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. 2017 Nov 3;66(43):1185-1191.
doi: 10.15585/mmwr.mm6643a6.

Update on Vaccine-Derived Polioviruses - Worldwide, January 2016-June 2017

Jaume Jorba, Ousmane M Diop, Jane Iber, Elizabeth Henderson, Roland W Sutter, Steven G F Wassilak, Cara C Burns

Update on Vaccine-Derived Polioviruses - Worldwide, January 2016-June 2017

Jaume Jorba et al. MMWR Morb Mortal Wkly Rep. .

Abstract

In 1988, the World Health Assembly launched the Global Polio Eradication Initiative (GPEI) (1). Among the three wild poliovirus (WPV) serotypes, only type 1 (WPV1) has been detected since 2012. Since 2014, detection of WPV1 has been limited to three countries, with 37 cases in 2016 and 11 cases in 2017 as of September 27. The >99.99% decline worldwide in polio cases since the launch of the GPEI is attributable to the extensive use of the live, attenuated oral poliovirus vaccine (OPV) in mass vaccination campaigns and comprehensive national routine immunization programs. Despite its well-established safety record, OPV use can be associated with rare emergence of genetically divergent vaccine-derived polioviruses (VDPVs) whose genetic drift from the parental OPV strains indicates prolonged replication or circulation (2). VDPVs can also emerge among persons with primary immunodeficiencies (PIDs). Immunodeficiency-associated VDPVs (iVDPVs) can replicate for years in some persons with PIDs. In addition, circulating vaccine-derived polioviruses (cVDPVs) can emerge very rarely among immunologically normal vaccine recipients and their contacts in areas with inadequate OPV coverage and can cause outbreaks of paralytic polio. This report updates previous summaries regarding VDPVs (3). During January 2016-June 2017, new cVDPV outbreaks were identified, including two in the Democratic Republic of the Congo (DRC) (eight cases), and another in Syria (35 cases), whereas the circulation of cVDPV type 2 (cVDPV2) in Nigeria resulted in cVDPV2 detection linked to a previous emergence. The last confirmed case from the 2015-2016 cVDPV type 1 (cVDPV1) outbreak in Laos occurred in January 2016. Fourteen newly identified persons in 10 countries were found to excrete iVDPVs, and three previously reported patients in the United Kingdom and Iran (3) were still excreting type 2 iVDPV (iVDPV2) during the reporting period. Ambiguous VDPVs (aVDPVs), isolates that cannot be classified definitively, were found among immunocompetent persons and environmental samples in 10 countries. Cessation of all OPV use after certification of polio eradication will eliminate the risk for new VDPV infections.

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Conflict of interest statement

Conflict of interest: No conflicts of interest were reported.

Figures

FIGURE 1
FIGURE 1
Vaccine-derived polioviruses (VDPVs) detected, by serotype and VDPV classification — worldwide, January 2016–June 2017 Abbreviations: AFP = Acute flaccid paralysis; aVDPV = ambiguous VDPV; cVDPV = circulating VDPV; iVDPV = immunodeficiency-associated VDPV. * Spread of cVDPVs followed the elimination of the corresponding serotype of indigenous wild poliovirus, but with continued introduction of oral poliovirus vaccine into communities with growing immunity gaps. All of the cVDPV outbreaks were detected first by the laboratory, using sequence data and evolutionary analyses.
FIGURE 2
FIGURE 2
Circulating vaccine-derived poliovirus (cVDPV) cases detected, by serotype — worldwide, January 2000–June 2017, Abbreviation: OPV= oral poliovirus vaccine. * Data available by August 25, 2017. † In April 2016, all OPV-using countries switched from trivalent OPV (types 1, 2, and 3) to bivalent OPV (types 1 and 3).
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