Is it time to switch to a formulation other than the live attenuated poliovirus vaccine to prevent poliomyelitis?

Front Public Health. 2024 Jan 8:11:1284337. doi: 10.3389/fpubh.2023.1284337. eCollection 2023.

Abstract

The polioviruses (PVs) are mainly transmitted by direct contact with an infected person through the fecal-oral route and respiratory secretions (or more rarely via contaminated water or food) and have a primary tropism for the gut. After their replication in the gut, in rare cases (far less than 1% of the infected individuals), PVs can spread to the central nervous system leading to flaccid paralysis, which can result in respiratory paralysis and death. By the middle of the 20th century, every year the wild polioviruses (WPVs) are supposed to have killed or paralyzed over half a million people. The introduction of the oral poliovirus vaccines (OPVs) through mass vaccination campaigns (combined with better application of hygiene measures), was a success story which enabled the World Health Organization (WHO) to set the global eradication of poliomyelitis as an objective. However this strategy of viral eradication has its limits as the majority of poliomyelitis cases today arise in individuals infected with circulating vaccine-derived polioviruses (cVDPVs) which regain pathogenicity following reversion or recombination. In recent years (between January 2018 and May 2023), the WHO recorded 8.8 times more cases of polio which were linked to the attenuated OPV vaccines (3,442 polio cases after reversion or recombination events) than cases linked to a WPV (390 cases). Recent knowledge of the evolution of RNA viruses and the exchange of genetic material among biological entities of the intestinal microbiota, call for a reassessment of the polio eradication vaccine strategies.

Keywords: live attenuated virus vaccine; nonhuman primate; poliovirus; recombinant virus; revertant virus.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't
  • Comment

MeSH terms

  • Behavior Therapy
  • Central Nervous System
  • Humans
  • Poliomyelitis* / prevention & control
  • Poliovirus Vaccines*
  • Vaccines*

Substances

  • Poliovirus Vaccines
  • Vaccines

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was funded by the French Government under the “Investissements d’avenir” (Investments for the Future) program managed by the Agence Nationale de la Recherche (French ANR: National Agency for Research; reference: Méditerranée Infection 10-IAHU-03), and annual funds from Aix-Marseille University and IRD to the MEPHI research unit (Director: Professor Jean-Christophe Lagier). Other funding sources were limited to the salaries of the authors (Centre National de la Recherche Scientifique for CD and PP), with no other role or involvement.