Paralytic poliomyelitis associated with live oral poliomyelitis vaccine in child with HIV infection in Zimbabwe: case report
BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7187.841 (Published 27 March 1999) Cite this as: BMJ 1999;318:841
- Inam Chitsike, paediatrician,
- Ralph van Furth (RvanFurth{at}thuisnet.leidenuniv.nl), Unesco-Unitwin professor of immunology and infectious diseases; emeritus professor of internal medicine and infectious diseases
- Departments of Paediatrics and Immunology, Medical School of the University of Zimbabwe, PO Box A 178, Harare, Zimbabwe
- Leiden University Medical Centre, Netherlands
- Correspondence to: Professor R van Furth, Laan van Oud Poelgeest 44, 2341 NL Oegstgeest, Netherlands
- Accepted 16 April 1998
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.
Key messages
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
Footnotes
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Funding None.
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Competing interests None declared.
- Accepted 16 April 1998