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. 2021 Oct;70(10):001441.
doi: 10.1099/jmm.0.001441.

Sensitivity of the acute flaccid paralysis surveillance system for poliovirus in South Africa, 2016-2019

Affiliations

Sensitivity of the acute flaccid paralysis surveillance system for poliovirus in South Africa, 2016-2019

Wayne Howard et al. J Med Microbiol. 2021 Oct.

Abstract

Introduction. Global poliovirus eradication is a public health emergency of international concern. The acute flaccid paralysis (AFP) surveillance programme in South Africa has been instrumental in eliminating polioviruses and keeping the country poliovirus free.Gap statement. The sensitivity of surveillance for polioviruses by every African country is of global interest in the effort to ensure global health security from poliovirus re-emergence.Aim. To describe the epidemiology of polioviruses from AFP cases and environmental samples in South Africa and to report the performance of the AFP surveillance system for the years 2016-2019 against targets established by the World Health Organization (WHO).Methods. Stool specimens from AFP or suspected AFP cases were received and tested as per WHO guidelines. Environmental samples were gathered from sites across the Gauteng province using the grab collection method. Concentration was effected by the two-phase polyethylene glycol method approved by the WHO. Suspected polioviruses were isolated in RD and/or L20B cell cultures through identification of typical cytopathic effects. The presence of polioviruses was confirmed by intratypic differentiation PCR. All polioviruses were sequenced using the Sanger method, and their VP1 gene analysed for mutations.Results. Data from 4597 samples (2385 cases) were analysed from the years 2016-2019. Two cases of immunodeficiency-associated vaccine-derived poliovirus (iVDPV) type 3 were detected in 2017 and 2018. A further 24 Sabin type 1 or type 3 polioviruses were detected for the 4 years. The national surveillance programme detected an average of 3.1 cases of AFP/100 000 individuals under 15 years old (2.8/100 000-3.5/100 000). The stool adequacy of the samples received was 53.0 % (47.0-55.0%), well below the WHO target of 80 % adequacy. More than 90 % of results were released from the laboratory within the turnaround time (96.6 %) and non-polio enteroviruses were detected in 11.6 % of all samples. Environmental surveillance detected non-polio enterovirus in 87.5 % of sewage samples and Sabin polioviruses in 12.5 % of samples.Conclusion. The AFP surveillance programme in South Africa is sensitive to detect polioviruses in South Africa and provided no evidence of wild poliovirus or VDPV circulation in the country.

Keywords: AFP; South Africa; eradication; infectious; paralysis; poliomyelitis; surveillance; vaccine-derived; viral.

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Conflict of interest statement

Dr Melinda Suchard, Wayne Howard, Shelina Moonsamy, Lerato Seakamela, Dr Sabelle Jallow, Faith Modiko, Heleen du Plessis and Rosinah Sibiya are employees of the NICD; Elizabeth Maseti is an employee of the Department of Health; and Dr Mercy Kamupira is an employee of the WHO, South Africa. Dr Melinda Suchard declares speaker honoraria from Sanofi-Pasteur and Pfizer.

Figures

Fig. 1.
Fig. 1.
Photographs of poliovirus permissive cell lines L20B (a, b) and RD (c, d) showing uninoculated cells (a, c) and inoculated cells with cytopathic effect indicative of enteroviral infection (b, d).
Fig. 2.
Fig. 2.
Non-polio acute flaccid paralysis (AFP) detection rate for South Africa 2016–2019. Detection rate varied from 3.0/100 000 in 2016 to 3.5/100 000 in 2019. Average detection rate was 3.1/100 000 for 2016–2019. Target is 4/100 000.
Fig. 3.
Fig. 3.
Stool adequacy rate for South Africa 2016–2019. Stool adequacy varied from 55.0 % in 2016 to 47.0 % in 2019. Average detection rate was 53.0 % for 2016–2019. Target is 80 %.
Fig. 4.
Fig. 4.
(a) Percentage of virus isolation results released within the target turnaround time and (b) the non-polio enterovirus isolation rate in specimens received in South Africa 2016–2019. Turnaround time for results varied from 99.0 % in 2016 to 91.8 % in 2019. Average turnaround time was 97.0 % for 2016–2019. Target is 90 %. The non-polio enterovirus isolation rate varied from 14.0 % in 2016 to 9.0 % in 2019. The average detection rate was 12.0 % for 2016–2019. Target is 10 %.

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