The early evolution of oral poliovirus vaccine is shaped by strong positive selection and tight transmission bottlenecks

Abstract

The evolution of circulating vaccine-derived polioviruses (cVDPV) from components of the live-attenuated oral poliovirus vaccine (OPV) presents a major challenge to global polio eradication. This process has largely been characterized by consensus sequencing of isolates collected from routine surveillance, and little is known about the early evolution of OPV within vaccinated hosts. These early events are critical steps in the progression of OPV to cVDPV. Here, we use whole genome, high depth of coverage sequencing to define the evolutionary trajectories of monovalent type 2 OPV in a cluster-randomized trial of polio vaccines in Matlab, Bangladesh. By sequencing 416 longitudinal samples from 219 mOPV2 recipients and 81 samples from 52 household contacts, we were able to examine the extent of convergent evolution in vaccine recipients and track the amount of viral diversity transmitted to new hosts. Using time-series data from a synchronized point of vaccine administration, we identify strong positive selection of reversion mutations at three known attenuating sites within two months post-vaccination. Beyond these three recognized "gate-keeper" mutations, we identify 19 mutations that exhibit significant parallelism across vaccine recipients, providing evidence for early positive selection not previously detected by phylogenetic inference. An analysis of shared genetic variants in samples from vaccinated individuals and their household contacts suggests a tight effective bottleneck during transmission. The absence of positively selected variants among household contacts across the cohort suggests that this tight bottleneck limits the transmission of these early adaptive mutations. Together, our results highlight the distinct evolutionary dynamics of live attenuated virus vaccines and have important implications for the success of novel OPV2 and other next generation approaches. SignificanceThe emergence of circulating vaccine-derived polioviruses (cVDPV) through evolution of the oral polio vaccine (OPV) poses a significant obstacle to global eradication. Understanding the genetic changes in OPV that occur as it evolves and transmits in populations is important for preventing future cVDPV outbreaks. Little is known about the early events in VDPV evolution and the selective forces that drive them. We used high depth-of-coverage genome sequencing to assess the within-host evolutionary dynamics of monovalent type 2 OPV in a vaccine trial in Matlab, Bangladesh. We leverage longitudinal sampling from vaccine recipients and household contacts to identify mutations that arise in parallel across individuals and estimate the size of the transmission bottleneck. We find evidence for strong positive selection on key sites in the capsid and the 5 noncoding region, many of which have not been previously identified. Our results also suggest that narrow transmission bottlenecks can constrain the spread of mutations selected within individuals. These results provide important insights into how OPV variants spread in populations and are highly relevant for ongoing poliovirus surveillance and the design of improved polio vaccines.