BMJ 1999;318:841-843 ( 27 March )

Papers

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

Inam Chitsike, paediatrician,  Ralph van Furth, Unesco-Unitwin professor of immunology and infectious diseases; emeritus professor of internal medicine and infectious diseases, Leiden University Medical Centre, Netherlands. 

Departments of Paediatrics and Immunology, Medical School of the University of Zimbabwe, PO Box A 178, Harare, Zimbabwe

Correspondence to: Professor R van Furth, Laan van Oud Poelgeest 44, 2341 NL Oegstgeest, Netherlands RvanFurth{at}thuisnet.leidenuniv.nl

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




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Poliomyelitis may occur in children with HIV after poliomyelitis vaccination
BMJ 1999 318: 0. [Full Text]

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