Importation and Circulation of Vaccine-Derived Poliovirus Serotype 2, Senegal, 2020–2021

Environmental surveillance for poliovirus is increasingly used in poliovirus eradication efforts as a supplement to acute flaccid paralysis (AFP) surveillance. Environmental surveillance was officially established in 2017 in Senegal, where no poliovirus had been detected since 2010. We tested sewage samples from 2 sites in Dakar monthly for polioviruses. We identified a vaccine-derived poliovirus serotype 2 on January 19, 2021, from a sample collected on December 24, 2020; by December 31, 2021, we had detected 70 vaccine-derived poliovirus serotype 2 isolates circulating in 7 of 14 regions in Senegal. Sources included 18 AFP cases, 20 direct contacts, 17 contacts in the community, and 15 sewage samples. Phylogenetic analysis revealed the circulation of 2 clusters and provided evidence on the virus introduction from Guinea. Because novel oral polio vaccine serotype 2 was used for response activities throughout Senegal, we recommend expanding environmental surveillance into other regions.     

Dual suppression with oral contraceptives and gonadotrophin releasing- hormone agonists improves in-vitro fertilization outcome in high responder patients

Certain patients have a tendency for high response to gonadotrophin therapy which is often not ameliorated with prior gonadotrophin- releasing hormone agonist (GnRHa) suppression. As a result, these patients are frequently cancelled and often experience ovarian hyperstimulation syndrome (OHSS) episodes during in-vitro fertilization (IVF)-embryo transfer cycles. Patients with polycystic ovarian syndrome (PCOS) have been noted to be particularly sensitive to exogenous gonadotrophin therapy. We have developed a protocol which is effective in improving IVF outcome in high responder patients, including those with PCOS. Oral contraceptive pills (OCP) are taken for 25 days followed by s.c. leuprolide acetate, 1 mg/day, which is overlapped with the final 5 days of oral contraceptive administration. Low-dose gonadotrophin stimulation is then initiated on the third day of withdrawal bleeding in the form of either human menopausal gonadotrophins or purified urinary follicle-stimulating hormone at a dosage of 150 IU/day. Over a 5 year period, we reviewed our experience utilizing this dual method of suppression in 99 cycles obtained in 73 high responder patients. There were only 13 cancellations prior to embryo transfer (13.1%). The clinical and ongoing pregnancy rates per initiated cycle were 46.5 and 40.4% respectively. Only eight patients experienced mild-moderate OHSS following treatment. For those patients who had undergone previous IVF-embryo transfer cycles at our centre, significant improvements were noted in oocyte fertilization rates, embryo implantation rates and clinical/ongoing pregnancy rates with this protocol. Hormonal analyses revealed that the chief mechanism may be through an improved luteinizing hormone/follicle-stimulating hormone ratio following dual suppression. An additional feature of this dual method of suppression is significantly lower serum androgen concentrations, particularly dehydroepiandrosterone sulphate.      

Occupational risk to surgeons of unrecognized HIV infection in a low-prevalence area

Data are available on the occupational risk to surgeons of the human immunodeficiency virus (HIV) for areas of high HIV prevalence but not for low-risk areas and particularly for unrecognized HIV infection. The 40-year cumulative occupational risk to surgeons caring for patients with unknown HIV serologies in a low-prevalence area was estimated. From May 1989 to May 1991, 4119 consecutive patients with unknown HIV status, hospitalized in our department, were proposed for testing; 100% complied. Acquired immunodeficiency syndrome (AIDS) patients and known seropositive patients operated on during this period were excluded from the study. The prevalence of unknown HIV infection was 0.07%. Taking into account the rate of parenteral injuries, the rate of contamination after an infected parenteral injury, and the total number of operations performed during a 40-year career, we estimated the cumulative risk of unknown HIV infection in our area to be 1%. This risk must be added to those of caring for known infected patients. In high-risk areas (cumulative risk 10%), a high standard of infection control is required for every surgical procedure, even if it is expensive or of doubtful efficacy. It is unrealistic to apply this standard in a low-risk area. HIV testing with informed consent of the patient is an imperfect guard against infection but has the advantage of alerting the surgeon to the risk of contamination on a case-by-case basis; it also offers the seropositive patient the best possibility for a longer life expectancy.

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Resumen Se disponde de información sobre el riesgo ocupacional para los cirujanos que representa el virus de la inmunodeficiencia humana (VIH) en áreas de elevada prevalencia de VIH, pero no sobre tal riesgo en áreas de baja prevalecencia o en casos de infección por VIH no reconocida. Se estimó el riesgo acumulativo a 40 años en los cirujanos que atienden pacientes con serologías desconocidas para VHI en un área de baja prevalencia. En el período mayo 1989 a mayo 1991 se propuso efectuar pruebas en 4119 pacientes consecutivos en quienes su estado VIH era desconocido y que fueron hospitalizados en nuestro departamento; el 100% aceptó. Los pacientes con SIDA y aquellos conocidos como seropositivos fueron excluidos del estudio. La prevalencia de infección por VHI desconocida fue de 0.07%. Teniendo en consideración la tasa de lesiones parenterales, la tasa de contaminación después de una lesión parenteral infectada, y el número total de operaciones realizadas en el curso de una carrera profesional de 40 años, hemos estimado el riesgo acumulado de infección por VIH desconocida en nuestra área en 1% Tal riesgo debe ser anadido al que poseen aquellos que atienden pacientes infectados conocidos. En las áreas de alto riesgo (riesgo acumulativo de 10%) se requiere un elevado estándar de control de infección para todo procedimiento quirúrgico, aún si es costoso o de dudosa eficacia; no es práctica aplicar tal estándar en un área de bajo riesgo, aunque la prueba para VIH, realizada con el consentimiento informado, es una protección imperfecta contra la infección, tiene la ventaja de alertar al cirujano sobre el riesgo de contaminación en cada caso individual y da al paciente seropositivo la mejor posibilidad para una mayor supervivencia.

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Résumé Le risque de contamination par le virus VIH des chirurgiens travaillant dans des populations où la prévalence du VIH est élevée est connu. Ceci n'est pas le cas pour les populations dont la prévalence est basse ou lorsqu'on ignore la séropositivité des patients. Dans cette étude, on a évalué le risque professionnel cumulé sur 40 ans de contamination par le VIH des chirurgiens travaillant avec une population dont la prévalence était basse et dont l'état sérologique était inconnu. Entre Mai 1989 et Mai 1991, on a proposé de déterminer une sérologie VIH à 4119 patients consécutifs dont l'état VIH était inconnu, hospitalisés dans notre unité de soins: tous ont accepté. On a exclu de cette étude tous les patients dont la séropositivité était connue et tous les patients ayant un SIDA. La prévalence des patients dont l'état VIH était inconnu était de 0.07%. En prenant en compte le taux de blessures du chirurgien, le pourcentage de contamination après exposition à l'infection et le nombre total d'interventions pratiqués par un chirurgien dans notre unité pendant 40 ans de carrière, le risque cumulé de contamination était de 1%. A ce risque, il faut ajouter celui associé au fait de travailler avec des patients séropositifs. Dans une population dont la prévalence de séropositivité est élevée (risque cumulé de 10%), un maximum de précautions est nécessaire pour chaque intervention, même si celles-ci sont chères ou d'efficacité douteuse. Ces mêmes précautions ne sont pas nécessaires pour les chirurgiens travaillant avec des populations dont la prévalence est basse. La détermination de la séropositivité des patients n'est bien sûr pas suffisante pour éviter la contamination, mais elle a l'avantage d'avertir le chirurgien du risque potentiel pour le patient en question et, en cas de séropositivité, de donner au patient le maximum de chances d'être soigné au mieux des possibilités thérapeutique actuelles.

     

Immortalization of bipotential and plastic glio-neuronal precursor cells.

Permanent clonal cell lines from newborn mouse striatum have been established after transfer of the simian virus 40 large tumor oncogene by means of a retroviral vector. Some of the lines obtained displayed properties of bipotential and plastic glio-neuronal precursors. Depending on the culture conditions, these cells express either the glial fibrillary acidic protein or neurofilaments. In addition, the cells can display adrenergic, D1 and D2 dopaminergic, muscarinic, and 5-hydroxytryptamine type 2 serotoninergic receptors, which are coupled either to the adenylate cyclase or to the phosphatidylinositol signaling pathways. The panel of receptors for neurotransmitters exhibited by these lines closely resembles that of primary striatal neurons. Results suggest that plastic common precursors of astrocytes and neurons persist in the striatum at a late developmental stage. As these permanent cell lines constitute an unlimited source of homogenous cell material, we suggest that they should be useful for molecular and pharmacological studies on the mechanisms and regulation of signal transduction as well as the commitment, plasticity, and differentiation of neural cells.