Ala67Thr mutation in the poliovirus receptor CD155 is a potential risk factor for vaccine and wild‐type paralytic poliomyelitis

Poliovirus infections can be asymptomatic or cause severe paralysis. Why some individuals develop paralytic poliomyelitis is unknown, but a role for host genetic factors has been suggested. To investigate if a polymorphism, Ala67Thr, in the poliovirus receptor, which has been found to facilitate increased resistance against poliovirus‐induced cell lysis and apoptosis, is associated with increased risk of paralytic poliomyelitis, poliovirus receptor genotyping was undertaken among Italian subjects with vaccine‐associated (n = 9), or with wild‐type paralytic poliomyelitis (n = 6), and control subjects (n = 71), using RFLP‐PCR and pyrosequencing. Heterozygous poliovirus receptor Ala67Thr genotype was found in 13.3% of the patients with paresis and in 8.5% of the controls (Odds Ratio = 1.667). The frequency of Ala67Thr among the controls is in agreement with earlier published data. It is concluded that the Ala67Thr mutation in the poliovirus receptor is a possible risk factor for the development of vaccine‐associated or paralytic poliomyelitis associated with wild‐type virus. J. Med. Virol. 81:933–936, 2009. © 2009 Wiley‐Liss, Inc.     

West nile virus infection and myasthenia gravis

Introduction: Viruses are commonly cited as triggers for autoimmune disease. It is unclear if West Nile virus (WNV) initiates autoimmunity. Methods: We describe 6 cases of myasthenia gravis (MG) that developed several months after WNV infection. All patients had serologically confirmed WNV neuroinvasive disease. None had evidence of MG before WNV. Results: All patients had stable neurological deficits when they developed new symptoms of MG 3 to 7 months after WNV infection. However, residual deficits from WNV confounded or delayed MG diagnosis. All patients had elevated acetylcholine receptor (AChR) antibodies, and 1 had thymoma. Treatment varied, but 4 patients required acetylcholinesterase inhibitors, multiple immunosuppressive drugs, and intravenous immune globulin or plasmapheresis for recurrent MG crises. Conclusions: The pathogenic mechanism of MG following WNV remains uncertain. We hypothesize that WNV‐triggered autoimmunity breaks immunological self‐tolerance to initiate MG, possibly through molecular mimicry between virus antigens and AChR subunits or other autoimmune mechanisms. Muscle Nerve 49 : 26–29, 2014     

Case reports - Infection following total hip arthroplasty with a hydroxyapatite-coated prosthesis: Histology and histomorphometry 6 years after implantation and infection a case report

No Abstract available.     

Vaccination coverage rates for Diphtheria,Tetanus, Poliomyelitis and Pertussis booster vaccination in France between 2013 and 2017: Learnings from an analysis of National Health System Real-World Data

BackgroundMaintaining a high vaccination coverage rate (VCR) throughout the lifetime and complying with the National Immunization Program are essential to optimize the protection of the population. The study objectives were to evaluate the evolution of the VCRs and the compliance with the vaccination visits for the diphtheria, tetanus, poliomyelitis and pertussis boosters in France since the changes implemented in the 2013 National Immunization Program.MethodsCumulative booster VCRs were estimated at all vaccination visits, from 2013 to 2017, among persons eligible for a booster vaccination from a 1/97th random sample of French claims data. Broader age groups around the recommended ages by the vaccination schedule (6, 11–13, 25, 45, 65, 75, 85, 95y) were used: all persons aged 5 to 8, 10 to 15, 21 to 29, 41 to 49, 61 to 69, 71 to 79, 81 to 89 and 91 to 99.ResultsOver the study period, the diphtheria-tetanus-poliomyelitis booster VCRs increased, reaching in 2017: 73.3% at 8 years old, 75.6% at 15 years old, 46.6% at 29 years old, 38.4% at 49 years old, 36.3% at 69 years old, 30.8% at 79 years old, 22.1% at 89 years old and 11.0% at 99 years old. The pertussis VCRs were also increasing at all vaccination visits, in particular at the vaccination visits at 6 and 11–13 years old (from 16.4% to 63.8% and from 50.3% to 61.2%, respectively). Delayed vaccinations were observed at all vaccination visits.ConclusionVCRs for Diphtheria, Tetanus, Poliomyelitis and Pertussis booster vaccination increased from 2013 to 2017 while remaining suboptimal across all ages and lower in the adult populations. The analysis also shows that the introduction in 2013 of a pertussis vaccination at 6 years of age was relatively well-established in 2017 while other changes in recommendations were slowly or partially implemented.     

2000 - 2014年安徽省疫苗相关麻痹型脊髓灰质炎病例的流行病学分析

目的 分析安徽省2000 - 2014年疫苗相关麻痹型脊髓灰质炎病例（VAPP）的流行病学特征。方法 查阅2000 - 2014年安徽省VAPP的相关资料,用描述性流行病学研究方法,分析相关指标,找出其流行病学特征。结果 2000 - 2014年安徽省共报告46例VAPP,2003年和2011年发生的VAPP病例数最多,占15.22%和10.87%;服苗者VAPP与接触者VAPP发生年龄差异有统计学意义（χ2 = 10.460,P ＜0.05 ）;病毒学检测结果显示,脊灰疫苗Ⅱ型病毒株30例,较其他2种型别的检出率为高（χ2 = 10.240,P ＜0.05）。结论 在维持无脊髓灰质炎后期,应制定出科学,可行的免疫措施,以减少VAPP的发生。     

Evaluation of the genetic stability of Sabin strains and the consistency of inactivated poliomyelitis vaccine made from Sabin strains using direct deep-sequencing

Inactivated poliomyelitis vaccine made from Sabin strains (sIPV) has been encouraged to introduce in the “Global Polio Eradication & Endgame Strategic Plan” and increasingly used worldwide. Attenuated Sabin strains used in manufacture of oral poliovirus vaccine (OPV) and sIPV may regain full or partial neurovirulence during growth in vaccine recipients and the vaccine manufacturing processes. Ensuring the molecular consistency of sIPV batches and that no mutation accumulates beyond the level present in past batches are important for quality control of vaccine manufacture process. Direct deep-sequencing allows the construction of a library of virus RNA and the detection of genetic mutations throughout the viral genome. In the present study, direct deep-sequencing was conducted to detect molecular mutations in virus passages, multiple sIPV monovalent lots, and virus monovalent lots from different polio type III strains. The results indicated that direct deep-sequencing can be used to identify and quantify small amounts of mutant viruses in vaccine preparations, trace the source of a specific virus seed, and monitor the batch-to-batch consistency of vaccines, suggesting that this technique could be suitable for the quality control and consistency monitoring of sIPV production.     

Bone erosion and subacromial bursitis caused by diphtheria–tetanus–poliomyelitis vaccine

Revaxis^® is a vaccine against diphtheria, tetanus and poliomyelitis (dT-IPV). This vaccine should not be administered by the intradermal or intravenous route. Poor injection techniques and related consequences are rare.We report a case of bursitis associated with reactive glenohumeral effusion complicated by bone erosion occurring after injection of the dT-IPV vaccine. A 26 year old patient was admitted for painful left shoulder causing functional impairment. Control magnetic resonance imaging showed bone oedema on the upper outer part of the humeral head, with a slight cortical irregularity, indicating that the vaccine was injected in contact with the bone at this location, causing erosion. Outcome was favourable after intra-articular corticosteroids.Reports of articular or periarticular injury after vaccination are extremely rare, in view of the substantial number of vaccines administered every year. The potential complications of vaccination are well known to general practitioners but under-reported in the literature.     

灭活脊髓灰质炎病毒疫苗在中国应用的咨询意见调查

目的从扩大免疫规划（Expanded Program on Immunization,EPI）专家认知,来探讨灭活脊髓灰质炎（脊灰）病毒疫苗（Inactivated Poliovirus Vaccine,IPV）在中国应用的相关问题,为制定脊灰疫苗免疫策略提供参考。方法以人口数多和疫苗需求量大为原则,在全国范围内选取7个省（自治区）,对30名EPI专家进行开放式问卷调查。结果50％的调查对象希望在2015年国家能将IPV纳入EPI,与世界卫生组织提出的{2013～2018年消灭脊灰终结战略计划》时间进度表同步,专家们一致认同在保证疫苗质量的前提下,应尽可能地降低疫苗成本,IPV可接受价格中位数为20元／剂（范围5～50元／剂）。实现IPV国产化势在必行,卫生行政等政府部门应尽快明确中国脊灰疫苗免疫策略和使用时间进度表,疾病预防控制中心依据卫生行政部门制定的免疫策略提供技术指导和支持,疫苗生产企业应加快IPV的研发、生产和上市。结论EPI专家一致赞同随着全球消灭脊灰的进程,中国逐步引入IPV是大势所趋。     

Immunogenicity and safety of one dose of diphtheria,tetanus, acellular pertussis and poliomyelitis vaccine (Repevax) followed by two doses of diphtheria,tetanus and poliomyelitis vaccine (Revaxis) in adults aged ≥40 years not receiving a diphtheria- and tetanus-containing vaccination in the last 20 years

Introduction

The immunogenicity and safety of one dose of Tdap-IPV (tetanus, diphtheria, acellular pertussis and inactivated poliomyelitis vaccine) and two doses of Td-IPV (tetanus, diphtheria and inactivated poliomyelitis vaccine) were assessed in adults who had not received a diphtheria- and tetanus-containing vaccine in the last 20 years.

Methods

This open-label, multicentre study was conducted in adults aged ≥40 years with no diphtheria- and tetanus-containing vaccine in the last 20 years. Participants received one dose of Tdap-IPV followed by two doses of Td-IPV (0, 1, 6 month schedule). Primary immunogenicity objectives: to demonstrate acceptable seroprotection rates (percentage of participants with antibody titre above threshold) post-dose 3 for diphtheria (≥0.1 IU/mL by seroneutralization assay [SNA]); tetanus (≥0.1 IU/mL by enzyme-linked immunosorbent assay [ELISA]); and poliomyelitis (≥8 1/dil by SNA); and to evaluate the percentage of participants with an antibody concentration ≥5 EU/mL (by ELISA) for pertussis antigens post-dose 1. Seroprotection rates were acceptable if the lower limit of the 95% confidence interval (CI) was >95%. Percentage of participants with basic clinical immunity against diphtheria (≥0.01 IU/mL) was also assessed. Safety (adverse events [AEs] and serious AEs) was assessed after each dose.

Results

Overall, 336 participants were included (mean age: 60.2 years). Post-dose 3 seroprotection rates were: diphtheria, 94.6% (CI 91.5–96.8); tetanus and poliomyelitis, 100% (CI: 98.8–100). Percentage of participants with an antibody titre ≥5 EU/mL against pertussis antigens was ≥95.8% for all five pertussis components. Basic clinical immunity against diphtheria was achieved in 100% (CI: 98.8–100) of participants. AEs were reported more frequently following vaccination with Tdap-IPV (post-dose 1: 65.3%) than with Td-IPV (post-dose 2: 48.3%; post-dose 3: 50.3%).

Conclusions

This study highlights the benefits of using Tdap-IPV followed by two doses of Td-IPV in an adult population to achieve maximal protection against diphtheria, tetanus, poliomyelitis and pertussis simultaneously.     

山东省临沂市1956-2002年消灭和防控脊髓灰质炎回顾性分析

目的　了解临沂市脊髓灰质炎 (脊灰 )的流行状况及控制效果。方法　按照《全国 1 996— 2 0 0 0年消灭脊髓灰质炎行动计划》等文件要求进行。结果　 1 956— 1 991年全市脊灰共发病 4 81 7例 ,年均发病率为 1 .47/ 1 0万 ;1 991年以来脊灰疫苗常规免疫、强化免疫接种率达 95 %以上 ;1 5岁以下儿童急性迟缓性麻痹 (AFP)监测报告年均发病率在 1 / 1 0万以上 ,报告、调查、采便送检、随访及时率达80 %以上 ;免疫成功率 :调查 435名初免儿童 ,Ⅰ、Ⅱ、Ⅲ型脊灰中和抗体阳转率为 88.0 5 %～ 94.94%。免疫水平 :调查 50 3名健康人群 ,Ⅰ、Ⅱ、Ⅲ型脊灰抗体阳转率分别为 91 .65 %、90 .0 6 %、88.0 7% ;抗体几何平均滴度 (GMT)分别为 1 4 6 .70、96 .47、88.1 4 ;采集AFP患者、密切接触者、健康人群粪便标本 1 653份 ,经病原学检测未检出脊灰野病毒株。结论　由于各项措施的落实 ,脊灰发病率大幅度下降 ,全市已连续 1 3年无脊灰野毒株引起的病例发生。