k? (L20-21) Flashcards

polio replication polio vaccination

1
Q

Category of baltimore scheme for herpes

A
class I (double stranded dna genome)
All herpes viruses become latent after infection
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2
Q

Picornaviruses

A

Picornaviruses (Picornaviridae)
Literally pico = small, RNA viruses

Generic characteristics:

  • Single stranded positive sense RNA (Baltimore Class IV)
  • Non enveloped icosahedral particle, 60 copies of VP1 - 4
  • RNA typically 7-8 kb, single open reading frame
  • Genome has covalently attached protein at 5’ end (VPg)
  • Cytoplasmic replication
  • Replication typically cytopathic
  • RNA-dependent RNA polymerase
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3
Q

human picornaviruses: Historic classification by disease caused

A
  • Hepatitis A: acute viral hepatitis
  • Rhinoviruses: Common cold - mild URT disease
  • Polioviruses: Paralytic Polio - acute flaccid paralysis
  • Coxsackie A & B viruses: human gut isolates causing skin rashes (A) or affecting heart, liver etc (B)
  • Echoviruses: “no disease” (enteric cytopathic human orphan)
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4
Q

what viruses are groupes as enteroviruses

A

Polio, Coxsackie and Echoviruses grouped as Enteroviruses
More recently isolated examples simply ‘Enterovirus (EV) XX’
because of what/how they infect- replicate in the gut (even with diff pathologies)

[[ Rhinoviruses group in the same place as enteroviruses (in terms of genome sequence) despite their different biology
Rhinovirus causes the common cold - extremely mutative ]]

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5
Q

Picornavirus classification (family, genus, species, serotypes)

A

Family = Picornaviridae
Genus = Enterovirus, Hepatovirus, Parechovirus, (others)
Species = Enterovirus A – J; Rhinovirus A - C
of which Enterovirus A – D = human enterovirus A – D

Further subdivided into serotypes
Unique groups neutralized by type-specific antisera
Poliovirus type 1, type 2, type 3
Echovirus type 7
Rhinovirus type 14

Total of ~100 human enteroviruses and probably ~200 human rhinoviruses

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6
Q

how may serotypes can we split polio into? (also explain serotypes)

A

3 different serotypes of polio

Serotypes have to do with the antibody response that the virus elicits and the extent to which that response cross reacts with other viruses

So if 2 viruses in the same serotype - the antibody response to one will neutralise the activity to the other one
If the antibody of the first virus do not destroy the infectivity of the other one, then they are very separate serotypes

From a functional disease point of view, the serotypic distinction will determine if the virus will infect us

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7
Q

steps of Poliovirus replication cycle

A
Attachment
Entry 
Uncoating
Gene Expression and Genome Replication
Assembly 
Release
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8
Q

Identifying Poliovirus Receptor

A

PRIMARY DETERMINANT: virus receptor
Cell infection restricted to human and primate cells
Virus replicates in mouse cells but cannot infect them

cDNA library transfer screen in murine cells led to PV receptor isolation:

  • CD155 (a.k.a. PVR)
  • Transmembrane anchor
  • Ig superfamily member
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9
Q

use of polio receptors

A

Level of infectability of a microorganism depends on if they have the right receptors on its surface

Viruses use that receptor to attach to the cell’s surface and it will allow it to enter the cell

We can turn some non-infectious viruses infectious by introducing the right receptors on their surfaces
CD155 is the human receptor that allows the polio virus inside our cells
it is a transmembrane protein, and each loop is an immunoglobulin like fold
poliovirus receptor has immunoglobulin domains on its extracellular parts

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10
Q

cDNA library transfer screen

A

cdna library transfer screen for every cdna coming out of the human cell, so every mrna copied into a DNA form, can the cdna molecule infect some mouse cells that are not usually infected by this virus?

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11
Q

use of CD155

A

CD155 renders mouse cells permissive

we’ve got a time course of infection here in the open symbols of what are human cells in the lab
here we have some mouse cells that have been persuaded to express the human protein using the clone DNA from the experiment
and they too are able to support a productive infection by poliovirus
there is no control of mouse cells without the CD155 to price that the virus cannot enter those cells

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12
Q

Virus particle with bound receptors

how does the CD155 interact with the polio virus particle?

A

particle with three different surface proteins VP1 2 and 3. is icosahedral and what that means is there are dotted around its surface 12 5 fold axis of symmetry, which are effectively the vertices of the icosahedral particle

the 5 fold axis of symmetry is seen in the red circle looking like a star
that’s the pointy bit of the particle formed by VP1
in yellow we can see the receptor interactions with the particle. so the receptor binds at 5 equivalent sites around each of the vertices of the particle

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13
Q

Receptor Binding Site: Canyon and Pocket

A

TOO MANY NOTES… GO TO L20 S12

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14
Q

Receptor-induced conformational change

A

Receptor binding displaces pocket factor
Increases flexibility of VP1; allows VP4 to interact with membrane
Probably needs interaction with multiple CD155 molecules

this shows the binding event, receptor and the particle with its vertex
the confirmation of the vertex changes to open up a channel which allows the RNA of the particle to pass across the membrane into the cytoplasm of the cell

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15
Q

Virus interaction with CD155 steps (3)

A
Attachment
Conformational change (Irreversible commitment)
Entry at cell surface (Delivery of genome & Usually in a pit)

LONG SUMMARY IN L20 S14

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16
Q

The poliovirus genome and proteins

A
KEY POINTS
SINGLE ORF
POLYPROTEIN
PROCESSING BY PROTEASES TO LIBERATE THE FINISH PRODUCT
CAPSID PROTEINS

LONG AF NOTES IN L20 S16

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17
Q

IRES element role

A

IRES element directs polyprotein translation
IRES – internal ribosome entry site:
a highly structured piece of RNA at the 5’ end of PV genome / mRNA

  • Non-canonical translation initiation mechanism ….
  • Allows virus to disrupt cap-dependent translation
    3C protease cleaves key cap recognition factors
  • Turns cell into virus protein factory
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18
Q

how does translation initiate on that rna molecule to produce that body protein?

A

On the right - shows protein synthesis in infected cells and then 1/3/5/7h after (this is radio labelling where every protein that is produced incorporated radioactivity and produces a black band on the film)
0h - all the proteins of diff sizes are being synthesised
1h - not much difference
5h - background of cellular activity has largely reduced and has been replaced by the synthesis of the viral proteins like the precursors and the finished products
→ so virus takes over the cell, they are cytolytic and destroy the cell

5 CAP recruits ribosome onto its rna - viral RNA doesn’t have a Cap only has VPG. but VPG fulfils the other role of the cap of protecting the RNA from degradation but it does not recruit ribosomes. it has a different mechanisms to recruit ribosomes.
in the untranslated region it has an IRES. it’s a place on the rna that allows the ribosomes to bind so that they can move along and find aug.

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19
Q

mRNA and Genome Synthesis

A

Replication complexes develop from cytoplasmic cis-Golgi membranes
(+) sense and (-) sense RNA made by same mechanism
Both have VPg at 5’ end: acts as primer for RNA synth
Far more (+) RNA made than (-) RNA
Only (+) RNA released from replication complex

this shows the flow of information that has to occur
the incoming RNA is positive sense so we need to produce a negative sense copy first, student form copies of positive sense by base pairing replication
you can have amplification in each step
in the infected cell we have a lot more positive sense RNA than negative sense. this initiates the hydroxyl group in the VPG.
Polymerase starts at the 3’ end, produces copies

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20
Q

Poliovirus reverse genetics

A

DIAGRAM IN L20 S19

the fact that the poliovirus RNA is all that is needed to initiate infection, is the reason why it is possible to have reverse genetics in the poliovirus (taking the genetic material of the virus and introducing it into the cell artificially, the cell will become infected and produce progeny virus)

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21
Q

Poliovirus Pathogenesis 1

transmission, initial replication, virus drains into?, natural human infections

A

Transmission primarily faecal-oral
Possibly by respiratory droplets where hygiene levels are high

Initial replication in the oropharyngeal and intestinal mucosa
Follicle-associated epithelium (M cells and Peyer’s patches)
Virus shed in faeces (major transmission route: faecal-oral)

Virus drains into cervical and mesenteric lymph nodes and then to the blood
Transient viraemia

Most natural human infections (~99%) end at this stage
Minor disease with non-specific symptoms
E.g. malaise, sore throat, fever

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22
Q

Poliovirus Pathogenesis 2

A

this is the other 1-2%
Transient viraemia established as before

Viraemia allows replication at extraneural sites (reticuloendothelial tissue, brown fat, muscle)

Virus enters the central nervous system (CNS)

  • Replication in motor neurons in spinal chord, brain stem or motor cortex leads to paralysis
  • Withered/deformed limb(s)
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23
Q

enterovirus diseases caused by ?

A

Many Enterovirus Diseases are due to secondary spread
All diff enteroviruses will replicate in pharynx or intestine, and spread via blood
They infect other regions like skin muscles brain or meninges

24
Q

what is the study done on mice to prove that the CD155 Receptor is necessary for Infection and Pathogenesis

A

Tg mice that express human CD155 now become susceptible to to polio infection
Tg mice not susceptible via oral route because of low/non-expn of CD155 in gut lymphoid tissue (Peyer’s patches)
Only 1-2% of polio infected people get paralysis
The vaccine strain is nonpathogenic in those animals

Animals that are not transgenic and so don’t have the receptors - will not get infection/disease
You can achieve disease with intracerebral production and via intravenous and intraperitoneal
Cannot achieve it with oral infection because very low chance of getting paralytic disease and they did not infect hundreds of mice for ethical reasons

25
Q

is the CD155 receptor sufficient for infection?
Why is virus replication restricted to just a few sites?
Are cell/tissue-dependent translation factors needed for IRES function?

A

Expression of CD155 is more widespread than the observed tissue tropism of PV (In humans and in transgenic mice)

Why is virus replication restricted to just a few sites?
Tropism is, in part, a post-receptor phenomenon

Are cell/tissue-dependent translation factors needed for IRES function?
NO: The IRES works in many tissues in which PV replication fails
i.e. Tropism determined at a post-translational step

26
Q

how does the Type 1 IFN response determine PV tropism

A

PV infection of CD155-expressing mice induces a robust IFN response and expression of ISGs in non-neuronal tissue
(( BUT in neuronal tissue the IFN response is weak ))
CD155-expressing mice that lack an IFN response allow PV replication in a much wider range of tissues
So IFNα/β is a key determinant in preventing PV infection in non-neuronal organs/tissues

Interferon receptor-negative (IFNAR-/-) mice transgenic for CD155 infected with poliovirus (virus replicates in liver, spleen, pancreas, and cns)
Infection of Tg mice usually induces robust expression of IFN-stimulated genes (ISG) in extraneural tissue
In contrast, ISG expression in neural tissue only moderately increased upon infection
IFNalpha/beta a key determinant in protecting extraneural organs from poliovirus infection (do paralyzed individuals have defects in IFN)

27
Q

how does poliovirus reach the CNS?

A

Two possible routes (not mutually exclusive):

  • Viraemia then crossing the blood – brain barrier
  • Axonal transport from a peripheral nerve
28
Q

Evidence to support direct transfer from blood

A

Viraemia precedes paralysis
- Antibodies block transmission to CNS
- Virus distribution in the brain of CD155 Tg and non-Tg mice is the same after i.v. inoculation
(crossing the blood – brain barrier is CD155-independent)
- Pharmacokinetics of virus transmission from tail vein to brain: very efficient and CD155 independent

29
Q

Evidence for axonal transport

A
  • Inoculation of sciatic nerve leads to spread of virus into CNS (1936)
  • Monkeys or CD155 Tg-mice inoculated i.m. always show paralysis in inoculated limb first
  • “Cutter incident” children inoculated with partially inactivated PV showed paralysis first in inoculated limb
  • Sciatic nerve transection of CD155 Tg-mice blocks transmission to spinal chord
  • Convincing evidence for fast (12 cm/day, replication independent) retrograde axonal transport from peripheral nerves to spinal chord
30
Q

POLIO VACCINATION LECTURE

A

LECTURE 21

31
Q

a History of Poliomyelitis

A
low endemic presence for centuries
improved antitation and increased population densities
- more unprotected hosts
- epidemic (0.5 million per year)
- quarantine in schools and pools
32
Q

the upswing of poliomyelitis through the start of the 20th century coincides with two socioeconomic changes:

A
  • first of all all the increasing size of cities and population density generally
  • secondly the improvements in sanitation which paradoxically mean the people get exposed to viruses later in life (which typically means the consequences of infection are greater by the early years of the twentieth century)
33
Q

First Polio Vaccines and its timeline from the 1950s

A
  • Inactivated polio vaccine (IPV) – Jonas Salk :

The first available polio vaccine, injected i.m.
Formaldehyde-inact., neurovirulent virus
Three serotypes
Prevents disease due to wPV, but not replication in gut, hence doesn’t block wPV transmission

  • Timeline (from early 1950’s)

used throughout in Scandinavia
“Cutter incident”: USA 1955
reintroduced as vaccine of choice in USA, 2000
replaced OPV in UK in 2004: component of 5-part vaccine [diptheria, pertussis, tetanus, Hib, polio]

34
Q

“Cutter Incident” - 1955 - and consequences

A

APRIL 1955: IPV from Cutter Laboratories used in ~200,000 children in West and Mid-West states
40,000 cases of disease; 200 paralysed, 10 died
Inadequately inactivated IPV batch

CONSEQUENCES:
Abandonment of first polio mass vaccination campaign
Replacement of IPV with OPV for US vaccinations
A ‘dangerous’ vaccine replaced by a more dangerous one
Effective Federal regulation of vaccines
Manufacturer’s legal liability: massive litigation despite finding of ‘no negligence’
National Vaccine Injuries Compensation Program

35
Q

Polio Vaccines - 2 - , its serotypes and timeline from late 1950s

A

Oral polio vaccine (OPV) – Albert Sabin

  • Oral delivery, live attenuated vaccine
  • Prevents replication in gut, and hence transmission, of wPV

Three serotypes, produced in monkey cells
- Low rate of vaccine-associated poliomyelitis (VAPP)

  • Timeline (from late 1950’s)
    used in most areas of the world since 1962
    was in standard use in USA until 2000, UK until 2004
    Basis for WHO global eradication campaign
36
Q

Attenuation of poliovirus: e.g. Sabin type 3

process to make the serotype 3

A

Process to make the serotype 3 - empirical process (no planning, no specific steps)

the basis of that attenuation is genetic change in the virus and the reason why such genetic changes are selected for in a process like this is because you’re growing the virus in an unnatural host and you are therefore requiring different properties of the virus in order for it to be successful in that non-natural situation
features of the virus that would be limiting for its growth in this non-natural host system will get changed by mutation (that will be what it was selected for when you put the virus into this situation)
and that selection process then ends up producing changes which limit the growth of the virus in human cells

37
Q

process of mutational changes

A

DIAGRAM IN L21 S9

process of mutational changes illustrated here for the sabin 3, sequence of the sabin 3 vaccine strain is represented as the line through the middle here with the position shown being shown where the sequence is different from that of the parent or from the sequence of a reverted (the parent viruses is neurovirulent, the strain it was derived from)
if you take that strain and use it in people repeatedly, you can get reversion which is the emergence of the polio virus, because you are now selecting in the opposite direction. Put it back into its natural host it will now be optimised in this unnatural host so the process of change will go into reverse and you will get different series of changes.

so from this information on here you can start to infer what actually might be the sequence differences that are really significant in determining virulence basically, the nucleotide that is different between the parent and the vaccine and different between the vaccine and the reversing (small nmbr of nucleotide positions)

38
Q

which experiments help us figure out which one is exactly responsible?

A

Can do experiments to figure out which one is exactly responsible by swapping different bits of the neurovirulent genome, into the vaccines (dark blue is vaccine, light blue is a different neurovirus genome).
If it isnt, it will not kill the monkey, if it is, it will kill the monkey

That allows you to determine that key position

39
Q

Sabin attenuation determinants

A

True for all 3 sabin strains
The key mutation between the attenuated virus and the virulent virus is the 5’ untranslated region of each of the 3 viruses

Would expect it to be in the protein sequence to make it dysfunctional

40
Q

Major polio vaccine attenuating mutations

A

5’ UR has an IRES (directs the ribosome onto it for translation)
Will determine how efficiently the genes are expressed

Alters the cognate region, reduces the strength of base pairing in stem loop region and alters the recruitment of a host cell protein onto the IRES (so makes it a worse virus)

As a result, the virus will not grow as well
Not an actual difference in quality of virus, but in the quantity of virus that alters the virulence

41
Q

Immune response to polio vaccine

A

GRAPHS IN L21 S12

42
Q

Comparison of IPV and OPV

A

TABLE IN L21 S13

the oral vaccine can revert to violence by recreating dangerous virus where as the killed vaccine cannot.

Only killed vaccine is suitable to use (would not be safe to use a l
live vaccine to immunocompromised people, because it could be non-attenuated, could revert to virulence)

Response in tropical countries is less good with OPV

43
Q

Impact of polio vaccination in western populations

A

the vaccine has been very effective in Western population in reducing and eliminating the burden of polio disease

44
Q

Rationale for Polio Eradication

possible because / difficult because

A

POSSIBLE BECAUSE
polio only affects humans, there is no animal reservoir
an effective, inexpensive vaccine exists
immunity is life-long
there are no long-term carriers*
the virus cannot survive for long outside the body

DIFFICULT BECAUSE
200:1 inapparent infection
Symptoms similar to other diseases
Vaccine reverts to virulence: disease in 1 in 106 recipients
Recombination of vaccine with other viruses

45
Q

Strategy for Polio Eradication - 1988

A

routine immunization with trivalent OPV
supplementary additional doses of tOPV during National Immunization Days
mopping-up immunization activities
enhanced surveillance for all cases of acute flaccid (floppy) paralysis and wild poliovirus
progressive declaration of areas as polio-free: requires three years without any locally transmitted cases

Target: global eradication by 2005

46
Q

GRAPHS AND MAPS IN L21 SLIDES 18-24

A

KEY MILESTONES ACHIEVED, DIFFICULTIES EMERGED, DON’T REMEMBER NUMBER OF CASES, MAYBE TREND OF NUMBER OF CASES

47
Q

Setbacks to polio eradication

A

Virus reintroduction (travel, migration)

Outbreaks in endemic countries

Loss of vaccine confidence: Nigeria

  • Vaccination halted in northern state of Kano during 2003 - a hotspot for transmission
  • Allegations that vaccine was deliberately contaminated
  • Vaccination restarted after a year, once the vaccine had been tested in countries that the people’s religious leaders trusted
  • Virus spread back to other parts of Nigeria and to neighbouring countries
  • Took several years to bring back under control
48
Q

Polio Outbreak Response

A

Rapid investigation and emergency planning:
( Initial investigation & international risk assessment within 72 hrs of confirmed outbreak )

Rapid sustained response:
( Minimum of 3 large-scale immunization campaigns, the first within 4 weeks of index case
Subsequent rounds at max 4 week intervals )

High quality response:
( House to house campaign for >90% coverage
Independent monitoring of coverage )

Vaccine formulation
( Use monovalent OPV of the type causing the outbreak
Improves vaccine ‘take’ and avoids introducing other PV types into the area )
49
Q

WILD POLIOVIRUS TRENDS 2011-2014

A

MAPS L21 S27 TO 31

50
Q

Vaccine-associated paralytic poliomyelitis (VAPP)

A

Inherent problem with Sabin vaccine strains (OPV)

Reversion to neurovirulence in most vaccinees within 2-3 days
( Excreted virus can infect unvaccinated contacts )

Cases of VAPP are caused by vaccine-derived PV (VDPV) and such strains can circulate to cause small outbreaks (cVDPV)
( Ease of reversion: VDPV2 > VDPV3&raquo_space; VDPV1 )

Only 1 in 0.75-1m OPV vaccinees develops VAPP
( Innate immune response probably protects most people from the pathogenic effects of neurovirulent revertants
Are VAPP cases different (how?) or just stochastically unlucky? )

51
Q

The VAPP problem in context

A

When large numbers of wPV – induced cases were occurring, VAPP problem was globally insignificant
[Risk / benefit ratio good]

At individual country level, VAPP was significant
[ Decision to move from OPV to IPV in the USA, Europe etc ]

Now low levels of wPV disease mean VAPP is significant everywhere
[ - No wPV2 cases since 1999
- Evidence mono- / bivalent OPV is more effective against PV1/3 than trivalent
- April 2016: Sabin PV2 was dropped from the OPV used in global eradication campaigns. Now bOPV (Sabin 1 and 3). ]

52
Q

current 2019 situation of Wild PV and cVDVP

A

Three endemic countries [ Afghanistan, Pakistan, Nigeria, with Nigeria having a potential to be declared wPV-free in 2020 (would mean Africa region declared free of wPV too) ]

No wPV importation cases globally since 2014

wPV1 case numbers up on 2018 (equiv period)

cVDPV case numbers similar to 2018 (equiv period)
[ Outbreak in Papua New Guinea ended, Somalia reduced
New outbreaks in Myanmar, W Nigeria, DRC, CAR and Angola ]

53
Q

SUMMARY OF ERADICATION MILESONES

A

1994: Americas WHO region
2000: W Pacific WHO region
2002: Europe WHO region
(6 endemic countries: afghanistan, egypt, india, nigeria, niger, pakistan)
2006 jan: Egypt and Niger declared wild polio-free
March 2014: India declared wild polio-free
2014: SE Asia WHO region
2015 sept: wPV2 declared eradicated
2019, 24 oct: wPV3 declared eradicated (none detected since 2012)

54
Q

Ongoing Eradication Issues

A

Breaking chains of transmission in remaining hot-spots (geo-political issues; monovalent vaccines)

Funding for continuing vaccination efforts: Many poorer polio-free countries have relatively low vaccination coverage in population

Environmental surveillance suggests some circulation of wild and cVDVP strains continues in the absence of cases of AFP

Are there long-term vaccinated carriers?

THE REVERSION OF OPV STRAINS IS MAKING ERADICATION DIFFICULT

55
Q

Polio: Beyond eradication (containment in labs, reclassification, when to stop the vaccinations)

A

Containment of laboratory stocks and specimens

Reclassification of wild PV2 and Sabin PV2 as level 3 pathogens (PV3/Sabin PV3 to follow)

Difficult issue: when and how to stop vaccinating

  • Coordinated cessation of use of OPV within 3 years of eradication of wild polio (ASAP actually)
  • There will still be reservoirs of wPV or cVDPV in the environment
  • Stockpiles of IPV to counter outbreaks
  • New stable attenuated strains to make nOPV and nIPV
56
Q

how long can we keep vaccinations going?

A

World cannot afford to maintain vaccination activities at the levels needed to achieve eradication. Once achieved, vaccination will cease.

Before stopping vaccination, need to be assured that all sources of reinfection have been isolated and contained. Polio will go up to a level 4 containment hazard. Key target is laboratory-held samples. Not as simple as identifying all vials of titred polio virus stocks. Lots of clinical specimens that might harbour either wild polio or revertant vaccine. Everyone who has been vaccinated with OPV will have been a vaccine excreter for a period of time.
‘Polio man’: a healthy carrier of wild polio identified in Europe in 2002. He had been vaccinated but had chronic immunodeficiency.