Pioneering Past and Bright of Impactful Research and Scholarly Achievements

“EXCELLENCE THROUGH KNOWLEDGE” P A G E 49 Molecular Analysis and Implications of Neurovirulent Circulating Vaccine- Derived Poliovirus in Jamaica: A Case Report and Review of Literature Since the last reported indigenous wild polio virus (WPV) case reported by the Caribbean Epidemiology Research Centre (CAREC) in 1982, Jamaica has continued collaborative surveillance with the World Health Organization (WHO) in its goal to achieve the global eradication of Polio. Some countries including Jamaica have achieved Polio eradication status but have experienced delays in the WHO recommended transition from the use of Sabin Oral Polio Vaccine (OPV) to the Inactivated Polio Vaccine (IPV). This delayed transition has resulted in the continued use of the OPV which has occasionally been associated with the isolation of vaccine-derived polioviruses (VDPV’s) from asymptomatic children. The circulation of VDPV will continue as long as oral polio vaccine (OPV) is in use. One of the critical factors defined by the WHO in the global eradication of Polio is the need to stop all Oral Polio Vaccine (OPV) use once wild polioviruses (WPVs) have been era-dicated. If surveillance emphasis does not greatly enhance the observation of cVDPV, detection of emerging neurovirulent cVDPV associated with non-paralytic and paralytic polio cases may be overlooked, thus prolonging the goal of global eradication and creating hidden reservoirs of potential mutant strains. This report describes a case of symptomatic VDPV infection in a child presenting with meningitis, reviews the significance of molecular analysis of this isolate and discusses the need to stop all OPV once wild poliovirus has been eradicated. Case Report: A three-year-old male was admitted to hospital with an abrupt onset of a two-day history of headache, photophobia and fever and a one-day history of nausea and vomiting. There was no history of similar illness in any other family members and the child lived in a lower income home with modern sanitary facilities. The child’s immunization status was incomplete as indicated by hospital records and a history from the mother. The last immunization (including OPV) had been given when the child was one year of age. On examination, the child was febrile and irritable. No abnormality was detected in the cardiovascular, respiratory or gastrointestinal system. There were signs of neck stiffness, although the Brudzinski’s sign was negative. No evidence of focal neurological involvement, papilleodema or motor weakness was detected. Cerebrospinal fluid (CSF), blood, throat and rectal swabs were taken for laboratory investigations where standard virologic procedures were followed. A provisional diagnosis of meningitis was made and the child was placed on empirical intravenous penicillin and chloramphenicol. Having received results that all bacterial laboratory investigations were negative, the diagnosis was subsequently changed to that of aseptic meningitis. Haematological results for CSF showed an elevated white blood cell (WBC) count of 48/mm3 but no differential was done. Other results included a normal CSF/blood sugar ratio of 0.6 (3.7 S.T. Jackson1; A.M. Mullings2; T.F. Booth3; L. MacDonald3; S.O. Henry4; C.A. Khan1; P.D. McLaughlin5 1Departments of Microbiology, The University of the West Indies, Kingston 7, Jamaica, West Indies 2Obstetrics, Gynaecology and Child Health, The University of the West Indies, Kingston 7, Jamaica 3National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada 4Bustamante Hospital for Children, Kingston 5, Jamaica 5Biochemistry Department, University of Technology, Kingston 6, Jamaica