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14th ICID - Poster Abstracts - International Society for Infectious ...

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When citing these abstracts please use the following reference:<br />

Author(s) of abstract. Title of abstract [abstract]. Int J Infect Dis 2010;14S1: Abstract number.<br />

Please note that the official publication of the <strong>International</strong> Journal of <strong>Infectious</strong> Diseases 2010, Volume 14, Supplement 1<br />

is available electronically on http://www.sciencedirect.com<br />

Final Abstract Number: 83.016<br />

Session: Vaccines and Vaccine Development<br />

Date: Thursday, March 11, 2010<br />

Time: 12:30-13:30<br />

Room: <strong>Poster</strong> & Exhibition Area/Ground Level<br />

Type: <strong>Poster</strong> Presentation<br />

A vaccine derived poliovirus case in an immunocompromised argentinian child<br />

M. E. Burgos 1 , S. Elkik 1 , P. Barbosa 1 , M. Oleastro 1 , C. Freire 2 , A. Parra 1 , M. Caparelli 3 , C.<br />

Sarkis 4<br />

1 Hospital Garrahan, Buenos Aires, Argentina, 2 Servicio de Neurovirosis Dpto. Virología . IENEI-<br />

NLIS “Dr. Carlos G. Malbran”, Buenos Aires, Argentina, 3 Ministerio de Salud, Buenos Aires,<br />

Argentina, 4 Hospital Garrahan , Capital Federal, Argentina, Argentina<br />

Background: Although poliomyelitis caused by wild-type poliovirus has been almost eradicated,<br />

especially in developed countries, vaccine associated paralytic poliomyelitis (VAPP) cases still<br />

continue to occur in Latin American countries. In Argentina, where OPV routine immunization<br />

policy is ongoing, the last wild poliovirus (WPV) case was registered in 1984. Since then, the<br />

several polio cases reported were VAPP and Vaccine Derived Poliovirus (VDPV) (first iVDPV<br />

case was detected in 1998).<br />

Methods: To report a polio case caused by a VDPV in an immunodeficient patient diagnosed<br />

with polyclonal agammaglobulinemia.<br />

Results: In May 2009 a 15 month-old patient was hospitalized in our institution <strong>for</strong> acute flaccid<br />

monoparesis in his left lower limb with areflexia, with residual paralysis 60 days after onset. The<br />

patient had a history of recurrent infections (sepsis meningitis and pneumonia).Vaccination<br />

calendar was completed <strong>for</strong> his age (DPt/Hib-HB & OPV: 3 doses). The child received OPV3, 8<br />

months be<strong>for</strong>e.<br />

LCR 8 cells / prot 25 mg/100 mL / Glu 50 mg/ml with negative cultures (bacteria -<br />

mycobacterium, fungi). EMG showed pre-ganglionic injury. Spine MRI showed focal<br />

intramedullary cone and lower thoracic spinal cord with hyperintense signal in T2 left hemicord.<br />

The major capsid protein (VP1) of the Sabin virus T1 isolated in feces showed a 96.5% genetic<br />

similarity to Sabin 1 vaccine strain (a 3.5% genetic divergence in this region).<br />

Conclusion: The occurrence of iVDPVs appears to be very rare; the majority of patients stopped<br />

excretion of the virus after a certain period or have died. The overriding factor <strong>for</strong> the emergence<br />

of all VDPVs is the same as <strong>for</strong> WPV circulation, i.e., low routine OPV coverage rates in children.<br />

Thus, a community can become susceptible to the emergence of all types of VDPV producing an<br />

impact in the public health of the population. New polio vaccination strategies should be<br />

considered to avoid future VDPV cases and to be aligned WHO end- game strategies.

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