624. Oral Polio Vaccine Shedding in HIV-Infected versus Uninfected Zimbabwean Infants
Session: Poster Abstract Session: Pediatric Vaccines
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • 624 SBT_IDSA_2011_Zim_poster_v2.pdf (1.0 MB)
  • Background: With prolonged replication, oral polio vaccine (OPV) can mutate into vaccine-derived poliovirus (VDPV), a cause of poliomyelitis outbreaks.  Individuals with humoral immunodeficiencies may shed OPV for years, resulting in VDPV formation.  Infants with perinatal human immunodeficiency virus (HIV) infection may have humoral as well as cellular immunodeficiencies, which might result in prolonged OPV replication.  Zimbabwe, where OPV is given routinely to all infants and antenatal HIV prevalence is 14%, provides a natural setting to compare OPV shedding in HIV-infected versus uninfected infants.

    Methods: For this NIH-funded prospective study in and around Chitungwiza, Zimbabwe, stool and blood samples were collected from 284 infants during and after OPV administration through 24 months of age.  Blood was tested by HIV DNA PCR, and OPV serotypes 1, 2, and 3 were detected by real time PCR from nucleic acid extracted directly from stool.

    Results: We analyzed 512 stool samples: 204 from 105 HIV-infected infants, and 308 from 179 HIV uninfected infants.  OPV shedding was significantly higher among samples from HIV-infected infants (21% vs. 14%, p=0.040).  Among the 463 samples collected after OPV administration from infants with known OPV receipt dates, shedding was similar after only 1 or 2 doses of OPV (34% in both groups, p=1.0), but significantly higher in the HIV-infected group after receipt of 3 OPV doses (24/127, 19% vs. 16/209, 8%, p=0.003).  Of samples collected after 3 OPV doses, more shedding was seen within 6 weeks of an OPV dose (12/37, 32% vs. 7/68, 10%, p=0.0075), but shedding persisted after 6 weeks (12/90, 13% vs. 9/141,  6%, p=0.099, in HIV-infected vs. uninfected respectively).  Shedding in both groups of infants was seen up to 56 weeks after an OPV dose.   

    Conclusion: This is the largest study to date of OPV shedding in HIV-infected versus uninfected infants, and the first to show increased shedding rates among HIV-infected children.  The increase was seen after receipt of 3 OPV doses, consistent with our previous data showing decreased polio seroconversion rates in HIV-infected children.  These data provide further support for a global switch to inactivated polio vaccine use as we near polio eradication to minimize the risk of circulating VDPV.


    Subject Category: I. Adult and Pediatric Vaccines

    Stephanie Troy, MD1, Georgina Musingwini, MBA2, ChunHong Huang, MS1, Meira Halpern, PhD1, Lynda Stranix-Chibanda, MBChB, MMED (Paediatrics)2,3, Avinash Shetty, MD2,4, Michael Chirara, PhD3, Kusum Nathoo, MBChB, MRCP (UK), MScClinEpi3 and Yvonne Maldonado, MD1, (1)Stanford University School of Medicine, Stanford, CA, (2)Zimbabwe AIDS Prevention Project- University of Zimbabwe Department of Community Medicine (ZAPP-UZ), Harare, Zimbabwe, (3)University of Zimbabwe College of Health Sciences, Harare, Zimbabwe, (4)Wake Forest University School of Medicine, Winston-Salem, NC

    Disclosures:

    S. Troy, None

    G. Musingwini, None

    C. Huang, None

    M. Halpern, None

    L. Stranix-Chibanda, None

    A. Shetty, Merck: Consultant, honorarium
    Novartis: Consultant, honorarium

    M. Chirara, None

    K. Nathoo, None

    Y. Maldonado, Novartis: ,
    Merck: ,

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