Nucleotide variation in Sabin type 2 poliovirus from an immunodeficient patient with poliomyelitis

• Published in: Journal of general virology Vol. 84; no. 5; pp. 1215 - 1221
• Main Authors: Buttinelli, Gabriele, Donati, Valentina, Fiore, Stefano, Marturano, Jill, Plebani, Alessandro, Balestri, Paolo, Soresina, Anna Rosa, Vivarelli, Rossella, Delpeyroux, Francis, Martin, Javier, Fiore, Lucia
• Format: Journal Article
• Language: English
• Published: England Soc General Microbiol 01-05-2003; Microbiology Society
• Subjects: 5' Untranslated Regions; 5' Untranslated Regions - genetics; Agammaglobulinemia; Agammaglobulinemia - virology; Amino Acid Substitution; Animals; Capsid Proteins; Capsid Proteins - genetics; Child, Preschool; Feces; Feces - virology; Genetic Variation; Humans; Life Sciences; Mice; Microbiology and Parasitology; Molecular Sequence Data; Poliomyelitis; Poliomyelitis - virology; Poliovirus; Poliovirus - classification; Poliovirus - genetics; Poliovirus - pathogenicity; Poliovirus Vaccine, Oral; Poliovirus Vaccine, Oral - genetics; Sequence Analysis, DNA; Vaccines, Attenuated; Vaccines, Attenuated - genetics; Variation (Genetics); Virology; Virulence; Italy
• ISSN: 0022-1317; 1465-2099
• DOI: 10.1099/vir.0.18974-0

1 Laboratory of Virology, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
2 Department of Pediatrics, University of Brescia, Italy
3 Pediatrics Unit, University of Siena, Italy
4 Epidemiologie Moleculaire des Enterovirus, Institut Pasteur, Paris, France
5 NIBSC, Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, UK
Correspondence Lucia Fiore fiore{at}iss.it
The molecular and antigenic properties of a Sabin-like type 2 poliovirus, isolated from the stool samples of a 2-year-old agammaglobulinaemic child who developed paralysis 1 year after receiving the third dose of oral poliovirus vaccine, were analysed. The virus revealed 0·88 % genome variation in the VP1 region compared with the standard reference strain, compatible with replication of the virus in the intestine over approximately 1 year. The typical mutations in the 5'NCR and VP1 associated with reversion to neurovirulence for Sabin type 2 poliovirus were found. Despite this, the virus was characterized by both PCR and ELISA tests as Sabin-like and showed temperature sensitivity and neurovirulence in transgenic mice typical of the Sabin type 2 vaccine strain. Gammaglobulin replacement therapy led rapidly to virus clearance, which, when combined with treatment with the antiviral drug pleconaril, stopped virus excretion; no further virus shedding occurred. This is the first case of poliomyelitis and long-term excretion from an immunodeficient patient to be reported in Italy through the active ‘Acute Flaccid Paralysis' surveillance system.