Journal of Infectious Diseases
Volume 209 Issue 11 June 1, 2014
http://jid.oxfordjournals.org/content/current

Protecting the Family to Protect the Child: Vaccination Strategy Guided by RSV Transmission Dynamics
Barney S. Graham
Author Affiliations – Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
Respiratory syncytial virus (RSV) is the most important respiratory pathogen of childhood and also contributes to substantial morbidity and mortality in the elderly. It was recently estimated that as a single infectious agent, RSV is second only to malaria as a cause of death in children between 1 month and 1 year of age [1]. In addition, the global impact as an adult pathogen has a comparable level of morbidity and mortality as influenza in the frail elderly [2, 3]. Further demonstration that RSV is a ubiquitous global pathogen is now reported in the prospective family cohort study performed by Munywoki et al and reported in this issue of the Journal of Infectious Diseases [4]. More than 80% of households with children experienced an RSV infection within the 6-month surveillance period, and RSV was detected in 64% of study infants (defined as <1 year of age). In about 50% of households, more than one person was infected, and repeat infections in the same individual from homologous or heterologous RSV subtypes within the same season were documented. Thus, transmission within family units is common, and natural infection with RSV, especially in very young infants, does not provide solid immunity against reinfection. These data that were collected in rural Kenya are consistent with another household study performed more than 40 years ago in Rochester, New York, that reported 2 months of surveillance data [5]. Although it would be useful to have more data from different geographic and climatic settings, the congruity of these 2 studies suggests the likelihood that these results are a realistic reflection of how RSV is transmitted within family units globally. Importantly, the current study was prospective, employed active …

The Source of Respiratory Syncytial Virus Infection In Infants: A Household Cohort Study In Rural Kenya
Patrick K. Munywoki1, Dorothy C. Koech1, Charles N. Agoti1, Clement Lewa1, Patricia A. Cane2, Graham F. Medley2 and D. J. Nokes1,2
Author Affiliations
1KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
2School of Life Sciences and WIDER, University of Warwick, Coventry, United Kingdom

Community Circulation Patterns of Oral Polio Vaccine Serotypes 1, 2, and 3 After Mexican National Immunization Weeks
Stephanie B. Troy1,a, Leticia Ferreyra-Reyes2,a, ChunHong Huang3, Clea Sarnquist3, Sergio Canizales-Quintero2, Christine Nelson1, Renata Báez-Saldaña2, Marisa Holubar3, Elizabeth erreira-Guerrero2, Lourdes García-García2 and Yvonne A. Maldonado3
Author Affiliations
1Eastern Virginia Medical School, Norfolk, Virginia
2Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
3Stanford University School of Medicine, Stanford, California
Abstract
Background With wild poliovirus nearing eradication, preventing circulating vaccine-derived poliovirus (cVDPV) by understanding oral polio vaccine (OPV) community circulation is increasingly important. Mexico, where OPV is given only during biannual national immunization weeks (NIWs) but where children receive inactivated polio vaccine (IPV) as part of their primary regimen, provides a natural setting to study OPV community circulation.
Methods In total, 216 children and household contacts in Veracruz, Mexico, were enrolled, and monthly stool samples and questionnaires collected for 1 year; 2501 stool samples underwent RNA extraction, reverse transcription, and real-time polymerase chain reaction (PCR) to detect OPV serotypes 1, 2, and 3.
Results OPV was detected up to 7 months after an NIW, but not at 8 months. In total, 35% of samples collected from children vaccinated the prior month, but only 4% of other samples, contained OPV. Although each serotype was detected in similar proportions among OPV strains shed as a result of direct vaccination, 87% of OPV acquired through community spread was serotype 2 (P < .0001).
Conclusion Serotype 2 circulates longer and is transmitted more readily than serotypes 1 or 3 after NIWs in a Mexican community primarily vaccinated with IPV. This may be part of the reason why most isolated cVDPV has been serotype 2.