{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T02:44:14Z","timestamp":1764989054320,"version":"3.46.0"},"reference-count":9,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2021,7,27]],"date-time":"2021-07-27T00:00:00Z","timestamp":1627344000000},"content-version":"unspecified","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"crossref","award":["WHO Reference- 2018\/811124-0"],"award-info":[{"award-number":["WHO Reference- 2018\/811124-0"]}],"id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,7,14]]},"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Children with primary immunodeficiency disorders (PID) are more susceptible to developing viral infections and are at a substantially increased risk of developing paralytic poliomyelitis. Such children, if given oral polio vaccines tend to excrete poliovirus chronically that may lead to the propagation of highly divergent vaccine-derived poliovirus (VDPV). Consequently, they may act as a reservoir for the community by introducing an altered virus potentially imposing a risk to global polio eradication. However, the risks of chronic and prolonged excretion are not well characterised in the study context. This study seeks to establish a pilot surveillance system for successful identification and monitoring of VDPV excretion among children with PID. It will assess whether the Jeffrey Modell warning signs of PID can be used as an appropriate screening tool for PID in Pakistan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>In this pilot surveillance, recruitment of PID cases is currently done at participating hospitals in Pakistan. Potential children are screened and tested against the Jeffrey Modell Foundation (JMF) warning signs for immunodeficiency and their stool is collected to test for poliovirus excretion. Cases excreting poliovirus are followed until the two consecutive negative stool samples are obtained over a period of 6\u2009months. The data will be analysed to calculate hospital-based proportions of total Immunodeficiency-related vaccine-derived poliovirus (iVDPV) cases over a 2-year period and to determine the sensitivity and specificity of the JMF signs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This protocol was reviewed and approved by the WHO (WHO Reference-2018\/811124-0), Aga Khan University (AKU ERC-2018-0380-1029) and National Bioethics Committee (Ref No. 4-87 NBC-308-Y2). The results will be published in an open access peer-reviewed scientific journal and presented to the iVDPV Working Group members, policy-makers, paediatric consultants and fellow researchers with the same domain interest. It may be presented in scientific conferences and seminars in the form of oral or poster presentations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-045904","type":"journal-article","created":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T12:30:14Z","timestamp":1627475414000},"page":"e045904","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Poliovirus excretion among children with primary immune deficiency in Pakistan: a pilot surveillance study protocol"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9157-1711","authenticated-orcid":false,"given":"Asma Sadruddin","family":"Pethani","sequence":"first","affiliation":[{"name":"Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zaubina","family":"Kazi","sequence":"additional","affiliation":[{"name":"Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ujala","family":"Nayyar","sequence":"additional","affiliation":[{"name":"Polio Eradication Initiative, World Health Organization Country Office for Pakistan, Islamabad, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad","family":"Shafiq-ur-Rehman","sequence":"additional","affiliation":[{"name":"Polio Eradication Initiative, World Health Organization Country Office for Pakistan, Islamabad, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Tahir","family":"Yousafzai","sequence":"additional","affiliation":[{"name":"Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mach","family":"Ondrej","sequence":"additional","affiliation":[{"name":"Polio Department, World Health Organization, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1804-9868","authenticated-orcid":false,"given":"Ali Faisal","family":"Saleem","sequence":"additional","affiliation":[{"name":"Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,7,28]]},"reference":[{"key":"2025120518123689000_11.7.e045904.1","doi-asserted-by":"crossref","first-page":"S368","DOI":"10.1093\/infdis\/jiu065","article-title":"Poliovirus excretion among persons with primary immune deficiency disorders: summary of a seven-country study series","volume":"210 Suppl 1","author":"Li","year":"2014","journal-title":"J Infect Dis"},{"key":"2025120518123689000_11.7.e045904.2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2017.01103"},{"key":"2025120518123689000_11.7.e045904.3","unstructured":"WHO, Initiative GPE . Polio endgame strategy 2019-2023: eradication, integration, certification and containment. World Health Organization, 2019."},{"key":"2025120518123689000_11.7.e045904.4","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-015-1115-5","article-title":"Modeling the prevalence of immunodeficiency-associated long-term vaccine-derived poliovirus excretors and the potential benefits of antiviral drugs","volume":"15","author":"Duintjer Tebbens","year":"2015","journal-title":"BMC Infect Dis"},{"key":"2025120518123689000_11.7.e045904.5","doi-asserted-by":"crossref","unstructured":"El Sayed ZA , Mach O , Hossny E . Poliovirus excretion among persons with primary immune deficiency disorders: summary of data from enhanced poliovirus surveillance in Egypt, 2011-2014. J Vaccines Vaccin;7:331.doi:10.4172\/2157-7560.1000331","DOI":"10.4172\/2157-7560.1000331"},{"key":"2025120518123689000_11.7.e045904.6","doi-asserted-by":"crossref","first-page":"S373","DOI":"10.1093\/infdis\/jiu221","article-title":"Screening for long-term poliovirus excretion among children with primary immunodeficiency disorders: preparation for the polio posteradication era in Bangladesh","volume":"210 Suppl 1","author":"Sazzad","year":"2014","journal-title":"J Infect Dis"},{"key":"2025120518123689000_11.7.e045904.7","doi-asserted-by":"publisher","DOI":"10.1097\/ACI.0b013e3283591534"},{"key":"2025120518123689000_11.7.e045904.8","doi-asserted-by":"crossref","first-page":"S113","DOI":"10.1093\/infdis\/175.Supplement_1.S113","article-title":"Poliovirus surveillance: building the global polio laboratory network","volume":"175 Suppl 1","author":"Hull","year":"1997","journal-title":"J Infect Dis"},{"key":"2025120518123689000_11.7.e045904.9","unstructured":"Organization WH . Polio laboratory manual. Geneva: World Health Organization, 2004."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-045904","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T02:12:43Z","timestamp":1764987163000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-045904"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7]]},"references-count":9,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,7,28]]},"published-print":{"date-parts":[[2021,7]]}},"alternative-id":["10.1136\/bmjopen-2020-045904"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-045904","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2021,7]]}}}