Paralytic poliomyelitis associated with live oral poliomyelitis vaccine in child with HIV infection in Zimbabwe: case report

Publisher Website
Google Scholar
Abstract
Objective: To describe a complication of oral vaccination with live, attenuated poliomyelitis virus in a child infected with HIV. Design: Case report. Setting: Teaching hospital in Harare, Zimbabwe. Subjects: A boy of 41/2 years and his mother. Main outcome measures: Results of clinical and laboratory investigations. Results: Two weeks after receiving the second dose of oral poliomyelitis vaccine during national immunisation days the child developed paralysis of the right leg. He had a high titre of antibodies against poliovirus type 2, as well as antibodies against HIV-1, a low CD4 count, a ratio of CD4 to CD8 count of 0.47, and hypergammaglobulinaemia. He did not have any antibodies against diphtheria, tetanus, or poliovirus types 1 and 3, although he had been given diphtheria, tetanus, and pertussis and oral polio vaccines during his first year and a booster of the diphtheria, tetanus, and pertussis vaccine at 24 months. He had no clinical symptoms of AIDS, but his mother had AIDS and tuberculosis. Conclusion: Paralytic poliomyelitis in this child with HIV infection was caused by poliovirus type 2 after oral poliomyelitis vaccine. The WHO's goal of eradicating poliomyelitis by 2000 means that children are given live, oral poliomyelitis vaccine during national immunisation days regardless of their vaccination history Live vaccines are contraindicated in people who are infected with HIV because of the risk of infection from attenuated micro-organisms The incidence of paralytic poliomyelitis associated with vaccination is low in children who are not infected with HIV A boy positive for HIV infection developed paralytic poliomyelitis after receiving his second dose of oral poliomyelitis vaccine during national immunisation days in Zimbabwe As the benefits of vaccination outweigh the risk of infection with wild poliomyelitis virus, oral poliomyelitis vaccine should continue to be used in countries where HIV infections are endemic