisms, including cell-mediated interactions, in mounting immune responses against poliovirus infections. This study could provide further insights into the immune mechanisms contributing to the clearance of enteroviral infections.
KeywordsHematopoietic stem cell transplantation poliomyelitis poliovirus vaccine primary immunodeficiency
We thank Ahmad Nejati, Maryam Yousefi, Yaghoob Mollaie, and all the staff members of the Iran National Polio Laboratory and also CDC-Atlanta for performing thorough virologic studies.
This study was done at the Research Center for Immunodeficiencies, Tehran University of Medical Sciences, Tehran, Iran. The Iran National Polio Laboratory is supported by the Ministry of Health and Medical Education, the World Health Organization, and Tehran University of Medical Sciences.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
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