Polio returns to the USA: An epidemiological alert

Evaluating the Compatibility of Three Aluminum Salt-Adjuvanted Recombinant Protein Antigens (Trivalent NRRV) Combined with a Mock Trivalent Sabin-IPV Vaccine: Analytical and Formulation Challenges

In this work, we describe compatibility assessments of a recombinant, trivalent non-replicating rotavirus vaccine (t-NRRV) candidate with a mock trivalent Sabin inactivated polio vaccine (t-sIPV). Both t-sIPV and t-NRRV are incompatible with thimerosal (TH), a preservative commonly used in pediatric pentavalent combination vaccines (DTwP-Hib-HepB) distributed in low- and middle-income countries (LMICs), preventing the development of a heptavalent combination. The compatibility of t-NRRV with a mock DTwP-Hib-HepB formulation is described in a companion paper. This case study highlights the analytical and formulation challenges encountered when combining a mock t-sIPV vaccine (unadjuvanted) with Alhydrogel® (AH) adjuvanted t-NRRV. Selective and stability-indicating competition ELISAs were implemented to monitor antibody binding to each of the six antigens (±AH). Simple mixing caused the undesired desorption of t-NRRV from AH with the concomitant binding of t-sIPV to AH. Although the former effect was mitigated by dialyzing sIPV bulks, decreased sIPV storage stability was observed at accelerated temperatures in the bivalent combination with a rank-ordering of P[8] > P[6] > P[4] and sIPV3 > sIPV2 > sIPV1. The compatibility of AH-adsorbed t-sIPV with alternative preservatives was evaluated, and parabens (methyl, propyl) were identified for potential use in this multi-dose bivalent formulation. Along with a companion paper, the lessons learned are discussed to facilitate the future formulation development of pediatric combination vaccines with new antigens.

Polio, public health memories and temporal dissonance of re-emerging infectious diseases in the global north

Social science research on polio has been centred in the global south, where countries that remain endemic or vulnerable to outbreaks are located. However, closely-related strains of poliovirus were detected in the sewage systems of several New York State counties and London boroughs in 2022. These detections constituted the first encounters with polio in the United States and United Kingdom for a generation - for both public health agencies and publics alike. This paper takes the transnational spread of poliovirus in 2022 as an opportunity to critique how public health memories of twentieth-century polio epidemics were mobilised to encourage vaccine uptake among groups considered vulnerable to transmission, notably Orthodox Jewish families. The study integrates data collected in London and New York as part of academic engagement with health protection responses to the spread of polio. Methods in both settings involved ethnographic research, and a total of 59 in-depth semi-structured interviews with public health professionals, healthcare providers, and Orthodox Jewish community partners and residents. Analysis of results demonstrate that narratives of epidemiological progress were deployed in public health responses in London and New York, often through references to sugar cubes, iron lungs, and timelines that narrate the impact of routine childhood immunisations. While memories of polio were deployed in both settings to provoke an urgency to vaccinate, vulnerable publics instead considered the more recent legacy of the COVID-19 pandemic when deciding whether to trust recommendations and responses. Critical attention to memory places analysis on the divergences between institutional (public health agencies) and peopled (publics) responses to disease events. Responses to re-emerging infectious disease outbreaks engender a temporal dissonance when historical narratives are evoked in ways that contrast with the contemporary dilemmas of people and parents.

Validation of the VirCapSeq-VERT system for differential diagnosis, detection, and surveillance of viral infections

IMPORTANCE

Broad range assay for accurate and sensitive diagnostics.

Outbreak of severe myocarditis in England: Havoc by a harmless virus

Background

The World Health Organization (WHO) has been alerted to a concerning upsurge of severe myocarditis, an inflammatory heart condition, in neonates within Wales and South West England. The myocarditis cases are being intricately associated with enterovirus infection, belonging to the Picornaviridae family. The concerned pathogen poses a significant global disease burden, with an estimated 10 to 15 million symptomatic cases occurring annually in the United States alone. Neonates are particularly vulnerable with children under the age of one accounting for approximately 40% of enterovirus infections.

Material and Methods

A comprehensive literature search was conducted using various databases including ClinicalTrials, Google Scholar, PubMed, ScienceDirect, MEDLINE, and Ovid Resources. The search strategy included utilizing keywords such as "myocarditis," "Randomized controlled trials (RCTs). Only articles written in English were considered, and selection criteria included relevance to the research objectives, reasonable sample sizes, and robust methodology. In addition to the identified articles, meta-analyses, animal models and studies, and references from the selected articles were also examined to ensure a comprehensive review of the literature.

Results

Ten hospitalized neonates, reported in the United Kingdom (UK), with positive PCR tests were reported to have myocarditis, predominantly caused by coxsackieviruses. The current situation in the region has brought global attention. With this study, we hope to draw attention to the critical aspects of the illness and, more crucially, the present strategies required to control the disease outbreak in England.

Discussion

Current European Society of Cardiology (ESC) recommendations for the treatment of acute heart failure apply. Emerging research supports the use of immunosuppressive medication in some circumstances. Patients are advised to avoid aerobic activities for several months after healing. Neonatal enterovirus infections can vary in how they respond to IVIG therapy. The majority of enterovirus infections are self-limited, require no special therapy, and only little supportive care is required.

Conclusion

The recent elevation in numbers for reported severe myocarditis in neonates within Wales and South West England, linked to enterovirus infection, poses a significant public health concern. Myocarditis caused by enteroviruses, particularly Group B coxsackieviruses, is associated with significant mortality rates. Diagnosis is supported by non-invasive techniques and cardiac enzyme blood tests. Treatment modalities primarily involve a palliative approach.