Concern poliovirus could be transmitted by FMT

Concern has been raised over the potential for faecal microbiota transplantation (FMT) to transmit poliovirus.

According to a Letter in the journal Gut, a small proportion of people who have primary immune deficiencies and received oral poliovirus vaccine in the past have been shown to excrete the virus for up to three decades.

The Australian authors calculated chronic faecal excretion of live vaccine-derived poliovirus in the US could be more prevalent than other diseases that were routinely screened for in FMT donors.

They said the greatest risk was with ‘poo pills’ in which faecal matter from large numbers of donors would be pooled.

Associate Professor Peter Speck, a virologist at Flinders University, told the limbic said there was no reason why the US data would not be similar in Australia.

Administration of oral poliovirus vaccine ceased in the US in 2000 and in Australia in 2005.

 “Obviously the old polio vaccine, which was a live attenuated vaccine which gave rise to excretion of live polio virus in the faeces, was used here until relatively recently. And it is reasonable to expect we would have people with primary immune deficiency in our population, some of whom might be excreting polio virus in their faeces.”

Professor Speck said PCR technology used to detect poliovirus was simple and robust.

“Given we are already testing for hepatitis, HIV, etcetera, to add in polio shouldn’t add too much to the cost and therefore is worth considering. We’re just suggesting that the advocates of FMT take a look at this and consider the costs of extending their screening to include polio virus.”

Associate Professor Speck said polio vaccination provided a high degree of protection against the disease but even in the best health systems, coverage never reached 100%.

“And there are many parts of the world where vaccination rates are low; sometimes alarmingly low. So if you have a proportion of the population with no protection, those are the people you would worry about as FMT recipients.”

“Some people might say we are drawing a long bow but the issue is that the increased cost of testing is small and the consequences of giving polio to someone who is susceptible are huge. We don’t want one single case of polio, not one, in any FMT recipient.”

Professor Jane Andrews, head of IBD Service & Education at the Royal Adelaide Hospital, commented that costs of screening donors for polio excretion could be minimised by using regular pre-screened donors to prepare multiple FMT aliquots.

“I also think it best that for C. difficile therapy, donors should not be blended as it would make tracing any infectious complication much more difficult.”

“It is also a good point that FMT is unlikely to be completely harmless and should be used with caution especially for indications other than recurrent C. difficile, where we are as yet uncertain whether there is any benefit and certainly do not know whether benefit outweighs risk.”

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