AUTHOR=Mohanty Madhu Chhanda , Madkaikar Manisha Ranjan , Desai Mukesh , Aluri Jahnavi , Varose Swapnil Yashwant , Taur Prasad , Sharma Deepa Kailash , Nalavade Uma Prajwal , Rane Sneha Vijay , Gupta Maya , Shabarish Snehal , Dalvi Aparna , Deshpande Jagadish Mohanrao TITLE=Natural Clearance of Prolonged VDPV Infection in a Child With Primary Immunodeficiency Disorder JOURNAL=Frontiers in Immunology VOLUME=10 YEAR=2019 URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2019.01567 DOI=10.3389/fimmu.2019.01567 ISSN=1664-3224 ABSTRACT=

The emergence of immunodeficiency-associated vaccine-derived polioviruses (iVDPV) from children with primary immunodeficiency disorders poses a threat to the eradication program. Herein, we report a patient with severe combined immunodeficiency (SCID), identified as a prolonged serotype 3 iVDPV (iVDPV3) excreter with 13 VDPV3 isolates and a maximum of 10.33% nucleotide divergence, who abruptly cleared infection after a period of 2 years. Occurrence of an episode of norovirus diarrhea associated with increased activated oligoclonal cytotoxic T cells, inverse CD4:CD8 ratio, significantly elevated pro-inflammatory cytokines, and subsequent clearance of the poliovirus suggests a possible link between inflammatory diarrheal illness and clearance of iVDPV. Our findings suggest that in the absence of B cells and sufficiently activated T/NK cells, macrophages and other T cells may produce auto-inflammatory conditions by TLR/RLR ligands expressed by previous/ongoing bacterial or viral infections to clear VDPV infection. The study highlights the need to screen all the patients with combined immunodeficiency for poliovirus excretion and intermittent follow-up of their immune parameters if found positive, in order to manage the risk of iVDPV excretion in the polio eradication endgame strategy.