Virology Chapter 5-6: Picornaviruses (Poliovirus) Flashcards
How are enteroviruses (such as poliovirus) usually transmitted?
fecal-oral route
Pathogenesis of Poliovirus – Route
- oropharyngeal mucosa
- replicated for 1-2 weeks
- asymptomatic, or mild illness (ie. sore throat) - stomach
- epithelial cells of lower intestinal tract
- extensive replication
- may result in transient viremia - [if it enters blood] may target CNS
- infect certain types of nerve cells
- kill these cells when egressing after replication - excreted in feces
- several weeks
What is transient viremia?
virus in bloodstream
What are the 4 responses that may occur after infection with poliovirus?
- subclinical infection without symptoms
- abortive polio (mild illness)
- non-paralytic poliomyelitis (aseptic meningitis)
- paralytic poliomyelitis
What is abortive polio?
- symptoms
- recovery period
- diagnosis
most common form of polio
symptoms:
- febrile illness
- non-specific symptoms – malaise, drowsiness, headache, nausea, vomiting, sore throate
recovery period:
- few days
diagnosis
- only recognized and confirmed if virus is detected in blood
What is non-paralytic polio (aseptic meningitis)?
- symptoms
- recovery
symptoms:
- same as abortive polio
- stiffness and pain in neck and back (2-10 days)
recovery:
- rapid
- complete
What is paralytic polio?
- symptoms
- recovery
major illness (< 1% of infections)
- antibodies to the virus appear early in infection, and are usually present when paralysis appears
symptoms:
- flaccid paralysis – results from LMN damage
- amount of damage varies
recovery:
- usually max. within 6 months, but can take longer
What is post poliomyelitis muscle atrophy (PPMA)?
‘reappearance’ of paralysis and muscle wasting observed decades after illness and recovery from paralytic poliomyelitis
What causes post poliomyelitis muscle atrophy (PPMA)?
result of the normal decline in function of motor neurons that had compensated for the loss in function of motor neutrons killed by poliovirus
not a consequence of a persistent infection or re-infection
How many poliovirus serotypes are there?
1, 2, 3
What is a serotype?
variant of the virus that will elicit production of a distinct population of antibodies
antibodies bind to the serotype used as the antigen, but not to other serotypes of the virus
infection (and subsequent antibody production) with one serotype of poliovirus does not confer protection against other serotypes
Where are the epitopes responsible for production of neutralizing antibodies?
on structural proteins VP1, VP2, and VP3
What are most of the neutralizing antibodies against?
epitopes on VP1
immunization with poliovirus serotype 1 will elicit production of antibodies that recognize VP1, VP2, and VP3 proteins of serotype 1
these antibodies will NOT bind to VP1, VP2, and VP3 proteins of poliovirus serotype 2
What are the two forms of poliovirus vaccine available?
- Salk’s IPV (inactivated poliovirus vaccine) –injected
- Sabin’s OPV (oral poliovirus vaccine) – ingested
How is the IPV vaccine made?
- the 3 serotypes of poliovirus are cultivated using monkey kidney cells or human cell lines
- viruses are concentrated, purified, and inactivated with formaldehyde
What does the IPV induce? What does it not?
production of protective serum antibodies (IgG)
does not confer localized immunity – no secretion of IgA antibody into mucosal lining of GI tract
Is reinfection after IPV possible?
reinfection of the alimentary tract is possible
What are the advantages of IPV? (2)
- confers protective antibody mediated immunity in the blood when given in sufficient doses
- no active viruses excludes the potential for reversion to virulence by mutation, and allows for its use in immunodeficient or immunosuppressed individual
What are the disadvantages of IPV? (3)
- requires boosters
- does not induce antibody mediated immunity in intestinal mucosa – vaccinated people might transmit wild poliovirus to susceptible people by oral-fecal route
- expensive – requires sterile needles and syringes, require highly trained personnel to administer
What does OPV contain?
active attenuated strains of two poliovirus serotypes cultivated from monkey kidney cell culture
Where do viruses of the OPV vaccine infect?
infects and replicates in cells of the host
What does OPV do?
confers both systemic (IgG) and localized (IgA in mucosal lining of GI tract) immunity
What are two significant problems with OPV?
- low rate of mutation, where virus reverts back to its virulent form and can cause paralytic poliomyelitis in vaccinated recipient
- virus is shed in feces of vaccinated recipient for several weeks, and can be disseminated to unvaccinated contacts
What is the recommended vaccination protocol?
IPV for initial vaccination
- would have serum antibodies against poliovirus
OPV for booster
- induces localized intestinal immunity
- serum antibodies would protect the person if the poliovirus reverted back to its virulent form
What are the advantages of OPV? (5)
- confers antibody mediated immunity at intestinal mucosa – mimics natural infection
- induces antibody production in recipient very quickly
- does not require boosters
- oral administration is more acceptable to recipient – easier to accomplish than injection
- relatively cheap to produce, administer (does not require highly trained individuals to administer vaccine), inexpensive mass immunization without the need for sterile equipment (ie. needles)
What are the disadvantages of OPV? (3)
- virus can mutate and (in rare instances) revert back to form of neurovirulence that is sufficient to cause paralytic polio in vaccine recipient or susceptible contacts
- vaccine progeny spreads to others in contact with recipient (ie. household) – often the virus that is excreted has mutated and may not be safe as the original virus used in the vaccine
- cannot be given to immunodeficient or immunosuppressed individuals or members of their household