Stem Cell Transplant in Immune-deficiency-associated Vaccine-derived Poliovirus

Heena Ranchod; Wayne Howard; Adele Roux; Walda van Zyl; Pieter Ekermans; Sylvia van den Berg; Lerato Seakamela; Koketso Makua; Mukhlid Yousif; Rosinah Sibiya; Heleen Du Plessis; Emmanuel Phalane; Kerrigan McCarthy; Shelina Moonsamy; David Reynders; Jeffrey Hincks; Melinda S Suchard; Nicolette M du Plessis

doi:10.1093/ofid/ofad678

Stem Cell Transplant in Immune-deficiency-associated Vaccine-derived Poliovirus

Open Forum Infect Dis. 2024 Jan 17;11(2):ofad678. doi: 10.1093/ofid/ofad678. eCollection 2024 Feb.

Authors

Heena Ranchod^{1

2}, Wayne Howard^{1

2}, Adele Roux³, Walda van Zyl⁴, Pieter Ekermans⁵, Sylvia van den Berg⁶, Lerato Seakamela¹, Koketso Makua¹, Mukhlid Yousif^{1

7}, Rosinah Sibiya¹, Heleen Du Plessis¹, Emmanuel Phalane^{1

7}, Kerrigan McCarthy¹, Shelina Moonsamy¹, David Reynders⁸, Jeffrey Hincks⁹, Melinda S Suchard^{1

2}, Nicolette M du Plessis⁸

Affiliations

¹ Centre for Vaccines and Immunology, National Institute for Communicable Diseases, Johannesburg, South Africa.
² Department of Chemical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
³ Dr Adéle Roux Practice, Life Groenkloof Hospital, Pretoria, South Africa.
⁴ Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, National Health Laboratory Services-Tshwane Academic Division, Pretoria, South Africa.
⁵ Department of Medical Microbiology, Ampath Laboratories, Pretoria, South Africa.
⁶ Department of Immunology, Ampath Laboratories, Pretoria, South Africa.
⁷ Department of Virology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁸ Department of Paediatrics, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
⁹ ViroDefense, Chevy Chase, Maryland, USA.

Abstract

Patients with severe primary immunodeficiency are at risk for complications from live-attenuated vaccines. Here, we report a case of a vaccine-associated paralytic polio and Bacille Calmette-Guérin disease in a 6-month-old girl with severe combined immunodeficiency resulting from homozygous recombinant activating gene 1 deficiency. The patient was successfully treated with intravenous immunoglobulins and oral pocapavir for poliovirus, and antimycobacterial therapy for regional Bacille Calmette-Guérin disease, allowing stem cell transplant. Following transplantation, poliovirus type 3 with 13 mutations was detected from cerebrospinal fluid but not from stool, indicating ongoing viral evolution in the central nervous system despite pocapavir treatment. Clinical improvement and immune reconstitution allowed the patient to be successfully discharged with no further detection of poliovirus.

Keywords: IRIS; RAG; SCID; VAPP; acute flaccid paralysis; disseminated BCG; iVDPV; immunodeficiency; intravenous immune globulin; pocapavir; polio; poliomyelitis; stem cell transplant; transplant; vaccine-associated; vaccine-derived poliovirus.