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Immunodeficient Patients May Be at Risk for Polio

Woman treated for common variable immunodeficiency chronically infected with polio

WEDNESDAY, June 15 (HealthDay News) -- Patients with long-standing immunodeficiency are susceptible to chronic infection with poliovirus, which may develop into poliomyelitis, according to a case report published in the June 16 issue of the New England Journal of Medicine.

Aaron S. DeVries, M.D., M.P.H., from the Minnesota Department of Health in St. Paul, and colleagues investigated a case of poliomyelitis in a 44-year-old woman with long-standing common variable immunodeficiency. The patient, who was receiving intravenous immune globulin, developed sudden paralysis of all four limbs and the respiratory muscles, resulting in death. Stool samples were analyzed, and complete genomic sequencing was carried out.

The investigators identified type 2 vaccine-derived poliovirus from the stool sample. The VP1 region of the viral capsid protein had diverged from the vaccine strain at 12.3 percent of nucleotide positions. Nucleotide substitutions were identified at the two attenuation sites that had reverted to the wild-type sequence. Infection was likely to have occurred 11.9 years previously, when the woman's child received the oral poliovirus vaccine. Secondary cases were not identified in close contacts or in health care workers.

"Patients with common variable immunodeficiency can be chronically infected with poliovirus, and poliomyelitis can develop despite treatment with intravenous immune globulin," the authors write.

One study author disclosed financial relationships with Pfizer, Ortho-McNeil, and 3M.

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