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| ISV Paper of the Month |
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August 2011 |
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Vaccine-derived poliomyelitis 12 years after infection
in Minnesota |
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DeVries AS, Harper J, Murray A, Lexau C, Bahta L, Christensen J, Cebelinski E, Fuller
S, Kline S, Wallace GS, Shaw JH, Burns CC, Lynfield R. |
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N Engl J Med. 2011 Jun 16;364(24):2316-23 |
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A 44-year-old woman with long-standing common variable
immunodeficiency who was receiving intravenous immune globulin suddenly had paralysis
of all four limbs and the respiratory muscles, resulting in death. Type 2 vaccine-derived
poliovirus was isolated from stool. The viral capsid protein VP1 region had diverged
from the vaccine strain at 12.3% of nucleotide positions, and the two attenuating
substitutions had reverted to the wild-type sequence. Infection probably occurred 11.9 years earlier (95% confidence interval [CI], 10.9 to 13.2), when her child
received the oral poliovirus vaccine. No secondary cases were identified among close
contacts or 2038 screened health care workers. Patients with common variable immunodeficiency
can be chronically infected with poliovirus, and poliomyelitis can develop despite
treatment with intravenous immune globulin. |
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