Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 25, Number 7—July 2019
Historical Review

Facility-Associated Release of Polioviruses into Communities—Risks for the Posteradication Era

Ananda S. BandyopadhyayComments to Author , Harpal Singh, Jacqueline Fournier-Caruana, John F. Modlin, Jay Wenger, Jeffrey Partridge, Roland W. Sutter, and Michel J. Zaffran
Author affiliations: Bill & Melinda Gates Foundation, Seattle, Washington, USA (A.S. Bandyopadhyay, J.F. Modlin, J. Wenger, J. Partridge); World Health Organization, Geneva, Switzerland (H. Singh, J. Fournier-Caruana, R.W. Sutter, M.J. Zaffran); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (R.W. Sutter)

Main Article

Table 2

Reported incidents of poliovirus release from laboratories and vaccine production facilities in the post–polio vaccine era*

Year Location (reference) Source Poliovirus type No. cases Exposure
 Description
Primary Secondary Tertiary
1955
 United States (27,28)
 Vaccine production facility
 Not indicated
 164
 Vaccine recipients(≈40,000 children)
 113 contacts of the children
 NA
 “Cutter incident”; inadequate formaldehyde virus inactivation during poliovirus vaccine production (≈120,000 doses); ≈40,000 children experienced muscle weakness, of whom 51 experienced paralysis; 5 deaths; 113 contacts of the children were also paralyzed, of whom 5 died
1991
 France (29)
 Lab and
vaccine production facility
 WPV3 (Saukett) strain
 1
 No definitive information on exposure of case
 Saukett strain isolated in France from a woman from Algeria; source of this lab strain could not be confirmed
1992
 Netherlands (30)
 Vaccine production facility
 WPV1 (Mahoney) strain
 1
 Father (worker at facility)
 Son
 NA
 Boy (age 19 mo) with respiratory symptoms (no paralysis); father with history of accidental exposure to Mahoney strains while working in a poliovirus vaccine production facility
1993
 Netherlands (30)
 Vaccine production facility
 WPV3 (Saukett) strain
 1
 No definitive information on exposure of case
 Child with gastroenteritis (no paralysis); had travel history to France; no epidemiology established to trace lab exposure; Saukett strains typical for IPV production in France isolated from the stool samples
2000
 India (31–33)
 Lab and
vaccine production facility
 WPV2 (MEF-1) strain
 3
 No definitive information on exposure of case
 WPV2 isolates found in Sep 2000 and Nov 2002–Feb 2003 from 10 children with AFP, 1 healthy contact, and 1 environmental sample; isolates unrelated to all previous WPV2 strains found in India; because this was a lab reference strain and not a community-derived wild strain, lab source was suspected
2002–2003
 India (31–33)
 Lab and
vaccine production facility
 WPV2 (MEF-1) strain
 8
 No definitive information on exposure of case
2014
 Belgium (34,35)
 Vaccine production facility
 WPV3 (Saukett) strain
 0
 NA
 NA
 NA
 ≈1013 infectious WPV3 particles accidentally released into sewage system from production plant in Belgium; no poliovirus detected in environmental or human samples
2017 Netherlands (12) Vaccine production facility WPV2 (MEF-1) strain 1 Worker None None Accidental leakage in vaccine production room; 1 of 2 exposed staff members tested positive by RT-PCR

*Cases are defined as laboratory positive (with or without paralysis) for poliovirus by standard methods of virus isolation or known exposure to poliovirus. AFP, acute flaccid paralysis; IPV, inactivated poliovirus vaccine; lab, laboratory; MEF-1, wild poliovirus type 2 laboratory reference strain; NA, not applicable; RT-PCR, reverse transcription PCR; WPV, wild poliovirus; WPV1, wild poliovirus type 1; WPV2, wild poliovirus type 2; WPV3, wild poliovirus type 3.

Main Article

References
  1. World Health Organization. World Health Assembly resolution WHA41.28. Global eradication of poliomyelitis by the year 2000 [cited 2018 Oct 10]. http://www.who.int/ihr/polioresolution4128en.pdf
  2. Global Polio Eradication Initiative. Global wild poliovirus 2012–2018 [cited 2018 Oct 10]. http://polioeradication.org/wp-content/uploads/2018/08/global-wild-poliovirus-2013-2018-20180807.pdf
  3. Martín  J. Vaccine-derived poliovirus from long term excretors and the end game of polio eradication. Biologicals. 2006;34:117–22. PubMed
  4. de Silva  R, Gunasena  S, Ratnayake  D, Wickremesinghe  GD, Kumarasiri  CD, Pushpakumara  BA, et al. Prevalence of prolonged and chronic poliovirus excretion among persons with primary immune deficiency disorders in Sri Lanka. Vaccine. 2012;30:7561–5. DOIPubMed
  5. Global Polio Eradication Initiative. Polio eradication and endgame strategic plan 2013–2018 [cited 2018 Nov 2]. http://polioeradication.org/wp-content/uploads/2016/07/PEESP_EN_A4.pdf
  6. World Health Organization. WHO global action plan to minimize poliovirus facility-associated risk after type-specific eradication of wild polioviruses and sequential cessation of oral polio vaccine use (GAPIII) [cited 2018 Nov 2]. http://www.polioeradication.org/wp-content/uploads/2016/12/GAPIII_2014.pdf
  7. Global Polio Eradication Initiative. Global eradication of wild poliovirus type 2 declared [cited 2018 Nov 2]. http://polioeradication.org/news-post/global-eradication-of-wild-poliovirus-type-2-declared
  8. Global Certification Commission for the Eradication of Poliomyelitis. Report from the sixteenth GCC meeting, Paris, France, 4–5 July 2017 [cited 2018 Nov 2]. http://polioeradication.org/wp-content/uploads/2017/09/GCC-16th-meeting-report-0405072017.pdf
  9. Global Certification Commission for the Eradication of Poliomyelitis. Report from the special meeting of the GCC on poliovirus containment, Geneva, Switzerland, 23–25 October 2017 [cited 2018 Nov 2]. http://polioeradication.org/wp-content/uploads/2018/01/polio-global-certification-commission-report-2017-10-final-en.pdf
  10. Rijksinstituut voor Volksgezondheid en Milieu (National Institute for Public Health and the Environment, the Netherlands). Employee vaccine manufacturer infected with polio virus [cited 2018 Nov 2]. https://www.rivm.nl/en/Documents_and_publications/Common_and_Present/Newsmessages/2017/Employee_vaccine_manufacturer_infected_with_polio_virus
  11. Bilthoven Biologicals. Employee infected with polio virus [cited 2018 Nov 2]. https://www.bbio.nl/nieuws/2017/april/medewerker-besmet-met-poliovirus
  12. Duizer  E, Ruijs  WL, van der Weijden  CP, Timen  A. Response to a wild poliovirus type 2 (WPV2)-shedding event following accidental exposure to WPV2, the Netherlands, April 2017. Euro Surveill. 2017;22:30542. DOIPubMed
  13. World Health Organization. Guidance to minimize risks for facilities collecting, handling, or storing materials potentially infectious for polioviruses. WHO/POLIO/18.03 [cited 2019 Jan 27]. http://polioeradication.org/wp-content/uploads/2018/06/polio-containment-guidance-for-non-poliovirus-facilities-20180614-en.pdf
  14. Dowdle  WR, Birmingham  ME. The biologic principles of poliovirus eradication. J Infect Dis. 1997;175(Suppl 1):S286–92. DOIPubMed
  15. Van Rooyen  CE, Rhodes  A. Virus diseases of man. New York: Thomas Nelson & Sons; 1948.
  16. Byers  K, Harding  A. Viral agents of human diseases: biosafety concerns. In: Wooley D, Byers K, editors. Biological safety: principles and practices. 5th edition. Washington: ASM Press; 2017. p. 187–220.
  17. Pike  RM. Laboratory-associated infections: summary and analysis of 3921 cases. Health Lab Sci. 1976;13:105–14.PubMed
  18. Pike  RM. Laboratory-associated infections: incidence, fatalities, causes, and prevention. Annu Rev Microbiol. 1979;33:41–66. DOIPubMed
  19. Sulkin  SE, Pike  RM. Viral infections contracted in the laboratory. N Engl J Med. 1949;241:205–13. DOIPubMed
  20. Pike  RM, Sulkin  SE, Schulze  ML. Continuing importance of laboratory acquired infections. Am J Public Health Nations Health. 1965;55:190–9. DOIPubMed
  21. Sabin  AB, Wright  AM. Acute ascending myelitis following a monkey bite, with the isolation of a virus capable of reproducing the disease. J Exp Med. 1934;59:115–36. DOIPubMed
  22. Leake  JP. Poliomyelitis following vaccination against this disease. Cal West Med. 1936;44:141–2.PubMed
  23. Sabin  AB, Ward  R. Poliomyelitis in a laboratory worker exposed to the virus. Science. 1941;94:113–4. DOIPubMed
  24. Beller  K. Laboratory infection with the Lansing virus [in German]. Zentralblatt für Bakteriologie, Parasitenkunde. Infektionskrankheiten und Hygiene. 1949;153:269–73.
  25. Burns  JS. Poliomyelitis: a case possibly due to intracutaneous inoculation. Can Med Assoc J. 1950;63:498–9.PubMed
  26. McMATH  WFT. Accidental inoculation with poliomyelitis virus. Lancet. 1955;268:702–3. DOIPubMed
  27. Nathanson  N, Langmuir  AD. The Cutter incident: poliomyelitis following formaldehyde-inactivated poliovirus vaccination in the United States during the spring of 1955. II. Relationship of poliomyelitis to Cutter vaccine. Am J Hyg. 1963;78:29–60.PubMed
  28. Offit  PA. The Cutter incident, 50 years later. N Engl J Med. 2005;352:1411–2. DOIPubMed
  29. Dowdle  WR, Wolff  C, Sanders  R, Lambert  S, Best  M. Will containment of wild poliovirus in laboratories and inactivated poliovirus vaccine production sites be effective for global certification? Bull World Health Organ. 2004;82:59–62.PubMed
  30. Mulders  MN, Reimerink  JHJ, Koopmans  MPG, van Loon  AM, van der Avoort  HG. Genetic analysis of wild-type poliovirus importation into The Netherlands (1979-1995). J Infect Dis. 1997;176:617–24. DOIPubMed
  31. Deshpande  JM, Nadkarni  SS, Siddiqui  ZA. Detection of MEF-1 laboratory reference strain of poliovirus type 2 in children with poliomyelitis in India in 2002 & 2003. Indian J Med Res. 2003;118:217–23.PubMed
  32. World Health Organization. Wild poliovirus type 2—reference strains isolated in India. Wkly Epidemiol Rec. 2003;78:88 [cited 2018 Oct 10]. https://apps.who.int/iris/bitstream/handle/10665/232120/WER7812_88-88.PDF
  33. World Health Organization. Update on actions taken following the isolation of MEF-1 reference poliovirus associated with acute flaccid paralysis cases in India in late 2002 and early 2003. Wkly Epidemiol Rec. 2003;78:277–84 [cited 2018 Oct 10]. https://www.who.int/wer/2003/wer7832
  34. Duizer  E, Rutjes  S, de Roda Husman  AM, Schijven  J. Risk assessment, risk management and risk-based monitoring following a reported accidental release of poliovirus in Belgium, September to November 2014. Euro Surveill. 2016;21:30169. DOIPubMed
  35. Duizer  E. Laboratory analysis of environmental samples taken following the reported release of live poliovirus. RIVM letter report 2015–0032 [cited 2018 Oct 10]. http://www.rivm.nl/bibliotheek/rapporten/2015-0032.pdf
  36. Wenner  HA, Paul  JR. Fatal infection with poliomyelitis virus in a laboratory technician; isolation of virus from lymph nodes. Am J Med Sci. 1947;213:9–18. DOIPubMed
  37. Gear  JH, Rodger  LM. Studies in poliomyelitis; poliomyelitis in Northern Rhodesia, with special reference to an outbreak occurring on the Roan Antelope Copper Mine, Luanshya, in 1946. S Afr Med J. 1946;20:670–3.PubMed
  38. Sushmi Dey. Contaminated vaccines put India’s “polio free” status at risk. The Times of India. October 1, 2018 [cited 2018 Nov 2]. http://timesofindia.indiatimes.com/articleshow/66021197.cms
  39. Upfill-Brown  A, Taniuchi  M, Platts-Mills  JA, Kirkpatrick  B, Burgess  SL, Oberste  MS, et al. Nonspecific effects of oral polio vaccine on diarrheal burden and etiology among Bangladeshi infants. Clin Infect Dis. 2017;65:414–9. DOIPubMed
  40. Her Majesty’s Stationery Office. Report on an investigation into the cause of the 1978 Birmingham smallpox occurrence. London: Her Majesty’s Stationery Office; 1980 [cited 2018 Nov 2]. https://biotech.law.lsu.edu/blaw/bt/smallpox/refs/report_1978_london.pdf
  41. Bandyopadhyay  AS, Garon  J, Seib  K, Orenstein  WA. Polio vaccination: past, present and future. Future Microbiol. 2015;10:791–808. DOIPubMed
  42. Sutter  RW. Unraveling the mucosal Immunity of inactivated poliovirus vaccine. J Infect Dis. 2018;217:344–6. DOIPubMed
  43. McKinlay  MA, Collett  MS, Hincks  JR, Oberste  MS, Pallansch  MA, Okayasu  H, et al. Progress in the development of poliovirus antiviral agents and their essential role in reducing risks that threaten eradication. J Infect Dis. 2014;210(Suppl 1):S447–53. DOIPubMed
  44. World Health Organization. World Health Assembly resolution WHA71.16. Poliomyelitis—containment of polioviruses. In: Seventy-first World Health Assembly, Geneva, Switzerland; May 20–26, 2018 [cited 2018 Nov 2]. http://apps.who.int/gb/ebwha/pdf_files/WHA71/A71_R16-en.pdf

Main Article

Page created: June 17, 2019
Page updated: June 17, 2019
Page reviewed: June 17, 2019
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external