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. 2019 Feb;39(2):414-425.
doi: 10.1111/risa.13193. Epub 2018 Sep 21.

Environmental Surveillance System Characteristics and Impacts on Confidence About No Undetected Serotype 1 Wild Poliovirus Circulation

Dominika A Kalkowska  1 , Radboud J Duintjer Tebbens  1 , Kimberly M Thompson  1
Affiliations

Environmental Surveillance System Characteristics and Impacts on Confidence About No Undetected Serotype 1 Wild Poliovirus Circulation

Dominika A Kalkowska et al. Risk Anal. 2019 Feb.

Abstract

Surveillance for poliovirus during the polio endgame remains uncertain. Building on prior modeling of the potential for undetected poliovirus transmission for conditions like those in Pakistan and Afghanistan, we use a hypothetical model to explore several key characteristics of the poliovirus environmental surveillance (ES) system (e.g., number and quality of sites, catchment sizes, and sampling frequency) and characterize their impacts on the time required to reach high (i.e., 95%) confidence about no circulation (CNC95%) following the last detected case of serotype 1 wild poliovirus. The nature and quality of the existing and future acute flaccid paralysis (AFP) surveillance and ES system significantly impact the estimated CNC95% for places like Pakistan and Afghanistan. The analysis illustrates the tradeoffs between number of sites, sampling frequency, and catchments sizes, and suggests diminishing returns of increasing these three factors beyond a point that depends on site quality and the location of sites. Limitations in data quality and the hypothetical nature of the model reduce the ability to assess the extent to which actual ES systems offer benefits that exceed their costs. Thus, although poliovirus ES may help to reduce the time required to reach high confidence about the absence of undetected circulation, the effect strongly depends on the ability to establish effective ES sites in high-risk areas. The costs and benefits of ES require further analysis.

Keywords: Disease eradication; disease surveillance; environmental surveillance; infection transmission modeling; poliomyelitis; poliovirus.

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Figures

Figure 1
Figure 1
CNC95% for WPV1 in Pakistan and Afghanistan (z-axis) for the increased relative SIA coverage 0.20 scenario as a function of catchment area per site (x-axis) and number of sites per country (y-axis) using: lower bound AFP detection level in under-vaccinated subpopulations with (a) worst ES performance (any ES approach with very bad quality and sampling frequency 0 times/year), (b) best SS-US performance (with good quality and sampling frequency 24 times/year), and (c) best SW-US performance (with good quality and sampling frequency 24 times/year); upper bound AFP detection level in the under-vaccinated subpopulations with (d) worst ES performance (any ES approach with very bad quality and sampling frequency 0 times/year), (e) best SS-US performance (with good quality and sampling frequency 24 times/year), and (f) best SW-US performance (with good quality and sampling frequency 24 times/year).
Figure 2
Figure 2
CNC95% for WPV1 in Pakistan and Afghanistan (z-axis) for the “increased relative SIA coverage 0.15” scenario as a function of catchment area per site (x-axis) and number of sites per country (y-axis) using: lower bound AFP detection level in the under-vaccinated subpopulations with (a) worst ES performance (any ES approach with very bad quality and sampling frequency 0 times/year), (b) best SS-US performance (with good quality and sampling frequency 24 times/year), and (c) best SW-US performance (with good quality and sampling frequency 24 times/year); upper bound AFP detection level in the under-vaccinated subpopulations with (d) worst ES performance (any ES approach with very bad quality and sampling frequency 0 times/year), (e) best SS-US performance (with good quality and sampling frequency 24 times/year), and (f) best SW-US performance (with good quality and sampling frequency 24 times/year).
Figure 2
Figure 2
CNC95% for WPV1 in Pakistan and Afghanistan (z-axis) for the “increased relative SIA coverage 0.15” scenario as a function of catchment area per site (x-axis) and number of sites per country (y-axis) using: lower bound AFP detection level in the under-vaccinated subpopulations with (a) worst ES performance (any ES approach with very bad quality and sampling frequency 0 times/year), (b) best SS-US performance (with good quality and sampling frequency 24 times/year), and (c) best SW-US performance (with good quality and sampling frequency 24 times/year); upper bound AFP detection level in the under-vaccinated subpopulations with (d) worst ES performance (any ES approach with very bad quality and sampling frequency 0 times/year), (e) best SS-US performance (with good quality and sampling frequency 24 times/year), and (f) best SW-US performance (with good quality and sampling frequency 24 times/year).
Figure 3
Figure 3
Minimal catchment area per site required for a CNC95% of 1 year for WPV1 in Pakistan and Afghanistan with the “increased relative SIA coverage 0.20” scenario as a function of the number of sites per country (x-axis) and sampling frequency (f, times/year, legend upper right corner) using lower bound AFP detection level in under-vaccinated subpopulations and: SS-NS approach with (a) good, (b) medium, and (c) bad ES quality; or SS-US approach with (d) good, (e) medium, and (f) bad ES quality.
Figure 3
Figure 3
Minimal catchment area per site required for a CNC95% of 1 year for WPV1 in Pakistan and Afghanistan with the “increased relative SIA coverage 0.20” scenario as a function of the number of sites per country (x-axis) and sampling frequency (f, times/year, legend upper right corner) using lower bound AFP detection level in under-vaccinated subpopulations and: SS-NS approach with (a) good, (b) medium, and (c) bad ES quality; or SS-US approach with (d) good, (e) medium, and (f) bad ES quality.
Figure 4
Figure 4
Minimal coverage per site required to reach CNC95% within 1 year for serotype 1 in Pakistan and Afghanistan under “increased relative SIA coverage 0.15” scenario as a function of the number of sites per country (x-axis) and the sampling frequency (f, times/year, legend upper right corner) using lower bound AFP detection level in under-vaccinated subpopulations and: SS-NS approach with (a) good, (b) medium, and (c) bad ES quality; or SS-US approach with (d) good, (e) medium, and (f) bad ES quality.
Figure 4
Figure 4
Minimal coverage per site required to reach CNC95% within 1 year for serotype 1 in Pakistan and Afghanistan under “increased relative SIA coverage 0.15” scenario as a function of the number of sites per country (x-axis) and the sampling frequency (f, times/year, legend upper right corner) using lower bound AFP detection level in under-vaccinated subpopulations and: SS-NS approach with (a) good, (b) medium, and (c) bad ES quality; or SS-US approach with (d) good, (e) medium, and (f) bad ES quality.
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References

    1. Alam MM, Sharif S, Shaukat S, Angez M, Khurshid A, Rehman L, & Zaidi SS (2016). Genomic surveillance elucidates persistent wild poliovirus transmission during 2013–2015 in major reservoir areas of Pakistan. Clin Infect Dis, 62(2), 190–198. doi:10.1093/cid/civ831 - DOI - PubMed
    1. Deshpande JM, Shetty SJ, & Siddiqui ZA (2003). Environmental Surveillance System To Track Wild Poliovirus Transmission. Applied and Environmental Microbiology, 69(5), 2919–2927. - PMC - PubMed
    1. Duintjer Tebbens RJ, Diop OM, Pallansch MA, Oberste MS, & Thompson KM. (2018). Characterizing the costs of the Global Polio Laboratory Network: A survey-based analysis. In preparation. - PMC - PubMed
    1. Duintjer Tebbens RJ, Pallansch MA, Cochi SL, Ehrhardt DT, Farag NH, Hadler SC,… Thompson KM (2018). Modeling poliovirus transmission in Pakistan and Afghanistan to inform vaccination strategies in undervaccinated subpopulations. Risk Analysis, 38(8), 1701–1717. doi:10.1111/risa.12962 - DOI - PMC - PubMed
    1. Duintjer Tebbens RJ, Pallansch MA, Kalkowska DA, Wassilak SG, Cochi SL, & Thompson KM (2013). Characterizing poliovirus transmission and evolution: Insights from modeling experiences with wild and vaccine-related polioviruses. Risk Analysis, 23(4), 703–749. - PubMed

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