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Host factors such as immune deficiency may also be involved in the establishment of the disease in certain cases, and may be related to heritable immunodeficiencies, immunodeficiencies caused by protein-calorie malnutrition, deficiency in vitamin A, or HIV infection (7,33,34,39,70-75). Intramuscular injections within 30 days of exposure to OPV through vaccine or contact with a recent vaccinee might also be a risk factor for VAPP cases (76). Other host factors and other pathological conditions could also be involved.