Lessons from Vaccine-Related Poliovirus in Israel, UK and USA.
Lessons from Vaccine-Related Poliovirus in Israel, UK and USA.
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DOI：
10.3390/vaccines10111969
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发表时间：
2022-11-20
期刊：
影响因子：
7.8
通讯作者：
Dharmapalan D
中科院分区：
文献类型：
--
作者：
John TJ;Dharmapalan D
2022年初，在耶路撒冷、伦敦和纽约的废水沃茨中检测到不明来源输入的疫苗脊髓灰质炎病毒2型的遗传变异体。2型野生脊髓灰质炎病毒于1999年在全球范围内被根除，但2型疫苗病毒持续了16年多; 2016年停止了疫苗的常规使用，并偶尔故意重新引入。作为一个意想不到的后果，模仿野生病毒传染性和神经毒性的2型疫苗病毒变种（循环疫苗衍生脊髓灰质炎病毒，cVDPVs）已经出现并传播。仅在过去四年（2018-2021年），35个低收入国家就有2296名儿童患上了cVDPV脊髓灰质炎。许多人认为病毒传播是通过粪口途径。在伦敦和纽约，尽管环境卫生和个人卫生标准很高，但仍有持续的病毒传播记录。在这里，病毒传播不能归因于食物或饮用水的粪便污染（粪口传播）。因此，传染性传播只能解释为吸入含有病毒的液滴/气溶胶，这些病毒在咽液中脱落（呼吸道传播），这是脊髓灰质炎流行病学的经典教导。如果VDPV的传播效率是通过卫生状况良好的呼吸道途径，那么在卫生状况差的国家也是如此，因为卫生状况差不能成为呼吸道传播的障碍。通过外推，野生脊髓灰质炎病毒的极端传播效率也一定是由于其利用呼吸道途径传播的能力。这些经验教训对全球根除脊髓灰质炎具有重要意义。由于假定粪便-口腔传播，试图用口服脊髓灰质炎减毒活疫苗（OPV）根除，忽视了其安全问题和在低收入国家的低效力。灭活脊髓灰质炎病毒疫苗（IPV）在保护儿童免受脊髓灰质炎方面是完全安全和高度有效的，只需三次常规剂量。保护所有儿童免受脊髓灰质炎之害必须是根除脊髓灰质炎的临时目标，直到脊髓灰质炎病毒的传播在持续的免疫压力下消失。应在IPV诱导免疫的掩护下停止OPV，以阻止VDPV新谱系的出现，不仅是2型，而且是1型和3型，以加快完成脊髓灰质炎根除。
Genetic variants of vaccine poliovirus type 2, imported from an unknown source, were detected in waste waters in Jerusalem, London and New York in early 2022. Wild poliovirus type 2 was globally eradicated in 1999, but vaccine virus type 2 continued for 16 more years; routine use of the vaccine was discontinued in 2016 and reintroduced occasionally on purpose. As an unintended consequence, type 2 vaccine virus variants (circulating vaccine-derived polioviruses, cVDPVs) that mimic wild viruses’ contagiousness and neurovirulence, have been emerging and spreading. To illustrate, in just the past four years (2018–2021), 2296 children developed cVDPV polio in 35 low-income countries. Many assume that virus transmission is via the faecal–oral route. Sustained virus transmission was documented in London and New York, in spite of high standards of sanitation and hygiene. Here, virus transmission cannot be attributed to faecal contamination of food or drinking water (for faecal–oral transmission). Hence, contagious transmission can only be explained by inhalation of droplets/aerosol containing virus shed in pharyngeal fluids (respiratory transmission), as was the classical teaching of polio epidemiology. If transmission efficiency of VDPV is via the respiratory route where hygiene is good, it stands to reason that it is the same case in countries with poor hygiene, since poor hygiene cannot be a barrier against respiratory transmission. By extrapolation, the extreme transmission efficiency of wild polioviruses must also have been due to their ability to exploit respiratory route transmission. These lessons have implications for global polio eradication. It was as a result of assuming faecal–oral transmission that eradication was attempted with live attenuated oral polio vaccine (OPV), ignoring its safety problems and very low efficacy in low-income countries. Inactivated poliovirus vaccine (IPV) is completely safe and highly efficacious in protecting children against polio, with just three routine doses. Protecting all children from polio must be the interim goal of eradication, until poliovirus circulation dies out under sustained immunisation pressure. OPV should be discontinued under cover of immunity induced by IPV to stop the emergence of new lineages of VDPVs, not only type 2, but also types 1 and 3, to expedite the completion of polio eradication.
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