Environmental Surveillance Complements Case-Based Surveillance of Acute Flaccid Paralysis in Polio Endgame Strategy 2019-2023
- PMID: 32444474
- PMCID: PMC7376550
- DOI: 10.1128/AEM.00702-20
Environmental Surveillance Complements Case-Based Surveillance of Acute Flaccid Paralysis in Polio Endgame Strategy 2019-2023
Abstract
The Polio Endgame Strategy 2019-2023 has been developed. However, more effective and efficient surveillance activities should be conducted with the preparedness of emergence for vaccine-derived poliovirus (VDPV) or wild poliovirus (WPV). We reviewed the impact of the case-based acute flaccid paralysis (AFP) surveillance (1991 to 2018) and environmental surveillance (2011 to 2018) in polio eradication in Shandong province of China. Clinical characteristics of AFP cases and enterovirus (EV) investigation of research samples were assessed. During the period, 10,224 AFP cases were investigated, and 352 sewage samples were collected. The nonpolio AFP rate sustained at over 2.0/100,000 since 1997. Of 10,224 cases, males and young children experienced a higher risk of severe diseases, and 68.5% suffered lower limb paralysis. We collected 1,707 EVs from AFP cases, including 763 polioviruses and 944 nonpolio enteroviruses (NPEVs). No WPV was isolated since 1992. The AFP surveillance showed high sensitivity in detecting 143 vaccine-associated paralytic poliomyelitis (VAPP) cases and 6 VDPVs. For environmental surveillance, 217 (61.6%) samples were positive for poliovirus, and altogether, 838 polioviruses and 2,988 NPEVs were isolated. No WPV was isolated in environmental surveillance, although one VDPV2 was identified. Phylogenetic analysis revealed environmental surveillance had the capacity to detect a large scope of NPEVs. The case-based AFP surveillance will be indispensable for detecting VAPP cases and VDPV circulation in countries using oral polio vaccine. Environmental surveillance is advantageous in identifying EV circulation and responding to ongoing circulating VDPV outbreaks and should be expanded to complement the AFP surveillance.IMPORTANCE Interrupting wild poliovirus transmission and stopping circulating vaccine-derived poliovirus (cVDPV) outbreaks have been proposed as two global goals by the World Health Organization in the Global Polio Eradication Initiative (GPEI). This analysis, based on the 28-year acute flaccid paralysis (AFP) surveillance and 8-year environmental surveillance, provides continued high-quality surveillance performance in achieving the GPEI and detecting the circulation of enterovirus. Given the ongoing cVDPV outbreaks in the world, we present the surveillance capacity of environmental surveillance in capturing enterovirus circulation. The final poliovirus (especially VDPV) elimination has become increasingly complex, and the case-based AFP surveillance alone will lead to difficulties in early detecting dynamics of poliovirus transmission and monitoring the extent of environmental circulation. This study goes beyond previous work to provide a detailed comprehensive evaluation of the enterovirus surveillance and can be used to formulate a set of implementation plan and performance indicators for environmental surveillance.
Keywords: acute flaccid paralysis surveillance; enterovirus; environmental surveillance; oral polio vaccine; poliomyelitis.
Copyright © 2020 American Society for Microbiology.
Figures
Similar articles
-
Surveillance to Track Progress Toward Polio Eradication - Worldwide, 2018-2019.MMWR Morb Mortal Wkly Rep. 2020 May 22;69(20):623-629. doi: 10.15585/mmwr.mm6920a3. MMWR Morb Mortal Wkly Rep. 2020. PMID: 32437342
-
Surveillance of poliomyelitis in Northern Italy: Results of acute flaccid paralysis surveillance and environmental surveillance, 2012-2015.Hum Vaccin Immunother. 2017 Feb;13(2):332-338. doi: 10.1080/21645515.2017.1264726. Epub 2016 Dec 8. Hum Vaccin Immunother. 2017. PMID: 27929744 Free PMC article.
-
Evaluating surveillance indicators supporting the Global Polio Eradication Initiative, 2011-2012.MMWR Morb Mortal Wkly Rep. 2013 Apr 12;62(14):270-4. MMWR Morb Mortal Wkly Rep. 2013. PMID: 23575241 Free PMC article.
-
Environmental surveillance for polioviruses in the Global Polio Eradication Initiative.J Infect Dis. 2014 Nov 1;210 Suppl 1(Suppl 1):S294-303. doi: 10.1093/infdis/jiu384. J Infect Dis. 2014. PMID: 25316848 Free PMC article. Review.
-
The critical role of acute flaccid paralysis surveillance in the Global Polio Eradication Initiative.Int Health. 2017 May 1;9(3):156-163. doi: 10.1093/inthealth/ihx016. Int Health. 2017. PMID: 28582560 Review.
Cited by
-
Serological investigation on the prevalence of poliovirus in Guangdong province: A cross-sectional study.Hum Vaccin Immunother. 2024 Dec 31;20(1):2300156. doi: 10.1080/21645515.2023.2300156. Epub 2024 Jan 8. Hum Vaccin Immunother. 2024. PMID: 38189143 Free PMC article.
-
Detection of SARS-CoV-2 RNA in wastewater and comparison to COVID-19 cases in two sewersheds, North Carolina, USA.Sci Total Environ. 2023 Feb 1;858(Pt 3):159996. doi: 10.1016/j.scitotenv.2022.159996. Epub 2022 Nov 7. Sci Total Environ. 2023. PMID: 36356771 Free PMC article.
-
Assessment of a mass balance equation for estimating community-level prevalence of COVID-19 using wastewater-based epidemiology in a mid-sized city.Sci Rep. 2022 Nov 9;12(1):19085. doi: 10.1038/s41598-022-21354-6. Sci Rep. 2022. PMID: 36352013 Free PMC article.
-
Early identification of a COVID-19 outbreak detected by wastewater surveillance at a large homeless shelter in Toronto, Ontario.Can J Public Health. 2023 Feb;114(1):72-79. doi: 10.17269/s41997-022-00696-8. Epub 2022 Sep 26. Can J Public Health. 2023. PMID: 36156197 Free PMC article.
-
Circulation of Type 2 Vaccine-Derived Poliovirus in China in 2018-2019.Open Forum Infect Dis. 2021 Oct 17;8(12):ofab535. doi: 10.1093/ofid/ofab535. eCollection 2021 Dec. Open Forum Infect Dis. 2021. PMID: 34926714 Free PMC article.
References
-
- Global Polio Eradication Initiative. 2019. The Polio Endgame Strategy 2019–2023: eradication, integration, containment, and certification. World Health Organization, Geneva, Switzerland: http://polioeradication.org/wp-content/uploads/2019/06/english-polio-end.... Accessed 19 June 2019.
-
- World Health Organization. 2019. Polio case count. World Health Organization, Geneva, Switzerland: https://extranet.who.int/polis/public/CaseCount.aspx. Accessed 3 October 2019.
-
- World Health Organization. 2019. Two out of three wild poliovirus strains eradicated. World Health Organization, Geneva, Switzerland: https://www.who.int/news-room/feature-stories/detail/two-out-of-three-wi.... Accessed 24 October 2019.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical