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Roland W. Sutter - One of the best experts on this subject based on the ideXlab platform.
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vaccine associated Paralytic Poliomyelitis a review of the epidemiology and estimation of the global burden
The Journal of Infectious Diseases, 2014Co-Authors: Lauren R Platt, Concepcion F Estivariz, Roland W. SutterAbstract:Background Vaccine-associated Paralytic Poliomyelitis (VAPP) is a rare adverse event associated with oral poliovirus vaccine (OPV). This review summarizes the epidemiology and provides a global burden estimate. Methods A literature review was conducted to abstract the epidemiology and calculate the risk of VAPP. A bootstrap method was applied to calculate global VAPP burden estimates. Results Trends in VAPP epidemiology varied by country income level. In the low-income country, the majority of cases occurred in individuals who had received >3 doses of OPV (63%), whereas in middle and high-income countries, most cases occurred in recipients after their first OPV dose or unvaccinated contacts (81%). Using all risk estimates, VAPP risk was 4.7 cases per million births (range, 2.4-9.7), leading to a global annual burden estimate of 498 cases (range, 255-1018). If the analysis is limited to estimates from countries that currently use OPV, the VAPP risk is 3.8 cases per million births (range, 2.9-4.7) and a burden of 399 cases (range, 306-490). Conclusions Because many high-income countries have replaced OPV with inactivated poliovirus vaccine, the VAPP burden is concentrated in lower-income countries. The planned universal introduction of inactivated poliovirus vaccine is likely to substantially decrease the global VAPP burden by 80%-90%.
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persistence of vaccine derived polioviruses among immunodeficient persons with vaccine associated Paralytic Poliomyelitis
The Journal of Infectious Diseases, 2003Co-Authors: Nino Khetsuriani, Olen M. Kew, Mark A Pallansch, Rebecca D Prevots, Linda Quick, Melissa E Elder, Roland W. SutterAbstract:Abstract To estimate long-term poliovaccine virus persistence among immunodeficient patients with vaccine-associated Paralytic Poliomyelitis (iVAPP), cases reported in the United States during 1975-1997 were reviewed, with subsequent follow-up and virological testing. Six (16.2%) of 37 subjects excreted poliovaccine viruses for > or =6 months. Partial genomic sequencing of their available poliovirus isolates showed considerable divergence from the prototype Sabin strain in all cases. Poliovirus persistence declined over time since the last oral poliovaccine dose: at 6 months, 19.4%; 1 year, 14.3%; 5 years, 4%; and 10 years, 0% (P<.05) of patients. Despite the high prevalence of poliovaccine virus persistence among patients with iVAPP, this group appears to be an unlikely source of poliovirus reintroduction in developed countries because of the rarity and high fatality rate of iVAPP and the possible spontaneous clearance of polioviruses. These results are important for developing "endgame" strategies for the Global Poliomyelitis Eradication Program.
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vaccine associated Paralytic Poliomyelitis in india during 1999 decreased risk despite massive use of oral polio vaccine
Bulletin of The World Health Organization, 2002Co-Authors: Kathryn A Kohler, Jon Kim Andrus, Kaushik Banerjee, Gary W Hlady, Roland W. SutterAbstract:OBJECTIVE: Vaccine-associated Paralytic Poliomyelitis (VAPP) is a rare but serious consequence of the administration of oral polio vaccine (OPV). Intensified OPV administration has reduced wild poliovirus transmission in India but VAPP is becoming a matter of concern. METHODS: We analysed acute flaccid paralysis (AFP) surveillance data in order to estimate the VAPP risk in this country. VAPP was defined as occurring in AFP cases with onset of paralysis in 1999, residual weakness 60 days after onset, and isolation of vaccine-related poliovirus. Recipient VAPP cases were a subset with onset of paralysis between 4 and 40 days after receipt of OPV. FINDINGS: A total of 181 AFP cases met the case definition. The following estimates of VAPP risk were made: overall risk, 1 case per 4.1 to 4.6 million OPV doses administered; recipient risk,1 case per 12.2 million; first-dose recipient risk, 1 case per 2.8 million; and subsequent-dose recipient risk, 1 case per 13.9 million. CONCLUSION: On the basis of data from a highly sensitive surveillance system the estimated VAPP risk in India is evidently lower than that in other countries, notwithstanding the administration of multiple OPV doses to children in mass immunization campaigns.
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outbreaks of Paralytic Poliomyelitis 1976 1995
The Journal of Infectious Diseases, 1997Co-Authors: Peter A Patriarca, Roland W. Sutter, Paul M. OostvogelAbstract:During 1976-1995, 48 outbreaks of Paralytic Poliomyelitis with a cumulative total of approximately 17,000 cases were reported worldwide. Outbreaks occurred on most continents, affected from 0.1 to 52 persons per 100,000 total population (median, 4.4), lasted 2-25 months (median, 7), typically involved unvaccinated or inadequately vaccinated subgroups within highly immunized communities, and were primarily caused by poliovirus type 1 (74%). Cases in developing countries occurred predominantly among children <2 years of age, while those in industrialized countries tended to occur in older persons who had escaped natural infection earlier in life and who had not been vaccinated or had received poliovirus vaccine of inadequate potency. Partial genomic sequencing studies indicated that at least 15 outbreaks resulted from importation of wild polioviruses, primarily from the Indian subcontinent. These findings illustrate the potential for wide dissemination of wild poliovirus infection and underscore the critical need for maintaining high levels of immunity in all countries and for more aggressive vaccination efforts in areas in which polio is endemic.
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vaccine associated Paralytic Poliomyelitis in the united states no evidence of elevated risk after simultaneous intramuscular injections of vaccine
Pediatric Infectious Disease Journal, 1995Co-Authors: Hector S Izurieta, Peter M. Strebel, Roland W. Sutter, Andrew L Baughman, John Stevenson, Melinda WhartonAbstract:During the past 30 years, Romania reported rates of vaccine-associated Paralytic Poliomyelitis (VAPP) approximately 10-fold higher than in the United States. The elevated VAPP risk was largely caused by multiple intramuscular (im) injections with antibiotics given within 30 days of onset of paralysis. Because it is not known whether im injections contribute to the VAPP risk in the United States, we examined VAPP cases reported since 1980. We reviewed injection histories of VAPP cases reported to the Centers for Disease Control and Prevention from 1980 to 1993 : with vaccines for 1980 to 1987 ; and for all substances for 1988 to 1993. Rates of VAPP by number of im injections with vaccines were calculated from 1988 to 1993 with estimated vaccine coverage data from the National Health Interview Survey. From 1980 to 1993 a total of 119 cases of Poliomyelitis were reported to the Centers for Disease Control and Prevention. Of these, 87 (73%) were vaccine-associated and immunologically normal : 41 were oral polio vaccine (OPV) recipient cases ; 40 were OPV contact cases ; and 6 were community-acquired cases. A history of im injections in the 45 days before onset of paralysis was obtained from 28 (72%) of 39 recipient cases reported from 1980 to 1993 for which dates of paralysis onset could be determined and from 1 (8%) of 13 contact cases reported from 1988 to 1993. With one exception all substances administered intramuscularly were routine childhood vaccines. No clustering of im injections in the high risk windows, 0 to 3 and 8 to 21 days before onset of paralysis, was observed. From 1988 to 1993 the rates of recipient vaccine-associated Paralytic Poliomyelitis (VAPP) (per 1 million population) in infants < 1 year of age did not vary significantly with the number of simultaneous im injections received, and ecologic analyses did not show increased risk with increasing use of injectable vaccines in children. Intramuscular injections of antibiotics or childhood vaccines did not appear to contribute to the risk of recipient VAPP in the United States. The low prevalence of im injections in contact VAPP cases suggests that the risk is attributable to OPV alone. Our study supports the current recommendation for the simultaneous administration of OPV with other childhood vaccines.
Mohammad Mehdi Gooya - One of the best experts on this subject based on the ideXlab platform.
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vaccine associated Paralytic Poliomyelitis in immunodeficient children iran 1995 2008
Emerging Infectious Diseases, 2010Co-Authors: Shohreh Shahmahmoodi, Setareh Mamishi, Asghar Aghamohammadi, Nessa Aghazadeh, Hamideh Tabatabaie, Mohammad Mehdi Gooya, Seyed Mohsen Zahraei, Taha Mousavi, Maryam Yousefi, Kobra FarrokhiAbstract:To determine the prevalence of vaccine-associated Paralytic Poliomyelitis (VAPP) in immunodeficient infants, we reviewed all documented cases caused by immunodeficiency-associated vaccine-derived polioviruses in Iran from 1995 through 2008. Changing to an inactivated polio vaccine vaccination schedule and introduction of screening of neonates for immunodeficiencies could reduce the risk for VAPP infection.
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Vaccine-associated Paralytic Poliomyelitis in Immunodeficient Children, Iran, 1995–2008
'Centers for Disease Control and Prevention (CDC)', 2010Co-Authors: Shohreh Shahmahmoodi, Setareh Mamishi, Asghar Aghamohammadi, Nessa Aghazadeh, Hamideh Tabatabaie, Mohammad Mehdi Gooya, Seyed Mohsen Zahraei, Taha Mousavi, Maryam Yousefi, Kobra FarrokhiAbstract:To determine the prevalence of vaccine-associated Paralytic Poliomyelitis (VAPP) in immunodeficient infants, we reviewed all documented cases caused by immunodeficiency-associated vaccine-derived polioviruses in Iran from 1995 through 2008. Changing to an inactivated polio vaccine vaccination schedule and introduction of screening of neonates for immunodeficiencies could reduce the risk for VAPP infection
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novel btk mutation presenting with vaccine associated Paralytic Poliomyelitis
European Journal of Pediatrics, 2008Co-Authors: Setareh Mamishi, Hamideh Tabatabaie, Shohreh Shahmahmoudi, Abdolreza Esteghamati, Shahram Teimourian, Babak Pourakbari, Yousof Gheisari, Mehdi Yeganeh, Ali Salavati, Mohammad Mehdi GooyaAbstract:Oral polio vaccine (OPV) has been used safely and efficiently for more than 40 years in preventive medicine. Vaccine-associated Paralytic Poliomyelitis (VAPP) is a rare adverse event of OPV due to reversion of the vaccine strain virus to a neurovirulent strain. VAPP can occur in healthy recipients or their close contacts. However, persons with primary humoral immunodeficiencies are at a much higher risk. X-linked agammaglobulinemia (XLA) is a prototypic humoral deficiency caused by mutations in the Bruton’s tyrosine kinase (BTK) gene. In addition to susceptibility to bacterial infections, patients with XLA are especially prone to enteroviruses. Here, we describe the occurrence of VAPP in a 15-month old Iranian boy. The child had received four doses of OPV, administered at birth, 2, 4, and 6 months of age. The patient’s infectious history was unremarkable. Laboratory evaluation revealed low levels of immunoglobulin G and CD19+ B cells of less than 1% of the lymphocyte population. A novel insertion (c.685_686insTTAC) in the SH3 domain of the BTK gene was detected as the underlying cause. Immunodeficient recipients of OPV can excrete poliovirus vaccine strains for a long period and are at risk of developing flaccid paralysis. They could also serve as a source of reverted virulent poliovirus to be reintroduced into the general population. This patient presented for the first time with VAPP, without any history of other major infections in 15 months. This suggests that a negative history for recurrent infections does not exclude the presence of a primary defect in the immune system.
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vaccine associated Paralytic Poliomyelitis in a patient with mhc class ii deficiency
Journal of Clinical Virology, 2007Co-Authors: Nima Parvaneh, Setareh Mamishi, Mohammad Mehdi Gooya, Taha Mousavi, Shohreh Shahmahmoudi, Hamideh Tabatabai, Mohsen Zahraei, Abdolreza Esteghamati, R Nategh, Olen M. KewAbstract:Vaccine-associated Paralytic Poliomyelitis (VAPP) is a rare complication of oral polio vaccine. We describe a fatal case of VAPP in an 8-month-old boy with Major Histocompatibility Class II deficiency. The isolated poliovirus was a Sabin type 2-type 1 recombinant that showed 1.4% VP1 divergence from Sabin type 2.
Hamideh Tabatabaie - One of the best experts on this subject based on the ideXlab platform.
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vaccine associated Paralytic Poliomyelitis in immunodeficient children iran 1995 2008
Emerging Infectious Diseases, 2010Co-Authors: Shohreh Shahmahmoodi, Setareh Mamishi, Asghar Aghamohammadi, Nessa Aghazadeh, Hamideh Tabatabaie, Mohammad Mehdi Gooya, Seyed Mohsen Zahraei, Taha Mousavi, Maryam Yousefi, Kobra FarrokhiAbstract:To determine the prevalence of vaccine-associated Paralytic Poliomyelitis (VAPP) in immunodeficient infants, we reviewed all documented cases caused by immunodeficiency-associated vaccine-derived polioviruses in Iran from 1995 through 2008. Changing to an inactivated polio vaccine vaccination schedule and introduction of screening of neonates for immunodeficiencies could reduce the risk for VAPP infection.
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Vaccine-associated Paralytic Poliomyelitis in Immunodeficient Children, Iran, 1995–2008
'Centers for Disease Control and Prevention (CDC)', 2010Co-Authors: Shohreh Shahmahmoodi, Setareh Mamishi, Asghar Aghamohammadi, Nessa Aghazadeh, Hamideh Tabatabaie, Mohammad Mehdi Gooya, Seyed Mohsen Zahraei, Taha Mousavi, Maryam Yousefi, Kobra FarrokhiAbstract:To determine the prevalence of vaccine-associated Paralytic Poliomyelitis (VAPP) in immunodeficient infants, we reviewed all documented cases caused by immunodeficiency-associated vaccine-derived polioviruses in Iran from 1995 through 2008. Changing to an inactivated polio vaccine vaccination schedule and introduction of screening of neonates for immunodeficiencies could reduce the risk for VAPP infection
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novel btk mutation presenting with vaccine associated Paralytic Poliomyelitis
European Journal of Pediatrics, 2008Co-Authors: Setareh Mamishi, Hamideh Tabatabaie, Shohreh Shahmahmoudi, Abdolreza Esteghamati, Shahram Teimourian, Babak Pourakbari, Yousof Gheisari, Mehdi Yeganeh, Ali Salavati, Mohammad Mehdi GooyaAbstract:Oral polio vaccine (OPV) has been used safely and efficiently for more than 40 years in preventive medicine. Vaccine-associated Paralytic Poliomyelitis (VAPP) is a rare adverse event of OPV due to reversion of the vaccine strain virus to a neurovirulent strain. VAPP can occur in healthy recipients or their close contacts. However, persons with primary humoral immunodeficiencies are at a much higher risk. X-linked agammaglobulinemia (XLA) is a prototypic humoral deficiency caused by mutations in the Bruton’s tyrosine kinase (BTK) gene. In addition to susceptibility to bacterial infections, patients with XLA are especially prone to enteroviruses. Here, we describe the occurrence of VAPP in a 15-month old Iranian boy. The child had received four doses of OPV, administered at birth, 2, 4, and 6 months of age. The patient’s infectious history was unremarkable. Laboratory evaluation revealed low levels of immunoglobulin G and CD19+ B cells of less than 1% of the lymphocyte population. A novel insertion (c.685_686insTTAC) in the SH3 domain of the BTK gene was detected as the underlying cause. Immunodeficient recipients of OPV can excrete poliovirus vaccine strains for a long period and are at risk of developing flaccid paralysis. They could also serve as a source of reverted virulent poliovirus to be reintroduced into the general population. This patient presented for the first time with VAPP, without any history of other major infections in 15 months. This suggests that a negative history for recurrent infections does not exclude the presence of a primary defect in the immune system.
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characterization of mutations in the vp1 region of sabin strain type 1 polioviruses isolated from vaccine associated Paralytic Poliomyelitis cases in iran
Journal of Clinical Virology, 2007Co-Authors: Pooneh Rahimi, Hamideh Tabatabaie, Mohammad Mehdi Gouya, Mohsen Zahraie, M Mahmudi, A Ziaie, Samimi K Rad, Sh Shahmahmudi, T Musavi, Mokhtari T AzadAbstract:Abstract Background The live-attenuated oral polio vaccine used to interrupt poliovirus transmission is genetically unstable. Reversion of some attenuating mutations, which normally occurs during vaccine strain replication in some recipients, and can rarely cause vaccine-associated Paralytic Poliomyelitis (VAPP). The poliovirus eradication program designed by the World Health Organization (WHO) includes immunization with OPV in addition to careful surveillance of all acute-flaccid paralysis (AFP) cases. Objectives In Iran we last isolated imported wild poliovirus in 2000 and the immunization coverage was 100% in 2002. During 2001, there were three AFP cases with residual paralysis from which Sabin-like type 1 polioviruses were isolated in our national polio laboratory. Study design The complete VP1 region of the three isolates was sequenced and amino acid substitutions associated with these neurovirulent isolates were recorded. Results These isolates had either 4, 2 or 1 nucleotide substitution(s) in the VP1 region, corresponding to amino acid change in the VP1 of isolate 1 of either ( H ⟶ 149 Y ), ( T ⟶ 106 A ) or ( I ⟶ 90 L ), respectively. Conclusions Surveillance of the VAPP cases in countries where endemic transmission has recently ceased increases our understanding of the important neurovirulent mutations in vaccine-strain isolates and assists in planning the next step in the eradication program in these countries.
Setareh Mamishi - One of the best experts on this subject based on the ideXlab platform.
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vaccine associated Paralytic Poliomyelitis in immunodeficient children iran 1995 2008
Emerging Infectious Diseases, 2010Co-Authors: Shohreh Shahmahmoodi, Setareh Mamishi, Asghar Aghamohammadi, Nessa Aghazadeh, Hamideh Tabatabaie, Mohammad Mehdi Gooya, Seyed Mohsen Zahraei, Taha Mousavi, Maryam Yousefi, Kobra FarrokhiAbstract:To determine the prevalence of vaccine-associated Paralytic Poliomyelitis (VAPP) in immunodeficient infants, we reviewed all documented cases caused by immunodeficiency-associated vaccine-derived polioviruses in Iran from 1995 through 2008. Changing to an inactivated polio vaccine vaccination schedule and introduction of screening of neonates for immunodeficiencies could reduce the risk for VAPP infection.
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Vaccine-associated Paralytic Poliomyelitis in Immunodeficient Children, Iran, 1995–2008
'Centers for Disease Control and Prevention (CDC)', 2010Co-Authors: Shohreh Shahmahmoodi, Setareh Mamishi, Asghar Aghamohammadi, Nessa Aghazadeh, Hamideh Tabatabaie, Mohammad Mehdi Gooya, Seyed Mohsen Zahraei, Taha Mousavi, Maryam Yousefi, Kobra FarrokhiAbstract:To determine the prevalence of vaccine-associated Paralytic Poliomyelitis (VAPP) in immunodeficient infants, we reviewed all documented cases caused by immunodeficiency-associated vaccine-derived polioviruses in Iran from 1995 through 2008. Changing to an inactivated polio vaccine vaccination schedule and introduction of screening of neonates for immunodeficiencies could reduce the risk for VAPP infection
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novel btk mutation presenting with vaccine associated Paralytic Poliomyelitis
European Journal of Pediatrics, 2008Co-Authors: Setareh Mamishi, Hamideh Tabatabaie, Shohreh Shahmahmoudi, Abdolreza Esteghamati, Shahram Teimourian, Babak Pourakbari, Yousof Gheisari, Mehdi Yeganeh, Ali Salavati, Mohammad Mehdi GooyaAbstract:Oral polio vaccine (OPV) has been used safely and efficiently for more than 40 years in preventive medicine. Vaccine-associated Paralytic Poliomyelitis (VAPP) is a rare adverse event of OPV due to reversion of the vaccine strain virus to a neurovirulent strain. VAPP can occur in healthy recipients or their close contacts. However, persons with primary humoral immunodeficiencies are at a much higher risk. X-linked agammaglobulinemia (XLA) is a prototypic humoral deficiency caused by mutations in the Bruton’s tyrosine kinase (BTK) gene. In addition to susceptibility to bacterial infections, patients with XLA are especially prone to enteroviruses. Here, we describe the occurrence of VAPP in a 15-month old Iranian boy. The child had received four doses of OPV, administered at birth, 2, 4, and 6 months of age. The patient’s infectious history was unremarkable. Laboratory evaluation revealed low levels of immunoglobulin G and CD19+ B cells of less than 1% of the lymphocyte population. A novel insertion (c.685_686insTTAC) in the SH3 domain of the BTK gene was detected as the underlying cause. Immunodeficient recipients of OPV can excrete poliovirus vaccine strains for a long period and are at risk of developing flaccid paralysis. They could also serve as a source of reverted virulent poliovirus to be reintroduced into the general population. This patient presented for the first time with VAPP, without any history of other major infections in 15 months. This suggests that a negative history for recurrent infections does not exclude the presence of a primary defect in the immune system.
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vaccine associated Paralytic Poliomyelitis in a patient with mhc class ii deficiency
Journal of Clinical Virology, 2007Co-Authors: Nima Parvaneh, Setareh Mamishi, Mohammad Mehdi Gooya, Taha Mousavi, Shohreh Shahmahmoudi, Hamideh Tabatabai, Mohsen Zahraei, Abdolreza Esteghamati, R Nategh, Olen M. KewAbstract:Vaccine-associated Paralytic Poliomyelitis (VAPP) is a rare complication of oral polio vaccine. We describe a fatal case of VAPP in an 8-month-old boy with Major Histocompatibility Class II deficiency. The isolated poliovirus was a Sabin type 2-type 1 recombinant that showed 1.4% VP1 divergence from Sabin type 2.
Stephen L. Cochi - One of the best experts on this subject based on the ideXlab platform.
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framework for evaluating the risks of Paralytic Poliomyelitis after global interruption of wild poliovirus transmission
Bulletin of The World Health Organization, 2004Co-Authors: Bruce R Aylward, Stephen L. CochiAbstract:With the interruption of wild poliovirus transmission globally, the need for new policies to deal with the post-certification era will rapidly arise. New policies will be required in four areas: detection and notification of circulating polioviruses; biocontainment of wild, vaccine-derived and attenuated strains of poliovirus; vaccine stockpiles and response mechanisms; and routine immunization against polioviruses. A common understanding of the potential risks of Paralytic Poliomyelitis in the post-certification period is essential to the development of these policies. Since 2000, there has been increasing international consensus that the risks of Paralytic Poliomyelitis in the post-certification era fall into two categories: those due to the continued use of the oral poliovirus vaccine (OPV) and those due to future improper handling of wild polioviruses. The specific risks within both categories have now been defined, and an understanding of the frequency and potential burden of disease associated with each is rapidly improving. This knowledge and clarity have provided a framework that is already proving valuable for identifying research priorities and discussing potential policy options with national authorities. However, this framework must be regarded as a dynamic tool, requiring regular updating as additional information on these risks becomes available through further scientific research, programmatic work, and policy decisions.
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intramuscular injections within 30 days of immunization with oral poliovirus vaccine a risk factor for vaccine associated Paralytic Poliomyelitis
The New England Journal of Medicine, 1995Co-Authors: Peter M. Strebel, Roland W. Sutter, Nicolae Ionnedelcu, Andrew L Baughman, Stephen L. CochiAbstract:Background In Romania the rate of vaccine-associated Paralytic Poliomyelitis is for unexplained reasons 5 to 17 times higher than in other countries. Long ago it was noted that intramuscular injections administered during the incubation period of wild-type poliovirus infection increased the risk of Paralytic disease (a phenomenon known as “provocation” Poliomyelitis). We conducted a case–control study to explore the association between intramuscular injections and vaccine-associated Poliomyelitis in Romania. Methods The patients were 31 young children in whom vaccine-associated Paralytic Poliomyelitis developed from 1988 through 1992. Eighteen were vaccine recipients, and 13 had acquired the disease by contact with vaccine recipients. Each of these children was matched with up to five controls according to health center, age, and in the case of vaccine recipients, history of receipt of the live attenuated oral poliovirus vaccine. Data were abstracted from medical records that documented the injections adm...
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Paralytic Poliomyelitis in romania 1984 1992 evidence for a high risk of vaccine associated disease and reintroduction of wild virus infection
American Journal of Epidemiology, 1994Co-Authors: Peter M. Strebel, Roland W. Sutter, Olen M. Kew, Andre Aubertcombiescu, Nicolae Ionnedelcu, Sanda Biberimoroeanu, Manana Combiescu, Mark A Pallansch, Peter A Patriarca, Stephen L. CochiAbstract:Although Poliomyelitis due to wild-virus infection has virtually disappeared from Romania, with no cases having been documented between 1984 and 1989, vaccine-associated Paralytic Poliomyelitis has been reported at very high rates for over two decades. In November 1990, to decrease the risk of vaccine-associated Paralytic Poliomyelitis, oral poliovirus vaccine produced in Romania was replaced by imported oral vaccine made by a Western European manufacturer. To better quantify the risk of vaccine-associated Paralytic Poliomyelitis and the impact of the change in vaccine manufacturer, the authors reviewed clinical, epidemiologic, and laboratory data on Poliomyelitis cases that occurred in Romania from 1984 to 1992. Poliovirus isolates were characterized at the US Centers for Disease Control and Prevention. During the period 1984-1992, 132 confirmed cases of Paralytic Poliomyelitis were reported in Romania, of which 13 were classified as wild-virus-associated, 93 as vaccine-associated, and 26 as "of unknown origin." Wild type 1 poliovirus was isolated during 1990-1992 from nine of 13 (69%) cases in an outbreak that occurred primarily among undervaccinated gypsy children. Vaccine-associated cases were epidemiologically and virologically distinct from wild-virus cases. Of the 93 vaccine-associated cases, 45 children were recipients and 48 were contacts. The overall risk of vaccine-associated Paralytic Poliomyelitis in Romania (1 case per 183,000 doses of oral poliovirus vaccine distributed) was 14-fold higher than the risk in the United States. The risks of recipient vaccine-associated Paralytic Poliomyelitis related to the first dose of oral vaccine were similar for Romanian and imported vaccine (1 case per 95,000 doses and 1 case per 65,000 doses, respectively), as were the total risks of vaccine-associated Paralytic Poliomyelitis. These findings definitively demonstrate a substantially elevated risk of vaccine-associated Paralytic Poliomyelitis in Romania which was not affected by a change in oral poliovirus vaccine manufacturer.
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completeness of reporting for Paralytic Poliomyelitis united states 1980 through 1991 implications for estimating the risk of vaccine associated disease
JAMA Pediatrics, 1994Co-Authors: Rebecca D Prevots, Peter M. Strebel, Roland W. Sutter, Robert E Weibel, Stephen L. CochiAbstract:Background: Although the risk of vaccine-associated Paralytic Poliomyelitis (VAPP) has remained relatively constant during the past 30 years, estimates of VAPP depend largely on the completeness of reporting to the existing passive surveillance system. The National Vaccine Injury Compensation Program constitutes an alternative system for reporting VAPP, and data available from this system permitted us to evaluate the completeness of the national Poliomyelitis surveillance system. Methods: We compared cases of Paralytic Poliomyelitis reported to the national surveillance system (maintained by the Centers for Disease Control and Prevention, Atlanta, Ga) with cases recommended for compensation by the National Vaccine Injury Compensation Program, Rockville, Md, and we calculated the observed completeness of reporting to the national system for 1980 through 1991. A capture-recapture method was also used to estimate completeness of reporting, ie, to account for cases potentially missed by both systems. In addition, we reviewed the epidemiology and updated the risk of VAPP based on the most current information on cases of VAPP. Results: From 1980 through 1991,105 cases of Paralytic Poliomyelitis were identified by the Centers for Disease Control and Prevention and National Vaccine Injury Compensation Program systems, 98 (93%) of which were VAPP (average, 8.2 cases per year). The observed completeness of reporting to the Centers for Disease Control and Prevention was 94%, and the estimated completeness of reporting (capture-recapture method) was 81%. The overall risk of VAPP was one case per 2.5 million doses of oral poliovirus vaccine distributed. In the sensitivity analysis, the risk estimates of VAPP remained relatively stable throughout a wide range of assumptions regarding underreporting and specificity of the case definition for Paralytic Poliomyelitis. Conclusion: The risk of VAPP remains virtually unchanged from previous estimates despite the inclusion of previously unidentified VAPP cases. Despite the potential for both underreporting and misclassification of cases, our risk estimates were relatively insensitive to either of these biases. Since both of these biases were in opposite directions, and both probably occurred with low frequency, the risk estimates provided in this report appear valid and approximate the "true" risk of VAPP in the United States. (Arch Pediatr Adolesc Med. 1994;148:479-485)
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attributable risk of dtp diphtheria and tetanus toxoids and pertussis vaccine injection in provoking Paralytic Poliomyelitis during a large outbreak in oman
The Journal of Infectious Diseases, 1992Co-Authors: Roland W. Sutter, Stephen L. Cochi, Peter A Patriarca, Ali Jaffer M Suleiman, Shaun Brogan, Pradeep Malankar, Ahmed A K Alghassani, Musallam S ElbualyAbstract:Although injections administered during the incubation period of wild poliovirus infection have been associated with an increased risk of Paralytic Poliomyelitis, quantitative estimates of the risk have not been established. During a Poliomyelitis outbreak investigation in Oman, vaccination records were reviewed for 70 children aged 5-24 months with Poliomyelitis and from 692 matched control children. A significantly higher proportion of cases received a DTP (diphtheria and tetanus toxoids and pertussis vaccine) injection within 30 days before paralysis onset than did controls (42.9% vs. 28.3%; odds ratio, 2.4; 95% confidence interval, 1.3-4.2). The proportion of Poliomyelitis cases that may have been provoked by DTP injections was 35% for children 5-11 months old. This study confirms that injections are an important cause of provocative Poliomyelitis. Although the benefits of DTP vaccination should outweigh the risk of subsequent paralysis, these data stress the importance of avoiding unnecessary injections during outbreaks of wild poliovirus infection.
