Polio OPV
Polio is a viral infection that has been associated with varying degrees of paralysis. On March 26, 1953, American medical researcher Dr. Jonas Salk announced on a national radio show that he had successfully developed a vaccine against poliomyelitis. For promising eventually to eradicate the disease, which is known as "infant paralysis" because it mainly affects children, Dr. Salk was celebrated as the great doctor-benefactor of his time. In 2012, polio is considered one of the global “filth diseases” and isolated outbreaks still occur in a handful of war-torn countries with inadequate sanitation.
OPV (Oral Polio Vaccine) Vaccine Package Insert (pdf)
November 9, 2017 - Polio "The global number of circulating Vaccine-Derived Poliovirus (cVDPV), January 2000 – May 2016
August 3, 2022 - UPDATE: In July 2022, CDC was notified of a case of polio caused by vaccine-derived poliovirus type 2 (VDPV2) in an unvaccinated individual from Rockland County, New York "Public health experts are working to understand how and where the individual was infected and provide protective measures, such as vaccination services to the community to prevent the spread of polio to under- and unvaccinated individuals. ... A vaccine-derived poliovirus (VDPV) is a strain related to the weakened live poliovirus contained in oral polio vaccine (OPV). If allowed to circulate in under- or unimmunized populations.
July 9, 2021 - Oral Polio Vaccine to Protect Against COVID-19: Out of the Box Strategies? "'While antibodies produced from vaccination help prevent disease, the immune training by live vaccines is thought to decrease the severity of disease and the amount of damage to organic tissue, including mucosal surfaces, by reducing viral shedding and invasive pathogens, allowing for nonspecific protection against other pathogens. This effect was demonstrated by Upfill-Brown et al. (2017), a randomized controlled trial that found that OPV use was associated with decreased prevalence of Shigella and E. coli diarrhea among male children and of Campylobacter jejuni diarrhea among children of both sexes in Bangladesh .
October 20, 2020 - A Health Economic Analysis for Oral Poliovirus Vaccine to Prevent COVID-19 in the United States "The costs of reintroducing a single OPV dose to 331 million Americans would exceed $4.4 billion. Giving a dose of bivalent OPV to the entire U.S. population would lead to an expected 40 identifiable cases of vaccine-associated paralytic polio, with young Americans at the highest risk. Reintroducing any OPV use in the U.S. poses a risk of restarting transmission of OPV-related viruses and could lead to new infections in immunocompromised individuals with B-cell related primary immunodeficiencies that could lead to later cases of paralysis. Due to the lack of a currently licensed OPV in the U.S., the decision to administer OPV to Americans for nonspecific immunological effects would require purchasing limited global OPV supplies that could impact polio eradication efforts. Health economic modeling suggests no role for reintroducing OPV into the U.S."
November 3, 2017 - CDC MMWR Progress in Childhood Vaccination Data in Immunization Information Systems — United States, 2013–2016 "To monitor progress toward achieving IIS program goals, CDC surveys jurisdictions through an annual self-administered IIS Annual Report (IISAR). Data from the 2013–2016 IISARs were analyzed to assess progress made in four priority areas: 1) data completeness, 2) bidirectional exchange of data with electronic health record systems, 3) clinical decision support for immunizations, and 4) ability to generate childhood vaccination coverage estimates. IIS participation among children aged 4 months through 5 years increased from 90% in 2013 to 94% in 2016, and 33 jurisdictions reported ≥95% of children aged 4 months through 5 years participating in their IIS in 2016."
November 3, 2017 - CDC MMWR Update on Vaccine-Derived Polioviruses — Worldwide, January 2016–June 2017 "During the reporting period, VDPV2s were detected both before and after the global withdrawal of OPV2 in April 2016. During the preswitch period (January 2016–April 2016), emergence of cVDPV2 in countries with low routine vaccination coverage underscored the risks of widening immunization gaps to PV2; detection of highly divergent cVDPV2s from sewage samples collected in the state capital adjacent to inaccessible areas of northeast Nigeria also indicated virus circulation that was missed by AFP 'outbreaks detected after the switch in both Syria and DRC highlighted the risks associated with chronically low tOPV vaccination coverage before the switch'surveillance. cVDPV2 ."
October 4, 2017 - Characterization of human monoclonal antibodies that neutralize multiple poliovirus serotypes "Following the eradication of wild poliovirus (PV), achieving and maintaining a polio-free status will require eliminating potentially pathogenic PV strains derived from the oral attenuated vaccine."
October 2017 - Community transmission of type 2 poliovirus after cessation of trivalent oral polio vaccine in Bangladesh: an open-label cluster-randomised trial and modelling study (full text) "These findings suggest that the low intestinal immunity to Sabin 2 due to the bOPV and IPV vaccine regimen in routine immunisation, relative to tOPV in routine immunisation, decreases population immunity against Sabin 2 transmission within a short time after tOPV cessation. After completing a routine immunisation schedule of bOPV and IPV, individuals remain more susceptible to Sabin 2 infection from either mOPV2 vaccination or transmission, and those infected shed more poliovirus and drive increased transmission to contacts previously immunised with tOPV. In our well-immunised population, we recorded Sabin 2 infection attributable to the mOPV2 campaign for at least 10 weeks, and one new infection was noted 22 weeks after the campaign and, thus, 8 weeks after cessation of tOPV use in Bangladesh."
July 5, 2017 - Modeling the costs and benefits of temporary recommendations for poliovirus exporting countries to vaccinate international travelers (full text) "Decreasing global population immunity to serotype 2 transmission implies a much greater potential for serotype 2 cVDPV (cVDPV2) exportations to cause new outbreaks than in the past and a failure to contain cVDPV2 outbreaks could lead to a need to restart serotype 2-containing OPV in countries currently using OPV. This would imply greater potential benefits of implementing TRs for cVDPV2 outbreaks. However, vaccinating travelers with serotype 2 monovalent OPV increases the risk of reintroducing a serotype 2 live poliovirus into other countries, which can eventually lead to new cVDPV2 outbreaks.
July 2017 - Detection of Emerging Vaccine-Related Polioviruses by Deep Sequencing (full text) "Nevertheless, we obtained high quality 5′-UTR and P1 sequences from 31 of 36 stool specimens, allowing sequence analysis of vaccine-related polioviruses without the bias of selection in culture. This analysis revealed the presence of large numbers of low-level synonymous and nonsynonymous variants throughout the 5′ UTR and P1 genomic region. In addition, mutations associated with phenotypic reversion were found in 39/40 (98%) sequenced vaccine-related polioviruses that underwent variant analysis, with many present at high levels. While these reversion mutations are known to increase virus fitness and be shed by healthy vaccinees, this deep-sequencing method allowed simultaneous evaluation of all known attenuating mutations and revealed the presence of viruses containing up to three canonical mutations 'associated with the reacquisition of neurovirulence"
April 17, 2017 - The polio endgame: rationale behind the change in immunisation "Similarly, the synchronised switch from trivalent OPV (all three types) to bivalent OPV (types 1 and 3) involved an unprecedented level of global coordination and country commitment. The important shift in vaccination policy seen through global IPV introduction and OPV withdrawal represents an historical milestone reached in the polio eradication effort." Comment: It should have been done years ago. The OPV was causing the virus to replicate in those who received them.
December 2016 - Unravelling mucosal immunity to poliovirus (full text) "Serotype 2 polioviruses will hopefully be consigned to the history books soon. However, the resurfacing in August, 2016, of polio in Nigeria as a result of wild serotype 1 virus after more than 2 polio-free years provides a stark warning against complacency.Comprehensive surveillance of children with acute flaccid paralysis and environmental samples is undoubtedly crucial to the success of the polio endgame. Even with robust surveillance, a pivotal question remains: how long has to pass without detection of polio before it can be concluded that the disease is gone for good?"
November 19, 2016 - New poliovirus vaccine schedules "Additionally, a case of circulating vaccine-derived poliovirus type 1 with onset of symptoms was detected in Madagascar in September, 2014. Therefore, we believe that a sequential administration of IPV–bOPV might be safer than that of bOPV–IPV, and ask the authors to comment on this issue."
November 19, 2016 - New poliovirus vaccine schedules – Authors' reply "In low-income countries, most cases of vaccine-associated paralytic poliomyelitis were reported as having received multiple previous doses of OPV. By contrast, in middle-income and high-income countries the risk of vaccine-associated paralytic poliomyelitis is '6·6 times higher in the recipients of their first dose of OPV compared with those receiving subsequent doses. The choice of sequence of poliovirus vaccines in the primary series has little effect on the generation of circulating vaccine-derived poliovirus. Areas at highest risk of circulating vaccine-derived poliovirus, mostly from the OPV type-2 component, are regions with low OPV coverage, and where epidemiological conditions (eg, low socioeconomic status, poor hygiene, sanitation, and crowding) favour poliovirus transmission."
October 10, 2016 - Contribution of polio eradication initiative to effective new vaccine introduction in Africa, 2010–2015 (full text) "Furthermore, with the global advancement in developing new vaccine, more sophisticated vaccines have become available and they need to be introduced in Africa in a timely manner and avoid the lag between high and low-income countries. The high cost of rolling out new vaccines and donor or co-payments required places additional burden for limited resources. The Gavi Alliance has spearheaded efforts to increase funding for immunization and increase availability of new vaccines to low-resource eligible countries. The challenge however lies in making these vaccines accessible to middle-income countries that do not qualify for financial support."
October 10, 2016 - Contribution of polio eradication initiative to strengthening routine immunization: Lessons learnt in the WHO African region (full text) "The Regional Vaccine Action Plan 2014–2020 (RVAP) has an ambitious goal to achieve 90% national coverage and 80% coverage in each district of EPI vaccines by the end of the target year. Availability of adequate resources remains a challenge and continued efforts are needed to mobilize national, regional and international support to strengthen and sustain high-quality immunization services in African countries. Strengthening RI will in turn sustain the gains made to eradicate poliovirus in the region and help build a stronger system to deliver other life-saving vaccines."
October 4, 2016 - Population Immunity against Serotype-2 Poliomyelitis Leading up to the Global Withdrawal of the Oral Poliovirus Vaccine: Spatio-temporal Modelling of Surveillance Data (full text)
- The Global Polio Eradication Initiative’s strategic plan includes the global withdrawal of all oral poliovirus vaccines (OPVs) because they can result, albeit rarely, in outbreaks of poliomyelitis caused by vaccine-derived poliovirus (VDPV).
- Serotype-2 OPV (OPV2) was withdrawn from trivalent OPV in all 155 countries using this vaccine in April 2016, as the last naturally occurring case of polio caused by serotype-2 wild poliovirus was reported in 1999.
- Strategies to minimise the risk of serotype-2 VDPVs during the period leading up to OPV2 withdrawal were required.
October 4, 2016 - Sailing in Uncharted Waters: Carefully Navigating the Polio Endgame (full text) "Subsequently, retrospective analysis of isolates from a type 2 outbreak in Egypt from 1988 to 1993 confirmed its origin as Sabin virus. Since then, many cVDPV polio outbreaks have been identified, and, although they can occur with any of the three vaccine strains, over 90% are due to type 2. Moreover, type 2 vaccine virus accounts for 40% of sporadic vaccine-associated paralytic polio cases. With no WPV2 cases since 1999, continued use of Sabin type 2 strain, with its associated risks, has become difficult to justify."
October 2016 - Vaccine-Derived Polioviruses and Children with Primary Immunodeficiency, Iran, 1995–2014 "Primary immunodeficiencies in patients were detected mostly after onset of paralysis (11 of 14 patients). Only 3 patients had been given a diagnosis of primary immunodeficiency before onset of VAPP. Patient 1 was screened and given a diagnosis of primary immunodeficiency at birth. Patients 9 and 10 received Mycobacterium bovis BCG vaccine and a first dose of OPV at birth. These 2 patients had multiple BCG-adenitis and respiratory infections at 10 months and 4 months of age, respectively, which led to a diagnosis of primary immunodeficiency. Despite initiation of immunoglobulin replacement, they subsequently had VAPP."..."Among the 7 newly identified case-patients, patient 12 died before he underwent specific immunologic investigations."
September 30, 2016 - Poliovirus seroprevalence before and after interruption of poliovirus transmission in Kano State, Nigeria (full text) "Besides WPV transmission, Nigeria has the problem of persistent transmission of circulating vaccine-derived poliovirus type 2 (cVDPV2) [9], [10] and [11]. Cases of cVDPV2 detected increased from 4 in 2013 to 30 in 2014. "
August 2016 - The Importance of Social Networking in a National Polio Vaccine Campaign "The campaign posed several challenges to winning public confidence: the reintroduction of a previously discontinued vaccine, the silent nature of the transmission, and the targeting of children who were already protected to protect others. Initially, the Ministry of Health allocated resources to traditional media to address these issues; the social networks were neglected. Meanwhile, individuals and groups with an antivaccine agenda began in June to flood the Hebrew-language Internet with postings that denied the significance of WPV1 in the sewage, decried the use of live vaccine, and rallied to stop the “dangerous” campaign. The Ministry of Health opened a dedicated Web site to address public concerns, but more was needed in the age of social networking."
July 19, 2016 - The effect of mass vaccination campaigns against polio on the utilization of routine immunization services: A regression discontinuity design "In most low and middle-income countries (LMIC), vaccines are primarily distributed by routine immunization services (RI) at health facilities. Additional opportunities for vaccination are also provided through mass vaccination campaigns, conducted periodically as part of disease-specific initiatives. It is unclear whether these campaigns are detrimental to RI services, or whether they may stimulate the utilization of RI."..."Children exposed to the campaign received between 0.296 and 0.469 additional doses of DPT vaccine by age 4 months than unexposed children."
July 6, 2016 - Preventing Vaccine-Derived Poliovirus Emergence during the Polio Endgame (full text) "Thirdly, although our simple mathematical model is mechanistic–describing OPV transmission and VDPV emergence–it does not attempt to capture the detailed genetic changes that result in reversion of Sabin poliovirus to a VDPV with transmissibility and virulence equivalent to wild-type virus. Attenuating mutations in the Sabin polioviruses have been identified, but the process of reversion and the significance of genetic changes for poliovirus transmission are not well understood."
July 2016 - A Cluster of Paralytic Poliomyelitis Cases Due to Transmission of Slightly Diverged Sabin 2 Vaccine Poliovirus "Here, an unusual outbreak of poliomyelitis caused by a Sabin-like virus is reported, which had an exceptionally high disease/infection ratio. This outbreak blurred the borderline between Sabin-like polioviruses and VDPVs both in pathogenicity and in the kind of responses required, as well as underscoring important gaps in understanding the pathogenicity, epidemiology, and evolution of vaccine-derived polioviruses."
May 19, 2016 - Humoral and intestinal immunity induced by new schedules of bivalent oral poliovirus vaccine and one or two doses of inactivated poliovirus vaccine in Latin American infants: an open-label randomised controlled trial "IPV induced small but significant decreases in a composite serotype 2 viral shedding index after mOPV2 challenge. 21 serious adverse events were reported in 20 patients during the study, including two that were judged to be possibly related to the vaccines. Most of the serious adverse events (18 [86%] of 21) and 24 (80%) of the 30 important medical events reported were infections and infestations."
May 1, 2016 - Public Health Innovations on the Way to Interruption of Poliovirus Transmission in Nigeria (full text) "The programmatic interventions that are described here include efforts to create demand for polio vaccination; strategies to detect every case of suspected WPV, including those in the environment; methods to determine the underlying population immunity; strategies to effectively plan for, implement, and track vaccination activities, using the latest technologies; and approaches to widen the polio partnership in noncompliant and security-compromised communities.
May 1, 2016 - Tracking Vaccination Teams During Polio Campaigns in Northern Nigeria by Use of Geographic Information System Technology: 2013–2015 (full text) "First, although the tracking provides important feedback on the settlements reached by the various vaccination teams using the different reports, recording and analyzing geographic coverage does not translate into actual vaccination of children in the settlements reached. Some areas may achieve a high geographic coverage but record a high number of missed children, which could be attributable to noncompliance, children being absent, and teams' attitudes. Comment: Spending all of this money on tracking vaccines when they could use it for sanitation, clean water, and a proper diet. Financial support. This work was supported by the Bill and Melinda Gates Foundation.
May 1, 2016 - Youth Group Engagement in Noncompliant Communities During Supplemental Immunization Activities in Kaduna, Nigeria, in 2014 (full text) "Supplementary immunization activities (SIAs) are aimed at delivering potent oral polio vaccine (OPV) to children aged <5 years, using various teams to vaccinate children at homes, on the street, at transit points, and at health facilities. However, in some cases this strategy is fraught with challenges, including harassment of vaccination team members and refusal of OPV, resulting in children who are chronically missed by SIAs."
April 19, 2016 - Challenges to health workers and their opinions about parents’ refusal of oral polio vaccination in the Khyber Pakhtoon Khawa (KPK) province, Pakistan "Overall, HWs disclosed that public attitude and harsh behaviour towards the HWs and security threats are the two main challenges they face. Common issues hindering parents’ willingness to vaccinate their children against OPV are: OPV is seen as haram and not permitted in Islam, it is said to contain the blood of pigs (Khinzir) and monkeys, and parents are afraid that it is done to induce sterility among their children. HWs also shared that parents have a strong belief in the conspiracies that are associated with OPV, i.e. the USA and CIA, are spying on us and our government is helping them to achieve their agenda. Furthermore, HWs revealed that frequent visits may further strengthen parents’ perceptions and make them more resistant to OPV."
April 8, 2016 - Surveillance Systems to Track Progress Toward Polio Eradication — Worldwide, 2014–2015 "As the number of reported polio cases declines, sensitive AFP surveillance becomes increasingly critical, and environmental surveillance will continue to be an important supplement to AFP surveillance. The risk for WPV and cVDPV importation, and cVDPV emergence exists even in countries within polio-free regions. To promptly identify and respond to all cases of polio, surveillance performance must be continuously assessed and quality must be maintained globally.
April 2016 - Is introduction of IPV “Good news for billions of children”? "In 2008, following the demonstration of methodological flaws in studies concluding that there was no sign of a negative effect of DTP, the Global Advisory Committee on Vaccine Safety stated that it would monitor the evidence of non-specific effects of vaccines. It remains to be assessed whether IPV has non-specific effects and especially whether IPV could be detrimental for child health. IPV has been used as a comparator vaccine in randomised trials; girls randomly assigned to IPV had 52% (95% 2–128) higher mortality than did boys who were randomly assigned to the vaccine.
April 2016 - Is introduction of IPV “Good news for billions of children”? – Author's reply – Author's reply "OPV cessation will prevent hundreds of estimated cases of vaccine-associated paralytic poliomyelitis every year. Developed countries like the USA switched from the oral to the IPV for routine immunisation decades ago to prevent the morbidity and in some cases mortality caused by vaccine-associated paralytic poliomyelitis.
March 31, 2016 - Two Cases of Vaccine-Derived Poliovirus Infection in an Oncology Ward "Assessment for poliovirus excretion in children with severe immunodeficiencies who are from countries where live poliovirus vaccine is used should be considered. Effective antiviral therapy against poliovirus infection would be useful to protect VDPV-infected persons against paralysis and prevent the spread of VDPV."
March 12, 2016 - Changing oral vaccine to inactivated polio vaccine might increase mortality "On average, about 75 cases of vaccine-associated paralytic poliomyelitis are reported each year worldwide, and WHO has suggested that OPV be gradually replaced by inactivated polio vaccine (IPV) to reduce the number of such cases. Results from a randomised trial in 2015 suggest that OPV might have beneficial non-specific effects that reduce all-cause mortality by 17%, possibly to a greater extent in boys than in girls, whereas previous evidence suggests that IPV increases all-cause mortality by 10%.5 Consequently, the proposed change from OPV to IPV might lead to increased all-cause mortality through loss of the beneficial non-specific effects of the live vaccine, and adverse non-specific effects of the inactivated vaccine. Replacement of OPV with IPV could translate to approximately 4000 deaths for each case of vaccine-associated paralytic poliomyelitis prevented, and might cause more than 300 000 additional deaths each year.
- KLF reports funds to attend and present at the Optimmunize meetings in Copenhagen hosted by Peter Aaby and Christine Stabell Benn, authors on publications describing non-specific effects of oral polio vaccine.
- OL's laboratory at Boston Children's Hospital has and anticipates patent applications for in-vitro platforms to assess vaccine immunogenicity and for novel vaccine adjuvants. All other authors declare no competing interests.
February 25, 2016 - Alternative administration routes and delivery technologies for polio vaccines "The target product profile of these vaccines includes not only dose sparing but also high stability, which is important for stockpiling, and easy application important for (emergency) vaccination campaigns."
February 11, 2016 - A World Free of Polio — The Final Steps (full text) "Type 2 poliovirus now exists only in laboratories and in trivalent oral polio vaccine (tOPV) in an attenuated form, though in rare circumstances it surfaces in the community, through persistent transmission, in the form of outbreaks of vaccine-derived viruses."
January 2016 - Sabin Vaccine Reversion in the Field: a Comprehensive Analysis of Sabin-Like Poliovirus Isolates in Nigeria "Despite success in eliminating wild poliovirus from most of the world, polio persists in populations where logistical, social, and political factors have not allowed vaccination programs of sustained high quality. One issue of critical importance is eliminating circulating vaccine-derived polioviruses (cVDPVs) that have properties indistinguishable from those of wild poliovirus and can cause paralytic disease. cVDPV emerges due to the genetic instability of the Sabin viruses used in the oral polio vaccine (OPV) in populations that have low levels of immunity to poliovirus."
August 27, 2015 - Twenty-Eight Years of Poliovirus Replication in an Immunodeficient Individual: Impact on the Global Polio Eradication Initiative (full text) "This is by far the longest reported poliovirus excretion and represents the most comprehensive collection of iVDPV sequential isolates available. Provided antibody titres and immunisation coverage are maintained it is likely that the population will be protected against paralytic disease, but it is also possible that this virus could circulate in populations only using IPV as described in Israel for wild poliovirus, thus representing a possible source of polio re-emergence, particularly as these iVDPV strains are antigenically atypical and drifted from both Sabin 2 and MEF-1 vaccine strains. This is particularly relevant at present as there are imminent plans to remove type 2 poliovirus from OPV. Moreover the use of IPV based on the Sabin strains is being encouraged by WHO for reasons of environmental safety and the data presented here suggest that it is less effective.
August 2015 - Immunogenicity of three doses of bivalent, trivalent, or type 1 monovalent oral poliovirus vaccines with a 2 week interval between doses in Bangladesh: an open-label, non-inferiority, randomised, controlled trial "104 adverse events were reported in 100 infants during follow up. 36 of these events needed admission to hospital (32 were pneumonia, two were vomiting or feeding disorders, one was septicaemia, and one was diarrhoea with severe malnutrition). One of the infants admitted to hospital for pneumonia died 5 days after admission. No adverse event was attributed to the vaccines."
August 2015 - New vaccine strategies to finish polio eradication "Second, circulating vaccine-derived polioviruses are continuing to cause poliomyelitis in a few countries, a rare outcome associated with continued use of the live-attenuated oral poliovirus vaccine (OPV). In The Lancet Infectious Diseases, the results of two clinical trials of OPV that address these challenges are reported by Fatima Mir and colleagues1 and Concepción Estívariz and colleagues."
July 25, 2015 - Polio vaccination in Pakistan "We believe that arresting people for refusal will not help them to understand the gravity of the issue, rather thoughts against the state will breed in arrested parents and might further strengthen their misconceptions towards polio vaccination. Third, the security of the general population and polio vaccine workers seems to be a much bigger problem.2 Lastly, the effectiveness of used vaccines is also a concern because in
February, 2015, a Federal Investigation Agency sealed 11 800 vials of spoiled polio vaccines in the National Institute of Health, Pakistan."..."Government officials should launch the campaign with full dedication and honesty, since previous campaigns have been dented by political corruption and mismanagement. These are the bold moves that are needed to liberate Pakistan from polio."
June 12, 2015 - Poliovirus immunity in newly resettled adult refugees in Idaho, United States of America "This study demonstrated a WPV immunity rate of <60% in a recently resettled adult refugee population in the United States, reinforcing the need to ensure poliovirus immunity in all newly arrived adult refugees, either by expanding pre-departure immunization or by screening for immunity at resettlement and vaccinating when indicated."
June 4, 2015 - Immunogenicity of poliovirus vaccines in chronically malnourished infants: A randomized controlled trial in Pakistan "Efficacy of oral poliovirus vaccine (OPV) varies and is lower among children living in tropical areas with impoverished environments. Malnutrition found as a risk factor for lower serological protection against PV."..."Chronically malnourished infants were more likely to be unprotected against polioviruses than normal infants. bOPV + IPV helped close the immunity gap better than bOPV alone." Comment: Then why keep giving the live vaccine? At gunpoint with parents being arrested.
June 2015 - A novel outbreak enterovirus D68 strain associated with acute flaccid myelitis cases in the USA (2012–14): a retrospective cohort study"Phylogenetic analysis revealed that all enterovirus D68 sequences associated with acute flaccid myelitis grouped into a clade B1 strain that emerged in 2010.Of six coding polymorphisms in the clade B1 enterovirus D68 polyprotein, five were present in neuropathogenic poliovirus or enterovirus D70, or both.One child with acute flaccid myelitis and a sibling with only upper respiratory illness were both infected by identical enterovirus D68 strains."
May 15, 2015 - Internet activity as a proxy for vaccination compliance
- In Summer 2013 poliovirus was detected in Israel's sewage system. In response, a nation-wide immunization campaign was launched.
- We analyzed Internet search statistics by district for polio-related terms for the time period of this campaign.
- We compared Internet search statistics with official reporting obtained from the MOH.
- Internet searches were highly correlated with same district MOH reported vaccination rates (R = 0.786).
- These findings suggest a novel method for monitoring vaccination campaigns.
May 05, 2015 - Vaccination and risk for developing inflammatory bowel disease: a meta-analysis of case-control and cohort studies "Subgroup analysis for Crohn’s disease (CD) and ulcerative colitis (UC) found an association between poliomyelitis vaccine and risk for developing CD (RR=2.28; 1,12-4,63) or UC (RR=3.48 ; 1,2-9,71). The RR of developing IBD after H1N1 vaccination was 1.13 (0.97-1.32). Conclusions: Results of this meta-analysis show no evidence supporting an association between childhood immunization or H1N1 vaccination in adult and risk of developing IBD. Association between poliomyelitis vaccine and risk for CD or UC should be analyzed with caution because of study heterogeneity.
March 5, 2015 - Partition and Poliomyelitis: An Investigation of the Polio Disparity Affecting Muslims during India's Eradication Program (full text) "In fact, there was generally a prevalent view that families, particularly Muslim ones, were taking the polio program and turning it into a “weapon” to bargain and get development done in their areas. As one male stakeholder explained: And another thing, because there has been no development in those areas where Muslims are living, they have made this program a bargaining point that if you want to give polio vaccine to our child, then you will have to provide roads, sewage facility, drinking water etc. to our areas. So it’s somewhat of a bargain going on between the community and the government."
March 3, 2015 - Immunodeficiency-
January 2015 - Kinetics of Poliovirus Shedding following Oral Vaccination as Measured by Quantitative Reverse Transcription-PCR versus Culture "The kinetics of shedding revealed by qPCR and culture were similar. qPCR quantitative cutoffs based on the day +11 or +18 stool samples could be used to identify the culture-positive shedders, as well as the long-duration or high-frequency shedders. Interestingly, qPCR revealed that a small minority (7%) of infants contributed the vast majority (93 to 100%) of the total estimated viral excretion across all subtypes at each time point. This qPCR assay for OPV can simply and quantitatively detect all three Sabin strains directly in stool samples to approximate shedding both qualitatively and quantitatively."
December 10, 2014 - Modeling Options to Manage Type 1 Wild Poliovirus Imported into Israel in 2013 "After 25 years without poliomyelitis cases caused by wild poliovirus' (WPV) circulation in Israel, sewage sampling detected WPV type 1 (WPV1) in April 2013, despite high vaccination coverage using only inactivated poliovirus vaccine (IPV) since 2005."
October 16, 2014 - Achieving and Maintaining Polio Eradication — New Strategies (full text) "In that event, the only realistic approach to control of the outbreak would be widespread immunization of the at-risk population with OPV or a combination of IPV and OPV. But either option requires creating a risk of downstream cVDPV, threatening final eradication. To better prepare for this possible threat, the Bill and Melinda Gates Foundation is supporting the development and clinical evaluation of new genetically stable OPV strains with reduced ability to genetically revert to cVDPVs. Note: cVDPV is circulating vaccine-derived poliovirus
September 22, 2014 - The muscle findings in a pediatric patient with live attenuated oral polio vaccine-related flaccid monoplegia "The serum levels of polio antibody type 1 and type 2 titers were elevated '64×' respectively, while the type 3 antibody titer was not elevated 4×. This patient was diagnosed as live attenuated oral polio '''vaccine-related flaccid monoplegia, with mild clinical course."
September 19, 2014 - Bioinformatics analysis and genetic diversity of the Poliovirus "The virus of OPV (oral poliovirus attenuated-live vaccine) strains can mutate in the human intestine during replication. Some mutations may lead to the recovery of serious neurovirulence."..."A group of strains was recorded in the USA; in these strains, mutation sites and types were the same and may be associated with distribution in the evolutionary tree and relationships to some degree."
September 2014 - Immune Responses in Macaques to a Prototype Recombinant Adenovirus Live Oral Human Papillomavirus 16 Vaccine "Here, we characterize the immune response to the recombinant after dual oral and intranasal immunization of pigtail macaques, in which the virus replicates as it would in' immunized humans. The immunization of macaques induced vigorous humoral responses to adenovirus capsid and nonstructural proteins, although, surprisingly, not against HPV L1. In contrast, immunization elicited strong T-cell responses to HPV VLPs as well as adenovirus virions. T-cell responses arose immediately after the primary immunization and were boosted by a second immunization with recombinant virus"
August 12, 2014 - The muscle findings in a pediatric patient with live attenuated oral polio vaccine-related flaccid monoplegia "This patient was diagnosed as live attenuated oral polio vaccine-related flaccid monoplegia, with mild clinical course."
August 5, 2014 - From Intense Rejection to Advocacy: How Muslim Clerics Were Engaged in a Polio Eradication Initiative in Northern Nigeria (full text) "In 2008, a community communication and awareness enhancement methodology known as Majigi (a roadside film show) was pilot-tested in Gezawa, Kano State, located in northwestern Nigeria. In this pilot campaign, coordinated by the National Primary Health Care Development Agency (the agency responsible for developing primary health care programs and policies in Nigeria), the participation of imams (Muslim clerics) was solicited through the traditional rulers to mobilize people at the community level. Active participation of the traditional rulers in PEI in northern Nigeria became a reality after the office of His Royal Highness, the Sultan of Sokoto, supported this program.
August 2014 - Efficacy of inactivated poliovirus vaccine in India (full text) "Despite the advantages of OPV (superior mucosal immunity, secondary spread to contacts, ease of administration, and lower price), the vaccine has limitations: low immunogenicity in some tropical countries; and incomplete intestinal immunity that wanes rapidly. To interrupt transmission, OPV must be administered to a high proportion of children. The intestinal immunity induced by OPV is incomplete. Even after a full series with OPV, between 10 and 20% of children excrete poliovirus after a challenge with Sabin poliovirus. Studies in India demonstrate that a fraction of children excrete Sabin strains after OPV exposure despite having received more than seven doses of OPV.
July 7, 2014 - Stool Microbiota and Vaccine Responses of Infants "Actinobacteria abundance was positively associated with T-cell responses to BCG, OPV, and TT; with the delayed-type hypersensitivity response; with immunoglobulin G responses; and with TI. B longum subspecies infantis correlated positively with TI and several vaccine responses. Bacterial diversity and abundance of Enterobacteriales, Pseudomonadales, and Clostridiales were associated with neutrophilia and lower vaccine responses."
July 2014 - Limited and Localized Outbreak of Newly Emergent Type 2 Vaccine-Derived Poliovirus in Sichuan, China "Our findings reinforce the point that cVDPVs can emerge and spread in isolated communities with immunity gaps and highlight the emergence risks of type 2 cVDPVs accompanying the trivalent OPV used. To solve this issue, it is recommended that type 2 OPV be removed from the trivalent OPV or that inactivated polio vaccine (IPV) be used instead."
June 28, 2014 - “AMBITIOUS BUT ACHIEVABLE” "In order to rid the world of the leading cause of vaccine-derived polio, by the end of 2015, more than 140 countries will need replace the widely-used trivalent formulation of OPV with the bivalent OPV, which contains only the types 1 and 3 serotypes. maintain type 2 immunity during this switch, the 126 countries that only use OPV are recommended to also introduce at least one dose of IPV – which carries no risk of paralysis and protects against three polio serotypes – into their routine immunization schedules at least six months before the switch."
June 28, 2014 - Polio will go, acute flaccid paralysis will stay (full text) "The remaining goal of the Global Polio Eradication Initiative is to stop the transmission of all wild poliovirus and vaccine-derived poliovirus through supplementary immunisation activities, and environmental and acute flaccid paralysis surveillance. It is therefore realistic to be optimistic that the global eradication of polio might be feasible in the not too distant future. But as the Global Polio Eradication Initiative and the scientific community plan to celebrate polio eradication sooner or later, there is need for recognition that the risk of acute flaccid paralysis due to other enteroviruses is still high."
May 30, 2014 - The non-specific effects of vaccines and other childhood interventions: the contribution of INDEPTH Health and Demographic Surveillance Systems "So far there are no studies of the possible NSEs of the many new vaccines, including rotavirus vaccine, PCV, yellow fever, conjugated meningococcal vaccin, or malaria vaccine. Only one study has examined the possible NSEs of vaccination campaigns with OPV or MV. Studies at INDEPTH member centres may help to explain how the immunological profile can change so quickly between different vaccines, why live vaccines have beneficial effects 'and inactivated vaccines have negative effects, and why the reactions of boys and girls differ."
April 25, 2014 - Surveillance Systems to Track Progress Toward Global Polio Eradication — Worldwide, 2012–2013 'Polio cases are detected through surveillance of acute flaccid paralysis (AFP) cases with stool specimens tested for polioviruses (PVs) at accredited laboratories within the Global Polio Laboratory Network. Some countries also test for polioviruses in samples taken from sewage. Genomic sequence analysis allows the Global Polio Eradication initiative to monitor pathways of PV transmission, both of wild poliovirus (WPV) and circulating vaccine-derived poliovirus (cVDPV)."
March 31, 2014 - Influence of enteric infections on response to oral poliovirus vaccine: a systematic review and meta-analysis (pdf) "Vaccine take. One trial considered the influence of concurrent diarrhea on OPV take. Over a 3-week period after OPV delivery, vaccine shedding was observed in 10% (1/10) of infants with diarrhea at the time of immunization, and 64.2% {9/14) of those without diarrhea.
February 1, 2014 - Refusal of oral polio vaccine in northwestern Pakistan: A qualitative and quantitative study "The qualitative assessments identified the grounded theory of OPV refusal involving facts known by the residents that are related to the OPV (too frequent OPV campaigns, an OPV boycott in northern Nigeria in 2003 and that birth control is viewed as is against Islam), the local interpretations of these facts (perceptions that OPV contained birth control or pork, that OPV was a foreign/central plot against Muslims, and that the vaccination was against the Hadith and the fate determined by God) and different manifestations of OPV refusal."
January 3, 2014 - Randomized trial: The effect of oral polio vaccine at birth on polio antibody titers at 6 weeks and 6 months of age "OPV0 contributes to early polio protection, but not to overall polio immunity after subsequent doses of OPV are given. At 6 months, the GMT for polio 1 was actually significantly higher in the 'No OPV0 group, presumably due to interference from maternal antibodies. However, the proportion of children with seroprotective levels was the same."
December 23, 2013 - Community Circulation Patterns of Oral Polio Vaccine Serotypes 1, 2, and 3 after Mexican National Immunization Weeks "OPV was detected up to 7 months after an NIW, but not at 8 months. 35% of samples collected from children vaccinated the prior month, but only 4% of other samples, contained OPV. While each serotype was detected in similar proportions among OPV strains shed as a result of direct vaccination, 87% of OPV acquired through community spread was serotype 2 (p<0.0001)."
December 1, 2013 - Oral polio vaccine response in breast fed infants with malnutrition and diarrhea "Children with malnutrition (WAZ <−2) had significantly lower OPV 3 titers (p = 0.029). Children who had 2 or more diarrhea episodes during the 1st months of life were more than twice as likely to experience OPV failure as those who had 1 diarrhea episode or no diarrhea (p = 0.0245). In contrast, each additional month in exclusive breastfeeding was associated with an increase in OPV 3 titer by 0.41 (p = 0.0072) and 0.16 (p = 0.0065) at the 25th and 50th percentiles of OPV 3 titers respectively. These data are consistent with a defect in induction of immunity in the gut for OPV but not parenteral vaccines, a '''''defect that may be amenable''''' to intervention in part via promotion of exclusive breastfeeding."
December 2013 - Highly Divergent Type 2 and 3 Vaccine-Derived Polioviruses Isolated from Sewage in Tallinn, Estonia "Highly divergent vaccine-derived polioviruses (VDPVs) have been isolated from sewage in Tallinn, Estonia, since 2002. Sequence analysis of VDPVs of serotypes 2 and 3 showed that they shared common noncapsid region recombination sites, indicating origination from a single trivalent oral polio vaccine dose, estimated to have been given between 1986 and 1998."
November 27, 2013 -Identification and Control of a Poliomyelitis Outbreak in Xinjiang, China (full text) "In accordance with the requirements of the “Technical Guideline for Emergency Response to Epidemics Caused by Imported Wild Poliovirus or Events Related to Vaccine-Derived Poliovirus” (Technical Guideline for Emergency Response to Epidemics Caused by Imported Wild Poliovirus or Events Related to Vaccine-derived Poliovirus pdf,)"..."Type 1 circulating vaccine-derived polioviruses were isolated from two patients with acute flaccid paralysisand four close contacts of patients with acute flaccid paralysis in Guizhou Province in 2004."
November 21, 2013 - No Country Is Safe without Global Eradication of Poliomyelitis (full text) "One essential part of the plan was to replace the current trivalent oral poliovirus vaccine with a bivalent vaccine containing only virus types 1 and 3. Oral poliovirus vaccine has been the major vaccine used in the eradication program because it is easy to administer, can passively immunize persons who do receive the vaccine directly, is relatively inexpensive, and induces greater intestinal immunity than that conferred by inactivated poliovirus vaccine. This superior intestinal immunity should be more effective in decreasing transmission, since in the developing world most poliovirus is thought to be spread by the fecal–oral route. However, on rare occasions, oral poliovirus vaccine has been known to cause paralysis, either as a result of vaccine-associated paralytic polio or by means of circulating vaccine-derived polioviruses that have acquired some properties of wild viruses. Removing type 2 oral poliovirus vaccine should reduce vaccine-associated paralytic polio and cases of circulating vaccine-derived poliovirus infection by about '''''40% and more than 95%, respectively."
October 26, 2013 - Polio eradication: where are we now? "The plan has four simultaneous objectives: detection and interruption of wild poliovirus, strengthening of routine immunisation and withdrawal of the oral polio vaccine (OPV), containment of all virus samples and certification of interruption of transmission, and legacy planning to benefit other health and development initiatives. Notably, the most ambitious vaccine introduction plan in history has been initiated, which aims to introduce inactivated polio vaccines (IPV) by the end of 2015 in 124 countries to replace OPV and eliminate the rare risk of vaccine-derived cases of polio. In June of this year, the GAVI board agreed to provide financial support and play a lead role in introduction of IPV."
October 2013 - Emergence of Vaccine-derived Polioviruses, Democratic Republic of Congo, 2004–2011 (full text) "We isolated VDPVs from fecal specimens from 70 patients with acute flaccid paralysis in DRC during 2004–2011. Sequence analysis of the VP1 coding region of these viruses showed that 51 isolates represented 7 circulating lineages of circulating VDPVs, and 19 others represented independent emergence events."
September 28, 2013 - Poliomyelitis: threats to eradication "We cannot afford to ignore these threats. A mass vaccination with OPV in Israel is a potential solution but does not eliminate future risks. IPV-only countries need to consider the implications of this incident and perhaps modify their immunisation policies, and implement enhanced environmental sampling and regulations for international travellers to have OPV vaccination."
May 17, 2013 - Oral and inactivated poliovirus vaccines in the newborn: A review "The percentage of newborns whoseroconverted at 8 weeks range from 6–42% for poliovirus type 1, 2–63% for type 2, and 1–35% for type 3. For mOPV type 1, seroconversion ranged from 10 to 76%; mOPV type 3, the range was 12–58%; and for the one study reporting bOPV, it was 20% for type 1 and 7% for type 3."
May 17, 2013 - Oral and inactivated poliovirus vaccines in the newborn: A review "The percentage of newborns whoseroconverted at 8 weeks range from 6–42% for poliovirus type 1, 2–63% for type 2, and 1–35% for type 3. For mOPV type 1, seroconversion ranged from 10 to 76%; mOPV type 3, the range was 12–58%; and for the one study reporting bOPV, it was 20% for type 1 and 7% for type 3."
March 2013 - 2018 must be the final target for polio eradication "The four objectives are, detection and interruption of wild poliovirus, strengthening of routine immunisation and withdrawal of the oral polio vaccine, containment and certification (enabling some facilities to store poliovirus and outlining the processes for certification of eradication), and legacy planning to ensure that resources put aside for polio eradication are repurposed when the goal is achieved. The milestones for the new strategic plan are for the last case of wild polio by 2014, withdrawal of type 2 oral polio vaccine by 2015—16, worldwide certification of polio eradication by the end of 2018, and cessation of bivalent oral polio vaccination during 2019."
January 24, 2013 - The human qualities needed to complete the global eradication of polio "Third, potentially important aspects of the pathogen or its control that were unrecognized at the outset of the eradication programme (e.g. vaccine-derived polioviruses) can be investigated and identified as the programme progresses. In the late stages of polio eradication, as the transmission of wild poliovirus is interrupted, the proportion of polio cases caused by circulating vaccine-derived polioviruses is expected to increase."
November 15, 2012 - Hypersensitivity reactions to the Sabin vaccine in children with cow's milk allergy "All of the patients had a history of milk allergy, and no history or current evidence of egg hypersensitivity was found. Levels of cow's milk- and Sabin vaccine-specific IgE were increased, and the result of a skin prick test with cow's milk proteins or the Sabin vaccine was positive in each patient. In addition, an ELISA using specific rabbit antiserum detected α-lactalbumin in the Sabin vaccine. When α-lactalbumin was employed as a soluble inhibitor in a competitive ELISA, binding to vaccine-coated plates by cow's milk- or α-lactalbumin-specific rabbit antiserum or by patient serum containing IgE was inhibited."
November 2012 - Development of the Polio Vaccine: A Historical Perspective of Tuskegee University’s Role in Mass Production and Distribution of HeLa Cells "In 1936, a polio epidemic swept through the Southern region of the United States, severely crippling children, both Black and White. This outbreak further exposed the challenges that Black polio patients faced when seeking or receiving medical care. The discriminatory practices of the time, especially in the South, left most Black patients with the disease perpetually searching for suitable treatment facilities."
September 17, 2012 - Modeling Population Immunity to Support Efforts to End the Transmission of Live Polioviruses "Eradication of wild poliovirus (WPV) types 1 and 3, prevention and cessation of circulating vaccine-derived polioviruses, and achievement and maintenance of a world free of paralytic polio cases requires active risk management by focusing on population immunity and coordinated cessation of oral poliovirus vaccine (OPV)."
August 26, 2015 - Re: Polio eradication: a complex end game - Eradication of polio by vaccination? Part 3 "Another important consideration in attempts to eradicate poliomyelitis by vaccination is the contamination of polio vaccines by chimpanzee coryza virus, renamed respiratory syncytial virus (RSV)."..."Chanock et al. (1957. Recovery from infants with respiratory illness of vius related to chimpanzee coryza agent (CCA). I. Am, J Hyg; 66: 281-290) wrote on the association of a new type of cytopathogic myxovirus with infantile croup."
August 31, 2012 - Vaccine trials in the developing world: Operational lessons learnt from a phase IV poliomyelitis vaccine trial in South Africa "Operational challenges of a vaccine trial in developing world populations include inexperienced staff, the close liaison required between researchers and public health care services, impoverished participants that require complex recruitment and retention strategies, and challenges of distance and access. These challenges can be overcome by innovative strategies that allow for the unique characteristics of the setting, trial population, and trial team."
August 2012 - Recent progress in mucosal vaccine development: potential and limitations "However, despite early success with the live attenuated oral polio vaccine over 50 years ago, only a few new mucosal vaccines have been subsequently launched. This is partly due to problems with developing safe and effective mucosal adjuvants."
June 27, 2012 - Seroepidemiology of Polioviruses among University Students in Northern Italy "Any risk of the wild virus recurring and causing paralytic poliomyelitis must be prevented, keeping Europe polio free by means of appropriate immunological protection, until polio has been conclusively eradicated all over the world. Judging from our findings, it may be worth considering administering a fifth dose of polio vaccine to adolescents."
July 24, 2012 - Human polyomavirus, designated the wu virus, obtained from human respiratory secretions (patent) "Besides JC and BK virus, in the late 1950s, .about.100 million people in the United States and many more worldwide may have been exposed to SV40, a polyomavirus that naturally infects rhesus monkeys, via contaminated polio vaccines, leading to widespread debate about whether or not SV40 is capable of sustained infection and replication cycles in humans.
June 6, 2012 - Immunodeficiency-associated Vaccine-Derived Poliovirus Type 3 in Infant, South Africa, 2011 "The patient, a 10-month-old boy, was born at term on October 28, 2010; X-linked immunodeficiency syndrome was diagnosed after he received 3 scheduled doses of polio vaccine (1 OPV dose at birth and 2 inactivated poliovirus vaccine doses at 10 and 14 weeks). On September 18 2011, [3 wks later], fever developed (38.5°C–40.0°C), and the next day, vomiting and 2 episodes of tonic-clonic convulsions occurred. A lumbar puncture was performed, and testing of cerebrospinal fluid (CSF) showed pleocytosis and mild increase of proteins. His condition deteriorated, and on day 5, acute flaccid paralysis developed, with generalized hypotonia and reduced power and reflexes in all limbs, more marked in the lower limbs. Respiratory distress developed, and some involvement of the facial nerve was manifested by left-sided eye drooping, mouth deviation, and drooling. A lumbar puncture was repeated on day 5, and CSF was positive by PCR for enterovirus and a pleocytosis. Stool samples taken on days 5 and 9 were positive for enterovirus, which was subsequently characterized as poliovirus type 3. Comment: This child did not receive the correct dosing of the poliovaccine (birth, 10 wks, 14 wks). There is no indication for giving OPV at birth. The child developed meningitis caused by a vaccine-strain polio virus.
April-June 2012 - Polio programme: let us declare victory and move on "Wimmer writes that the test-tube synthesis of poliovirus has wiped out any possibility of eradicating poliovirus in the future. Poliovirus cannot be declared extinct because the sequence of its genome is known and modern biotechnology allows it to be resurrected at any time in vitro. Man can thus never let down his guard against poliovirus. indeed the 18-year-old global eradication campaign for polioviruses will have to be continued in some format forever. The long promised “infinite” monetary benefits from ceasing to vaccinate against poliovirus will never be achieved. The attraction that ‘eradication’ has for policy makers will vanish once this truth is widely known.
May 1, 2012 - The Probability of Undetected Wild Poliovirus Circulation After Apparent Global Interruption of Transmission "In this analysis, the authors revisit the topic and highlight important considerations for policy-makers related to the impact of initial conditions and seasonality and emphasize the need to focus on appropriate characterization of conditions in the last likely reservoirs of the virus. The authors conclude that the probability of undetected WPV circulation may vary significantly for different poliovirus serotypes, places, and conditions, which suggests that achieving the same level of confidence about the true interruption of WPV transmission will require different periods of time for different situations." Comment: This says the vaccine is not working and wild poliovirus is still in circulation despite billions of dollars spent over the last 20+ years to eradicate it.
May 2012 - Common and diverse features of cocirculating type 2 and 3 recombinant vaccine-derived polioviruses isolated from patients with poliomyelitis and healthy children. "This study confirms the genetic relationship between type 2 and 3 VDPVs, indicating that both types can be involved in a single outbreak of disease. Our results highlight the various ways in which a vaccine-derived poliovirus may become pathogenic in complex viral ecosystems, through frequent recombination events and mutations. Comment: Vaccine Derived Polio Viruses (VDPVs) and can cause polio. Polioviruses are part of a family of viruses called Enteroviruses. The live viruses from the polio vaccine are combining in nature with other viruses to form new, virulent, NON-VACCINE STRAIN viruses, rendering the vaccine ineffective and potentially leading to more disease.
April 19, 2012 - Systematic Review of Mucosal Immunity Induced by Oral and Inactivated Poliovirus Vaccines against Virus Shedding following Oral Poliovirus Challenge (full text) "Despite over 50 years of vaccination with Salk's IPV, questions remain about the ability of this vaccine to prevent poliovirus circulation in remaining polio-endemic countries. In addition, basic immunology research is required to better understand the mucosal immune response to both IPV and OPV, and in particular the adaptive cellular and innate components." April 19, 2012 - Systematic Review of Mucosal Immunity Induced by Oral and Inactivated Poliovirus Vaccines against Virus Shedding following Oral Poliovirus Challenge (full text) "Despite over 50 years of vaccination with Salk's IPV, questions remain about the ability of this vaccine to prevent poliovirus circulation in remaining polio-endemic countries. In addition, basic immunology research is required to better understand the mucosal immune response to both IPV and OPV, and in particular the adaptive cellular and innate components." Comment: Since the injectable polio vaccine (IPV) isn’t working, and the oral polio vaccine has been the primary cause of remaining polio outbreaks, new mucosal vaccines are being investigated.
March 23, 2012 - Waning intestinal immunity following vaccination with oral poliovirus vaccines in India "Infection with OPV (vaccine ‘take’) is highly seasonal in India and results in intestinal mucosal immunity that appears to wane significantly within a year of vaccination."
October 2011 - Simian virus 40 transformation, malignant mesothelioma and brain tumors (full text) ""It is unfortunate that the controversy about the presence of SV40 in human tumors has been too heated to allow an unbiased analysis of the results. As noted by a panel of the Institute of Medicine that reviewed this issue, this area of investigation deserves further attention. At the same time, the conflicting arguments and lack of funding caused many researchers to leave this field. Progress in the near future remains unclear because of lack of funding. We are pleased to note, however, that regardless of the ‘controversy’ over the role of SV40 in human carcinogenesis, this research has led to important discoveries about mechanisms of SV40 infection, carcinogenesis and cocarcinogenesis that are important to the whole field of cancer. In addition, this research has uncovered the extent of human exposure to SV40, and has and will continue to influence future regulatory decisions related to vaccine production and safety."
June 2011 - Vaccine-derived poliomyelitis 12 years after infection in Minnesota. "Type 2 vaccine-derived poliovirus was isolated from stool. The viral capsid protein VP1 region had diverged from the vaccine strain at 12.3% of nucleotide positions, and the two attenuating substitutions had reverted to the wild-type sequence. Infection probably occurred 11.9 years earlier (95% confidence interval [CI], 10.9 to 13.2), when her child received the oral poliovirus vaccine. No secondary cases were identified among close contacts or 2038 screened health care workers. Patients with common variable immunodeficiency can be chronically infected with poliovirus, and poliomyelitis can develop despite treatment with intravenous immune globulin.
February 2010 - Characterization of a rare natural intertypic type 2/type 3 penta-recombinant vaccine-derived poliovirus isolated from a child with acute flaccid paralysis. (full text)"A type 2 vaccine-derived poliovirus (VDPV) (strain CHN1025), with a 1.1 % (10/903) difference from Sabin strain in the VP1 coding region, was isolated from a child with poliomyelitis caused by a poliovirus variant infection."..."While the genetic variability of polioviruses is mostly due to nucleotide substitutions resulting from a high error frequency during the replication of the viral RNA (Freistadt et al., 2007), genetic changes in polioviruses can also occur during the molecular genomic rearrangements that happen during virus replication."
July 24, 2009 - FDA Dietary Supplements "A significant number of early vaccine lots were contaminated with the previously unknown viral agent, SV40. In 1960, Drs. Sweet and Hilleman identified SV40 in monkey kidney cells and seed stocks used to produce the poliovirus. In 1961, Drs. Gerber, Hottle, and Grubbs discovered that the treatment used to inactivate SV40 was not completely effective."
June 2008 - The role of polio-vaccine in pleural mesothelioma–an epidemiological observation.
January 5, 2008 - Recovery of strains of the polyomavirus SV40 from rhesus monkey kidney cells dating from the 1950s to the early 1960s (full text) "SV40 isolates have been recovered from poliovirus and adenovirus stocks prepared in the 1950s and early 1960s on primary rhesus monkey kidney cells. The complete sequences of ten cloned genomes demonstrated that five new strains have been identified as well as strains previously identified. Because the same strains are being isolated from rhesus macaque cells from the 1950s to the present (e.g., 777 and 776), it is possible that the number of SV40 strains present in colonies of rhesus macaques in the United States is limited."
December 2007 - Simian virus 40 and mesothelioma in Great Britain. "Although the results for females show a reduction in the mesothelioma mortality rate coinciding with the introduction of the SV40-free Sabin polio vaccine, the absence of a similar result in males and of a priori biological evidence of a sex-specific SV40 effect, makes chance the most plausible interpretation of these findings."
October 22, 2007 - CDC - Concerns - Cancer, Simian Virus 40 (SV40), and Polio Vaccine Fact Sheet - Vaccine Safety "More than 98 million Americans received one or more doses of polio vaccine from 1955 to 1963 when a proportion of vaccine was contaminated with SV40; it has been estimated that 10–30 million Americans could have received an SV40 contaminated dose of vaccine."
April 2007 - SV40 association with human malignancies and mechanisms of tumor immunity by large tumor antigen. "SV40 was discovered as a contaminant of poliovirus vaccine lots distributed to millions of individuals in the United States between 1955 and 1963 while contaminated vaccine batches were later circulated worldwide. After SV40 was observed to cause in vitro animal and human cell transformations and in vivo tumor formations in animals, the search for a connection betweenthe virus and human malignancies has continued to the present day."
November 21, 2006 - Infant dies after being given polio drops - "A six-month-old child died here on Tuesday after she was administered Pulse Polio drops in the Ghosiya Bazar area. The condition of Khushi deteriorated soon after she was administered polio drops as part of the ongoing immunisation campaign, a Pulse Polio campaign official said."
July 7, 2006 - The test-tube synthesis of a chemical called poliovirus: The simple synthesis of a virus has far-reaching societal implications (full text) "Once poliovirus, the chemical, has entered the cell, however, it has a plan for survival. Its proliferation is then subject to evolutionary laws: heredity, genetic variation, selection towards fitness, evolution into different species and so forth—that is, poliovirus obeys the same rules that apply to living entities. One could even argue that poliovirus undergoes sexual reproduction in the infected cell, as it readily recombines with sibling progeny or with other related viruses (P. Jiang, J.A.J. Faase, H. Toyoda, A.E. Gorbalenya and E. Wimmer, unpublished data) to exchange genetic information (Wimmer et al, 1993)."
December 2005 - Th2-Associated Local Reactions to the Acellular Diphtheria-Tetanus-Pertussis Vaccine in 4- to 6-Year-Old Children “if the DTaP booster is accompanied by concomitant IPV boosting at the same site, ensuing Th2-associated local reactions and the accompanying boosting of TT-specific IgE are significantly reduced, while IgG boosting improves. This suggests the possibility that reactivation of Th1-polarized poliovirus-specific memory cells by IPV may provide “bystander” feedback inhibition of the Th2 component of DTaP-specific memory, both locally and in the draining lymph node. This possibility merits more-detailed investigation employing larger study groups, including subjects primed during infancy with IPV, which is now used in many countries in preference to oral poliovirus vaccine.”
November 15, 2005 - Some Oral Poliovirus Vaccines Were Contaminated with Infectious SV40 after 1961 (full text) "The finding of live SV40 in EEVM vaccines suggests that epidemiologic studies done to explore possible links between the exposure of human populations to SV40 and the risk of developing cancer should consider that large blocks of population may have been vaccinated with vaccines containing live SV40."
February 9, 2004 – Rep. Dave Weldon, M.D. Before The Institute of Medicine(pdf) “It is past time that individuals are persecuted for asking questions about vaccine safety.We haverecognized error before in the case of live polio, whole-cell pertusis, and rotavirus. I am repeatedly informed by researchers difficulty in getting their papers published, and the loss of research grants. Some report overt discouragement, intimidation and threats who encounter apathy from government officials charged with investigating these matters, and have abandoned this field of research. Some have had their clinical privileges revoked and others have been hounded out of their institutions.”
June 2003 - Simian virus 40 in human cancers. "Thirteen studies fulfilled the criteria for the investigation of primary brain cancers (661 tumors and 482 control samples). Specimens from patients with brain tumors were almost four times more likely to have evidence of SV40 infection than were those from controls (odds ratio [OR] = 3.9; 95% confidence interval [CI]: 2.6 to 5.8). The association was even stronger for mesothelioma (OR = 17; 95% CI: 10 to 28; based on 15 studies with 528 mesothelioma samples and 468 control samples) and for bone cancer (OR = 25; 95% CI: 6.8 to 88; based on four studies with 303 cancers and 121 control samples). SV40 DNA was also more frequent in samples from patients with non-Hodgkin's lymphoma (OR = 5.4; 95% CI: 3.1 to 9.3; based on three studies with 301 cases and 578 control samples) than from controls."
March 2003 - Simian cytomegalovirus and contamination of oral poliovirus vaccines. " African green monkey kidney (AGMK) cultures free of SV40 were used as an alternative cell substrate for vaccine manufacture. In this study we evaluate oral poliovirus seeds, vaccine bulks and vaccines themselves for the presence of a common contaminant of AGMK cultures, simian cytomegalovirus (SCMV). Using sensitive polymerase chain reaction (PCR) techniques, nearly half of the samples analysed were found to be contaminated with SCMV sequences."
September 2002 - Live oral poliovirus vaccines and simian cytomegalovirus. (pdf) "Although SCMV has never been shown to be infectious for humans, the virus does replicate efficiently in human cells in vitro. Moreover, the experience with SV40 contamination of early poliovirus and adenovirus vaccines underscores the value of ensuring the freedom of vaccines from any viable adventitious agents. Although OPV is no longer produced in the United States, it seems likely that OPV will be used in other countries for some time. The present study illustrates the complexity of testing for and guaranteeing the absence of adventitious agents in vaccines."
2000 - A severe adverse event after vaccine for diphtheria, tetanus, pertussis and poliomyelitis (DTP + polio) in a 4.5 month old infant "We report the case of neuroallergic reaction 5 days after receiving the second course of DTP + Polio vaccine in a 4.5 month old girl."
December 12, 1999 - Unique Strains of SV40 in Commercial Poliovaccines from 1955 Not Readily Identifiable with Current Testing for SV40 Infection (full text) "SV40 DNA has been found in several human tumor types, including mesotheliomas (14 , 15) , ependymomas (16) , and osteosarcomas(17) . In many cases, these DNA sequences have corresponded to viruses with archetypal regulatory regions (reviewed in Ref. 2 ). Although the original source(s) of SV40 in humans remains unclear, SV40-contaminated poliovaccines and adenovaccines administered in the 1950s and 1960s may have infected millions of individuals with the virus."
October 25, 1999 - Workshop on Standards for Inactivation and Clearance of Infectious Agents in the Manufacture of Plasma Derivatives from Non-Human Source Materials for Human Injectable Use (pdf) In this transcript the issue of viral contaminants in vaccines are discussed. There are contaminants not just in animal, but human biologic materials which don’t cause acute and obvious disease. But as the situation with retroviruses indicates, there can be real problems in source materials that may have an outcome that is only apparent many years later and may not necessarily be easy to tie to the source material. Sources such as bovine, avian, macaque, and porcine are examined. Testing used in finding retroviruses, excipients used to kill viruses i.e., formalin (formaldehyde) which did not work against SV-40 in the live polio vaccine are all touched upon.
May 27, 1998 - Vaccines and Related Biological Products Advisory Committee Meeting: Oral Poloio Vaccine Box Warnings (pdf) "....issue of including a boxed warning for a vaccine associated paralytic poliomyelitis (VAPP) in the package insert for live, oral polio virus vaccine. Moreover, in light of the fact that boxed warnings have been rarely included in labeling in biological products and not included in labeling for vaccines, the FDA would like the VRBPAC to consider and comment upon the utility of including a boxed warning for a vaccine associated paralytic polio in the package insert for live, oral polio."
April 1998 - Serological evidence of SV40 infections in HIV-infected and HIV-negative adults. "'SV40 is a simian polyomavirus that was a contaminant of some viral vaccines administered to people between 1955 and 1962.... The SV40 seropositivity rates in the patients born between 1941 and 1962 may be explained by the likelihood of those individuals having received SV40-contaminated vaccines. Although cross-reactive antibodies might theoretically contribute to the observed reactivities, these results suggest that SV40 neutralizing antibodies are present in certain individuals and raise the possibility that SV40 continues to infect humans long after vaccines were freed from contamination.
September 21, 1991 - Outbreak of paralytic poliomyelitis in Oman: evidence for widespread transmission among fully vaccinated children "Genomic sequencing indicated that the outbreak strain had been recently imported from South Asia and was distinguishable from isolates indigenous to the Middle East. Accumulation of enough children to sustain the outbreak seems to have been due to previous success of the immunisation programme in reducing spread of endemic strains, suboptimum efficacy of OPV, and delay in completing the primary immunisation series until 7 months of age. Additionally, the estimated attack rate of infection among children aged 9-23 months exceeded 25% in some regions, suggesting that a substantial proportion of fully vaccinated children had been involved in the chain of transmission.
March 1968 - The Safety of Human Diploid Cell Strains for Man: A Controlled Study of Symptoms Occurring After The Administration WM-3 Living Attenuated Polio-Virus Prepared in the WI-38 Human Diploid Cell Strain "In the 12-month period following vaccination, six cases of infectious hepatitis were recorded in the two groups given the HDCS vaccine and seven cases in the two groups given the MKTC vaccine. Cancer was diagnosed over a 3-year followup period in 9 children who received HDCS vaccine, and 8 who received MKTC vaccine. Our findings support previous observations and laboratory evidence that the HDCS system does not contain the virus of infectious hepatitis or any other known pathogenic agent."
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