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Polio in the Cancer Ward (article)

New England Journal of Medicine recently published a short message on two cases of polio vaccine-derived, which originated in the German pavilion of childhood cancer three years ago. Two girls severely immune from the Middle East - one from Libya and other Saudi Arabia - had traveled with their families to search for a specialist in Germany medical treatment.

Five-month-old girl, known as a patient in one article, requires a bone marrow transplant for severe combined immune deficiency (SCID), a rare genetic disorder (1). This condition is achieved public notoriety in the case of "Bubble Boy," David Vetter, a child who was isolated in a sterile environments for more than a decade from childhood to protect it from exposure to infectious killer diseases. The patient was 2 years of asking the same treatment for other rare immune disease, major histocompatibility complex class II deficiency, which is a variant of the SCID.

Each of the two genetic disorders that lead to, immune deficiency profound life-threatening. Children are diagnosed at birth, usually after suffering from repeated bouts of ear and lung infections and multiple hospitals. The prognosis is poor, with patients usually die in childhood or adolescence of bacterial infections, viral or fungal majority (2). Bone marrow transplant operation is the only treatment available.

And vaccinate a child while watching the Jonas Salk, creator of IPV, and management of the vaccine on television. Image: US National Library of Medicine. Click to get the source.
And vaccinate a child while watching the Jonas Salk, creator of the polio vaccine slain, and management of the vaccine on television. Image: US National Library of Medicine. Click to get the source.
In 2013, and the patient 1 and 2, the patient traveled to Germany to receive a bone marrow transplant. As is common after receipt of the gaseous procedure, the girls received both medical workups routine to diagnose any potential or ongoing infection. Rather unexpectedly, but was detected polio virus in stool samples, in spite of all the girls were free of any of the symptoms associated with polio infection. It should be noted, had previously been vaccinated all the children who suffer from polio vaccine by mouth as is common in their country of origin.

Polio vaccines come in two flavors. A polio vaccine slain, administered by intramuscular injection. In this vaccine virus or been revoked "kill" of formalin, still maintaining a lot of the molecular structure which allows the immune system to recognize and develop protective antibodies virus.

Another type of polio vaccine is available for oral polio vaccine (OPV), a "live" vaccine contains a virus has weakened - attenuated in technical language - through the cultivation of multiple generations of the virus in cell cultures. With each new generation, or "serial passage" of the virus in the culture of cells, the virus is evolving, and the loss of virulence and ability to cause paralysis and death (3). Vaccine being "live", this virus is weak is still capable of replication. As such, the management of infection mimics OPV with the actual polio virus both in terms of their access through the mouth and in the type of immune protection it generates polio infection and disease. And it manages the vaccine through two oral drops and moves into the intestines, where the virus is weak and repeat stimulate antibody response. After that is the revival of these same antibodies in the future should be the body becomes susceptible to the actual virus polio.

Photograph depicting oral administration of the polio vaccine to immunize this baby for this disease. Vaccination against polio in the well-child clinic in DeKalb, Georgia 0.1977 Province.
Baby receiving the oral polio vaccine (OPV) in DeKalb County, Georgia, in 1977. Image: CDC / Meredith Hickson
There are advantages to both vaccines, but this is an oral vaccine that we owe the tremendous success of the global eradication of polio over the past fifty-odd years. This vaccine does not require refrigeration or injections and is therefore easier to ship and take advantage in areas that lack the resources, which makes the vaccine, the vaccine of choice in developing countries (4). It is commonly used in large-scale vaccination campaigns that take place in areas that are lacking in the midst of the polio outbreak and has served as the most effective in the ongoing elimination of polio worldwide is our weapon.

But the oral vaccine does come with risks, and has been known to cause extremely rare cases of polio vaccine-associated (VAPP) in recipients. Undergone these viruses associated with the vaccine, borne of the polio virus is diluted, and the change is hereditary and it was repeated in the intestine after immunization was recovered later in the ability to cause neurological damage in vaccine recipients (5) (6). This situation is a bargain for once, and only occurs in one person who had received the vaccine.

There are also related to polio infection from the vaccine virus phenomenon (VDPV) that the virus in the vaccine mutated and back to the "virulent nervous" phenotype capable of causing an outbreak of (4). This VDPVs vary from VAPPs that the new virus can be disseminated widely. VDPVs usually occur in areas where polio had been eradicated successfully, and there is a low degree in later vaccination coverage with some of the children who have been vaccinated by the vaccine and others do not (4). According to the publication by the Center for Disease Control in February, and there are currently five countries - Guinea, Laos, Madagascar, Myanmar, Ukraine - experiencing outbreaks of polio ongoing child-derived vaccine (7).

It is known that patients with immunodeficiency, SCID, especially, are at increased risk of secretion-derived strains of the polio vaccine. Without the immune system works to respond adequately to this disease Owalsatrh weakness, these patients can harbor the virus for years, allowing the virus to mutate, and act as a re-polio in places that eliminate the virus has been the source. In 2013, five cases of VDPV in India to monitor, in each case attributed to a person diagnosed with HIV - specifically, the circumstances in which their immune system is unable to produce antibodies (8).

Although rare case, these two cases of VDPV in young patients from the Middle East as a reminder that those with serious immune deficiency who received the vaccine should receive to monitor the development of each of polio, as well as the secretion of the virus. This awareness must be our ongoing commitment to success in the extinction of the virus that has plagued humanity since antiquity time
Title : Polio in the Cancer Ward (article)
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