Poliovirus
Patricia G. Melloy in Viruses and Society, 2023
As an enterovirus, poliovirus enters the body through the digestive system (the mouth) and then multiplies in the pharynx region or lymphatic tissue in the walls of the gastrointestinal tract, before being excreted in waste to potentially be spread to others. When someone is infected with poliovirus, they may present with a headache, sore throat, and/or nausea, or be asymptomatic. Roughly 1% (or a little less) of the time, the virus will enter the central nervous system (CNS; brain and spinal cord) by way of the bloodstream, leading to muscle pain and spasms and potentially causing paralysis, often of the legs. The disease caused by the poliovirus is known as infantile paralysis or poliomyelitis, which became shortened to polio (Oshinsky 2005; Jacobs 2015; Wilson 2005; Paul 1971; Yin-Murphy and Almond 1996). A person with poliovirus can shed virus in their feces for several weeks (CDC 2021b; Yin-Murphy and Almond 1996). Unlike some other pathogens, poliovirus is not killed by stomach acid or bile, so it can pass through the entire digestive tract (Yin-Murphy and Almond 1996). Polio has now been eradicated from the United States, but hundreds of thousands of people contracted polio in the early to mid-20th century, peaking in the 1940s and 1950s.
Polio
Rae-Ellen W. Kavey, Allison B. Kavey in Viral Pandemics, 2020
During the summer of 1911, three Rockefeller clinicians performed a classic clinical study of a polio outbreak in New York city, describing the natural history of the disease in 71 hospitalized children and 90 outpatient cases.14 Their findings in families indicated that polio was highly contagious and confirmed that a significant number of those infected with the poliovirus had few if any symptoms. Their series emphasized that paralysis was not the presenting symptom of polio, but instead followed an initial stage characterized by non-specific symptoms of fever, lethargy, muscle pain, and headache. They reviewed multiple laboratory results trying to identify a defining diagnostic pattern, without success. Thirty-four cases were described in great detail including the history of the illness, the physical findings on presentation and the hospital course, day by day. These case descriptions illuminated the variety of presentations of infection with the poliovirus. The histories of 12 infants and children who died are described in heart-rending detail as hour by hour, progressive paralysis of the intercostal muscles and the diaphragm led to respiratory failure and death.
Enteroviruses
Avindra Nath, Joseph R. Berger in Clinical Neurovirology, 2020
With IPV, the virus has been killed so it is not possible to become infected and paralyzed with poliovirus from the vaccine. However, there are some negatives associated with the Salk vaccine. Some reports have indicated that after the first dose of IPV only 36% of the patients will have developed a sufficient Ab response: Thus, it is more imperative to complete the series when the killed vaccine is used [90]. Repeat vaccination has been a problem in countries with migratory populations. Second, killed vaccine does not promote the “herd” effect whereby a vaccinated person can vaccinate another in the population via contact. Third, the killed vaccine is not as efficient at promoting gut immunity [91,92]. Therefore, those people vaccinated only with killed vaccine may still be able to host wildtype poliovirus replication in their gut. Should wild-type poliovirus be reintroduced into the United States the IPV alone will prevent disease but will be insufficient to eradicate poliovirus from the environment [88]. Considering the latest findings of wild-type virus in the coastal waters surrounding the United States, it is conceivable that those receiving the killed vaccine will serve as hosts and allow for the repopulation of the environment with wild-type poliovirus. OPV remains the vaccine of choice for controlling poliovirus outbreaks [93].
Research progress on substitution of in vivo method(s) by in vitro method(s) for human vaccine potency assays
Published in Expert Review of Vaccines, 2023
Xuanxuan Zhang, Xing Wu, Qian He, Junzhi Wang, Qunying Mao, Zhenglun Liang, Miao Xu
IPV plays a crucial role in preventing poliovirus. During the initial after licensure, the in vivo assays of IPV were generally performed in the lot release process, namely, the post-immunization neutralizing antibody titers in sera of animals (e.g. Guinea pigs, chickens, and rats) were detected [57]. D antigen, the protective immunogen of IPV, can stimulate the production of protective neutralizing antibodies within the body. Therefore, a D antigen-based in vitro assays can be established and used to ensure consistency throughout production. Based on a well-established production process, in vitro assays can more sensitively detect the degradation of poliomyelitis antigens and are more suitable for evaluating the consistency of batch-manufactured products [58].
A review of the DTaP-IPV-HB-PRP-T Hexavalent vaccine in pediatric patients
Published in Expert Review of Vaccines, 2023
Andrew Dakin, Ray Borrow, Peter D. Arkwright
In 1988, the World Health Assembly developed a Global Polio Eradication Initiative (GPEI) to eradicate polio worldwide [21]. Since then, cases of polio have dropped 99% from an estimated 350,000 wild poliovirus cases in 1988 across 125 endemic countries, to only 6 cases reported in 2021. There are two main types of vaccines against polio, the live attenuated oral poliovirus vaccine (OPV) and the inactivated poliovirus vaccine (IPV). OPV is still in use in certain countries due to its lower cost, easier transportation, and the superior intestinal immunity induced when compared to IPV. Despite the advantages of OPV, developed countries have switched to IPV, due to OPV rarely causing paralytic disease [22]. The virus has three serotypes, all of which are included in the DT2aP-IPV-Hib-HBV vaccine [7,23]. In June 2022, the UK Health Security Agency (UKHSA) announced that vaccine-derived poliovirus type 2 (VDPV2) had been repeatedly detected in sewage in London, UK [24]. Several weeks later, the New York State Department of Health reported a case of acute flaccid paralysis caused by VDPV2 in an unvaccinated individual; the first case of poliomyelitis in almost a decade in the USA [25]. A similar virus has also been detected in sewage from Jerusalem, Israel [26]. Vaccines elicit serum antibodies that neutralize poliovirus infection with titers of 1:4, measured using sero-neutralization [27].
Cross-neutralization Capacity of Immune Serum from Different Dosage of Sabin Inactivated Poliovirus Vaccine Immunization against Multiple Individual Polioviruses
Published in Expert Review of Vaccines, 2021
Kai Chu, Weixiao Han, Deyu Jiang, Zhiwei Jiang, Taotao Zhu, Wenbo Xu, Yuemei Hu, Gang Zeng
Poliomyelitis is a paralytic disease caused by any of the three poliovirus types 1, 2, and 3, especially in children aged <5 years [1]. The vaccination era started in 1955 when the inactivated poliovirus vaccine (IPV) developed by Jonas Salk was licensed in the USA, followed by the oral polio vaccine (OPV) by Albert Sabin licensed in 1961 [2]. The widespread introduction of polio vaccines has prompted a rapid decline in cases with poliomyelitis worldwide. Furthermore, the World Health Organization (WHO) launched the Global Polio Eradication Initiative (GPEI) in 1988, which reduced the global incidence of polio by 99.9% [3,4]. The WHO currently recommends the need to not only rapidly eradicate wild polioviruses but also prevent the occurrence of vaccine-associated paralytic poliomyelitis (VAPP), recurrent circulating vaccine-derived poliovirus (cVDPV), and immunodeficient vaccine-derived poliovirus (iVDPV) [5–7]. The incidence of VAPP is estimated to be 2–4 cases/million birth cohort per year in countries using OPV [8], and the attenuated viruses in live OPV may re-acquire neurovirulence and transmissibility through prolonged replication in an individual or community and finally transform into cVDPVs [9–11].
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