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Ueno MK, Kitamura K, Nishimura Y, Arita M. Evaluation of Direct Detection Protocols for Poliovirus from Stool Samples of Acute Flaccid Paralysis Patients. Viruses 2023; 15:2113. [PMID: 37896890 PMCID: PMC10612058 DOI: 10.3390/v15102113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Polio surveillance in the Global Polio Eradication Initiative has been conducted with virus isolation from stool samples of acute flaccid paralysis (AFP) cases. Under the current biorisk management/regulations, challenges arise in the timelines of the report, sensitivity of the test and containment of poliovirus (PV) isolates. In the present study, we evaluated protocols of previously reported direct detection (DD) methods targeting the VP1 or VP4-VP2 regions of the PV genome in terms of sensitivity and sequencability. An optimized protocol targeting the entire-capsid region for the VP1 sequencing showed a high sensitivity (limit of detection = 82 copies of PV genome) with a simpler and faster reaction than reported ones (i.e., with the addition of all the primers at the start of the reaction, the RT-PCR reaction finishes within 2.5 h). The DD methods targeting the VP1 region detected PV in 60 to 80% of PV-positive stool samples from AFP cases; however, minor populations of PV strains in the samples with virus mixtures were missed by the methods. Sequencability of the DD methods was primarily determined by the efficiency of the PCRs for both Sanger and nanopore sequencing. The DD method targeting the VP4-VP2 region showed higher sensitivity than that targeting the VP1 region (limit of detection = 25 copies of PV genome) and successfully detected PV from all the stool samples examined. These results suggest that DD methods are effective for the detection of PV and that further improvement of the sensitivity is essential to serve as an alternative to the current polio surveillance algorithm.
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Affiliation(s)
| | | | | | - Minetaro Arita
- Department of Virology II, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama, Tokyo 208-0011, Japan; (M.K.U.); (K.K.); (Y.N.)
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Nanteza MB, Bakamutumaho B, Tushabe P, Namuwulya P, Birungi M, Dhatemwa R, Eliku JP, Tibanagwa M, Kakooza P, Bukenya H, Bwogi J, Byabamazima CR. Sabin polio virus protein 1 (VP1) evolution in patients with acute flaccid paralysis from 2010 to 2016 in Uganda. Virol J 2023; 20:172. [PMID: 37533043 PMCID: PMC10399017 DOI: 10.1186/s12985-023-02143-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 07/26/2023] [Indexed: 08/04/2023] Open
Abstract
Acute flaccid paralysis (AFP) is a rare side effect of the oral polio vaccine but can be associated with outbreaks and permanent disability in patients harboring circulating vaccine-derived polioviruses (cVDPVs). With the advancement of polio abolition in a glimpse, cVDPVs are causing outbreaks and slowing the polio eradication process. The polio virus protein 1 (VP1) contains the binding site that is key for virus transmission. Understanding the evolution of VP1 among AFP patients could yield more insight into the early events of cVDPVs. Polioviruses were identified from stool specimens of AFP patients using cell culture; and confirmed by the real time RT PCR intra-typic differentiation and vaccine-derived poliovirus assays. Seventy-nine (79) Sabin-like poliovirus 1 (SL1) and 86 Sabin-like poliovirus 3 (SL3) were sequenced. The VP1 amino acid substitutions T106A in Sabin poliovirus 1 and A54V in Sabin poliovirus 3 were common among the AFP patients as has been found in previous studies. Other substitutions that were associated with AFP were: T290A and A54T in SL1 and SL3 respectively. Nucleotide mutations that were common among the AFP patients included T402C, C670A, and T816C in SL1, and G22A, C375Y, A472R, and A694T in SL3 polioviruses. Characterizing mutations that are associated with AFP could contribute to efforts pursued to mitigate the risk of vaccine-derived polioviruses and promote development of safer vaccines.
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Affiliation(s)
- Mary Bridget Nanteza
- Uganda Virus Research Institute, Plot 51-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda.
| | - Barnabas Bakamutumaho
- Uganda Virus Research Institute, Plot 51-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Phionah Tushabe
- Uganda Virus Research Institute, Plot 51-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Prossy Namuwulya
- Uganda Virus Research Institute, Plot 51-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Molly Birungi
- Uganda Virus Research Institute, Plot 51-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Rajab Dhatemwa
- Uganda Virus Research Institute, Plot 51-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - James Peter Eliku
- Uganda Virus Research Institute, Plot 51-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Mayi Tibanagwa
- Uganda Virus Research Institute, Plot 51-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | | | - Henry Bukenya
- Uganda Virus Research Institute, Plot 51-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Josephine Bwogi
- Uganda Virus Research Institute, Plot 51-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Charles Rutebarika Byabamazima
- World Health Organization AFRO, East and Southern Africa (ESA), 82-86 Enterprise Road, Highlands, Belvedere, P. O. Box BE 773, Harare, Zimbabwe
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Mbani CJ, Nekoua MP, Moukassa D, Hober D. The Fight against Poliovirus Is Not Over. Microorganisms 2023; 11:1323. [PMID: 37317297 DOI: 10.3390/microorganisms11051323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/13/2023] [Accepted: 05/14/2023] [Indexed: 06/16/2023] Open
Abstract
Poliovirus (PV), the virus that causes both acute poliomyelitis and post-polio syndrome, is classified within the Enterovirus C species, and there are three wild PV serotypes: WPV1, WPV2 and WPV3. The launch of the Global Polio Eradication Initiative (GPEI) in 1988 eradicated two of the three serotypes of WPV (WPV2 and WPV3). However, the endemic transmission of WPV1 persists in Afghanistan and Pakistan in 2022. There are cases of paralytic polio due to the loss of viral attenuation in the oral poliovirus vaccine (OPV), known as vaccine-derived poliovirus (VDPV). Between January 2021 and May 2023, a total of 2141 circulating VDPV (cVDPV) cases were reported in 36 countries worldwide. Because of this risk, inactivated poliovirus (IPV) is being used more widely, and attenuated PV2 has been removed from OPV formulations to obtain bivalent OPV (containing only types 1 and 3). In order to avoid the reversion of attenuated OPV strains, the new OPV, which is more stable due to genome-wide modifications, as well as sabin IPV and virus-like particle (VLP) vaccines, is being developed and offers promising solutions for eradicating WP1 and VDPV.
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Affiliation(s)
- Chaldam Jespère Mbani
- Laboratoire de Virologie URL3610, Université de Lille, CHU Lille, 59000 Lille, France
- Laboratoire de Biologie Cellulaire et Moléculaire, Faculté des Sciences et Technique, Université Marien Ngouabi, Brazzaville BP 69, Congo
| | | | - Donatien Moukassa
- Laboratoire de Biologie Cellulaire et Moléculaire, Faculté des Sciences et Technique, Université Marien Ngouabi, Brazzaville BP 69, Congo
| | - Didier Hober
- Laboratoire de Virologie URL3610, Université de Lille, CHU Lille, 59000 Lille, France
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Perepliotchikov Y, Ziv-Baran T, Hindiyeh M, Manor Y, Sofer D, Moran-Gilad J, Stephens L, Mendelson E, Weil M, Bassal R, Anis E, Singer SR, Kaliner E, Cooper G, Majumdar M, Markovich M, Ram D, Grotto I, Gamzu R, Martin J, Shulman LM. Inferring Numbers of Wild Poliovirus Excretors Using Quantitative Environmental Surveillance. Vaccines (Basel) 2021; 9:870. [PMID: 34451995 PMCID: PMC8402366 DOI: 10.3390/vaccines9080870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/22/2021] [Accepted: 07/29/2021] [Indexed: 01/19/2023] Open
Abstract
Response to and monitoring of viral outbreaks can be efficiently focused when rapid, quantitative, kinetic information provides the location and the number of infected individuals. Environmental surveillance traditionally provides information on location of populations with contagious, infected individuals since infectious poliovirus is excreted whether infections are asymptomatic or symptomatic. Here, we describe development of rapid (1 week turnaround time, TAT), quantitative RT-PCR of poliovirus RNA extracted directly from concentrated environmental surveillance samples to infer the number of infected individuals excreting poliovirus. The quantitation method was validated using data from vaccination with bivalent oral polio vaccine (bOPV). The method was then applied to infer the weekly number of excreters in a large, sustained, asymptomatic outbreak of wild type 1 poliovirus in Israel (2013) in a population where >90% of the individuals received three doses of inactivated polio vaccine (IPV). Evidence-based intervention strategies were based on the short TAT for direct quantitative detection. Furthermore, a TAT shorter than the duration of poliovirus excretion allowed resampling of infected individuals. Finally, the method documented absence of infections after successful intervention of the asymptomatic outbreak. The methodologies described here can be applied to outbreaks of other excreted viruses such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), where there are (1) significant numbers of asymptomatic infections; (2) long incubation times during which infectious virus is excreted; and (3) limited resources, facilities, and manpower that restrict the number of individuals who can be tested and re-tested.
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Affiliation(s)
- Yuri Perepliotchikov
- Central Virology Laboratory, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (Y.P.); (M.H.); (Y.M.); (D.S.); (E.M.); (M.W.); (D.R.)
| | - Tomer Ziv-Baran
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (T.Z.-B.); (R.G.)
| | - Musa Hindiyeh
- Central Virology Laboratory, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (Y.P.); (M.H.); (Y.M.); (D.S.); (E.M.); (M.W.); (D.R.)
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (T.Z.-B.); (R.G.)
| | - Yossi Manor
- Central Virology Laboratory, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (Y.P.); (M.H.); (Y.M.); (D.S.); (E.M.); (M.W.); (D.R.)
| | - Danit Sofer
- Central Virology Laboratory, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (Y.P.); (M.H.); (Y.M.); (D.S.); (E.M.); (M.W.); (D.R.)
| | - Jacob Moran-Gilad
- Public Health Services, MOH, Jerusalem 9101002, Israel; (J.M.-G.); (E.A.); (S.R.S.); (E.K.); (I.G.)
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Laura Stephens
- National Institute for Biological Standards and Controls, Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, UK; (L.S.); (G.C.); (M.M.); (J.M.)
| | - Ella Mendelson
- Central Virology Laboratory, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (Y.P.); (M.H.); (Y.M.); (D.S.); (E.M.); (M.W.); (D.R.)
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (T.Z.-B.); (R.G.)
| | - Merav Weil
- Central Virology Laboratory, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (Y.P.); (M.H.); (Y.M.); (D.S.); (E.M.); (M.W.); (D.R.)
| | - Ravit Bassal
- Israel Center for Disease Control, Ministry of Health, Gertner Building, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (R.B.); (M.M.)
| | - Emilia Anis
- Public Health Services, MOH, Jerusalem 9101002, Israel; (J.M.-G.); (E.A.); (S.R.S.); (E.K.); (I.G.)
- Braun School of Public Health and Community Medicine, Hebrew University Hadassah Faculty of Medicine, Ein Kerem. P.O. Box 12271, Jerusalem 9112102, Israel
| | - Shepherd Roee Singer
- Public Health Services, MOH, Jerusalem 9101002, Israel; (J.M.-G.); (E.A.); (S.R.S.); (E.K.); (I.G.)
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Ehud Kaliner
- Public Health Services, MOH, Jerusalem 9101002, Israel; (J.M.-G.); (E.A.); (S.R.S.); (E.K.); (I.G.)
| | - Gillian Cooper
- National Institute for Biological Standards and Controls, Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, UK; (L.S.); (G.C.); (M.M.); (J.M.)
| | - Manasi Majumdar
- National Institute for Biological Standards and Controls, Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, UK; (L.S.); (G.C.); (M.M.); (J.M.)
| | - Michal Markovich
- Israel Center for Disease Control, Ministry of Health, Gertner Building, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (R.B.); (M.M.)
| | - Daniela Ram
- Central Virology Laboratory, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (Y.P.); (M.H.); (Y.M.); (D.S.); (E.M.); (M.W.); (D.R.)
| | - Itamar Grotto
- Public Health Services, MOH, Jerusalem 9101002, Israel; (J.M.-G.); (E.A.); (S.R.S.); (E.K.); (I.G.)
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Ronni Gamzu
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (T.Z.-B.); (R.G.)
- Public Health Services, MOH, Jerusalem 9101002, Israel; (J.M.-G.); (E.A.); (S.R.S.); (E.K.); (I.G.)
| | - Javier Martin
- National Institute for Biological Standards and Controls, Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, UK; (L.S.); (G.C.); (M.M.); (J.M.)
| | - Lester M. Shulman
- Central Virology Laboratory, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (Y.P.); (M.H.); (Y.M.); (D.S.); (E.M.); (M.W.); (D.R.)
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (T.Z.-B.); (R.G.)
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Odoom JK, Obodai E, Boateng G, Diamenu S, Attiku K, Avevor P, Duker E, Boahene B, Eshun M, Gberbie E, Opare JKL. Detection of vaccine-derived poliovirus circulation by environmental surveillance in the absence of clinical cases. Hum Vaccin Immunother 2021; 17:2117-2124. [PMID: 33517832 PMCID: PMC8189041 DOI: 10.1080/21645515.2020.1852009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/22/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND On August 25, 2019, the Noguchi Memorial Institute for Medical Research notified the confirmation of a circulating-vaccine-derived poliovirus type-2 (cVDPV2) from the Agbogbloshie environmental surveillance (AES) site, in the Greater Accra Region. A field investigation of the outbreak was conducted to describe the results of epidemiological and laboratory investigations, and control efforts. METHODS We conducted a descriptive investigation, records review, and active-case-search. Caregivers were interviewed on the vaccination status of their children; knowledge, attitude, and practices on polio prevention; water, sanitation and hygiene practices, and health-seeking behaviors. Stool from healthy children <5 y and sewage samples were taken for laboratory diagnosis. RESULTS cVDPV2 genetically similar to the cVDPV2 diagnosed recently in the Northern Region of Ghana and Nigeria was identified. 2019 half-year coverage of OPV and IPV was 22%. Fully immunized children were 49% (29/59). Most health workers (70%) had a fair knowledge of polio and acute flaccid paralysis (AFP). Forty-six percent of care-givers admitted to using the large drain linked to the site where the cVDPV2 was isolated as their place of convenience and disposing of the fecal matter of their children. No AFP case was identified. Stool samples from 40 healthy children yielded non-polio enteroviruses while 75% (3/4) of the additional sewage samples yielded cVDPV2. CONCLUSION cVDPV2 was isolated from the AES site. No AFP or poliovirus was identified from healthy children. There is a need to improve health workers' knowledge on AFP and to address the dire sanitation conditions in the Agbogbloshie market and its environs.
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Affiliation(s)
- John Kofi Odoom
- Noguchi Memorial Institute of Medical Research, University of Ghana, Legon, Ghana
| | - Evangeline Obodai
- Noguchi Memorial Institute of Medical Research, University of Ghana, Legon, Ghana
| | - Gifty Boateng
- Public Health and Reference Laboratory, Ghana Health Service, Accra, Ghana
| | | | - Keren Attiku
- Noguchi Memorial Institute of Medical Research, University of Ghana, Legon, Ghana
| | - Patrick Avevor
- Ghana Health Service, Private Mail Bag, Ministries, Accra, Ghana
| | - Ewurabena Duker
- Noguchi Memorial Institute of Medical Research, University of Ghana, Legon, Ghana
| | - Bismarck Boahene
- Noguchi Memorial Institute of Medical Research, University of Ghana, Legon, Ghana
| | - Miriam Eshun
- Noguchi Memorial Institute of Medical Research, University of Ghana, Legon, Ghana
| | - Emmanuel Gberbie
- Noguchi Memorial Institute of Medical Research, University of Ghana, Legon, Ghana
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Akhtar R, Mahmood N, Alam MM, Naeem M, Zaidi SSZ, Sharif S, Khattak Z, Arshad Y, Khurshid A, Mujtaba G, Rehman L, Angez M, Shaukat S, Mushtaq N, Umair M, Ikram A, Salman M. Genetic Epidemiology Reveals 3 Chronic Reservoir Areas With Recurrent Population Mobility Challenging Poliovirus Eradication in Pakistan. Clin Infect Dis 2021; 71:e58-e67. [PMID: 31665247 DOI: 10.1093/cid/ciz1037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 10/23/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pakistan is among 3 countries endemic for wild poliovirus type 1 (WPV1) circulation that are still struggling for eradication of poliomyelitis. Active clinical and environmental surveillance with meticulous laboratory investigations provide insights into poliovirus transmission patterns and genomic diversity to inform decisions for strategic operations required to achieve eradication. METHODS We analyzed epidemiological and virological data to comprehend the current epidemiological status of WPV1 in Pakistan during 2015-2017. Stool specimens of patients with acute flaccid paralysis (AFP) and sewage samples collected from 60 environmental sites were tested. Viral culturing, intratypic differentiation by real-time polymerase chain reaction, and nucleic acid sequencing of the VP1 region of the poliovirus genome to determine genetic relatedness among WPV1 strains were applied. RESULTS Poliovirus isolates were grouped into 11 distinct clusters, which had ≥95% nucleotide homology in the VP1 coding region. Most of the poliovirus burden was shared by 3 major reservoirs: Karachi, Peshawar, and Quetta block (64.2% in 2015, 75.4% in 2016, and 76.7% in 2017). CONCLUSIONS Environmental surveillance reveals importations and pockets of unimmunized children that dictate intensive target mop-up campaigns to contain poliovirus transmission. A decrease in the number of orphan isolates reflects effective combination of AFP and environmental surveillance in Pakistan. The genetic data reflect sustained transmission within reservoir areas, further expanded by periodic importations to areas of high immunity reflected by immediate termination of imported viruses. Improved immunization coverage with high-quality surveillance is vital for global certification of polio eradication.
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Affiliation(s)
- Ribqa Akhtar
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan.,Department of Biotechnology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Nayab Mahmood
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Muhammad Masroor Alam
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Muhammad Naeem
- Department of Biotechnology, Quaid-i-Azam University, Islamabad, Pakistan
| | | | - Salmaan Sharif
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Zainab Khattak
- Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Yasir Arshad
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Adnan Khurshid
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Ghulam Mujtaba
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Lubna Rehman
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Mehar Angez
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Shehzad Shaukat
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Nighat Mushtaq
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Massab Umair
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Aamer Ikram
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Muhammad Salman
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
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Risk Assessment and Virological Monitoring Following an Accidental Exposure to Concentrated Sabin Poliovirus Type 3 in France, November 2018. Vaccines (Basel) 2020; 8:vaccines8020331. [PMID: 32580378 PMCID: PMC7350213 DOI: 10.3390/vaccines8020331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/19/2020] [Accepted: 06/19/2020] [Indexed: 11/23/2022] Open
Abstract
The safe and secure containment of infectious poliovirus (PV) in facilities where live PV are handled is the condition to achieve and maintain poliomyelitis eradication. Despite precautions to minimize the risk of release of PV from such facilities to the environment, breaches of containment have already been documented. Here, we report the management of an incident that occurred on 30 November 2018 in a French vaccine manufacturing plant. Five adequately vaccinated operators were exposed to a Sabin poliovirus type 3 (PV3) spill. A microbiological risk assessment was conducted and the operators were monitored for PV shedding. On day 5 after exposure, Sabin PV3 was detected only in the stool sample of the most exposed worker. Shedding of Sabin PV3 (as detected by viral culture) was restricted to a very short period (less than 15 days). Monitoring of this incident was an opportunity to assess the relevance of our national response plan. We concluded that the measures undertaken and reported here were appropriate and proportional.
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8
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Estívariz CF, Pérez-Sánchez EE, Bahena A, Burns CC, Gary HE, García-Lozano H, Rey-Benito G, Peñaranda S, Castillo-Montufar KV, Nava-Acosta RS, Meschke JS, Oberste MS, Lopez-Martínez I, Díaz-Quiñonez JA. Field Performance of Two Methods for Detection of Poliovirus in Wastewater Samples, Mexico 2016-2017. FOOD AND ENVIRONMENTAL VIROLOGY 2019; 11:364-373. [PMID: 31571037 PMCID: PMC10389298 DOI: 10.1007/s12560-019-09399-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/29/2019] [Indexed: 06/10/2023]
Abstract
To enhance our ability to monitor poliovirus circulation and certify eradication, we evaluated the performance of the bag-mediated filtration system (BMFS) against the two-phase separation (TPS) method for concentrating wastewater samples for poliovirus detection. Sequential samples were collected at two sites in Mexico; one L was collected by grab and ~ 5 L were collected and filtered in situ with the BMFS. In the laboratory, 500 mL collected by grab were concentrated using TPS and the sample contained in the filter of the BMFS was eluted without secondary concentration. Concentrates were tested for the presence of poliovirus and non-poliovirus enterovirus (NPEV) using Global Poliovirus Laboratory Network standard procedures. Between February 16, 2016, and April 18, 2017, 125 pairs of samples were obtained. Collectors spent an average (± standard deviation) of 4.3 ± 2.2 min collecting the TPS sample versus 73.5 ± 30.5 min collecting and filtering the BMFS sample. Laboratory processing required an estimated 5 h for concentration by TPS and 3.5 h for elution. Sabin 1 poliovirus was detected in 37 [30%] samples with the TPS versus 24 [19%] samples with the BMFS (McNemar's mid p value = 0.004). Sabin 3 poliovirus was detected in 59 [47%] versus 49 (39%) samples (p = 0.043), and NPEV was detected in 67 [54%] versus 40 [32%] samples (p < 0.001). The BMFS method without secondary concentration did not perform as well as the TPS method for detecting Sabin poliovirus and NPEV. Further studies are needed to guide the selection of cost-effective environmental surveillance methods for the polio endgame.
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Affiliation(s)
- Concepción F Estívariz
- Global Immunization Division, Global Health Center, Centers for Control Disease and Prevention, 1600 Clifton Rd NE, Atlanta, GA, 30329, USA.
| | - Elda E Pérez-Sánchez
- Instituto de Diagnóstico y Referencia Epidemiológico, Francisco de P. Miranda 177, Lomas de Plateros-Alvaro Obregon, Ciudad De México, 01480, Mexico
| | - Anita Bahena
- Organización Panamericana de la Salud, Ciudad de México, Montes Urales 440, 2nd floor, Col. Lomas de Chapultepec, 11000, Ciudad De Mexico, Mexico
| | - Cara C Burns
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Howard E Gary
- Global Immunization Division, Global Health Center, Centers for Control Disease and Prevention, 1600 Clifton Rd NE, Atlanta, GA, 30329, USA
| | - Herlinda García-Lozano
- Instituto de Diagnóstico y Referencia Epidemiológico, Francisco de P. Miranda 177, Lomas de Plateros-Alvaro Obregon, Ciudad De México, 01480, Mexico
| | - Gloria Rey-Benito
- Immunization Unit, Pan American Health Organization, 525 23rd Street NW, Washington, DC, 20037, USA
| | - Silvia Peñaranda
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Katy V Castillo-Montufar
- Organización Panamericana de la Salud, Ciudad de México, Montes Urales 440, 2nd floor, Col. Lomas de Chapultepec, 11000, Ciudad De Mexico, Mexico
| | - Raúl S Nava-Acosta
- Organización Panamericana de la Salud, Ciudad de México, Montes Urales 440, 2nd floor, Col. Lomas de Chapultepec, 11000, Ciudad De Mexico, Mexico
| | - John Scott Meschke
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Seattle, WA, 98195, USA
| | - M Steven Oberste
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Irma Lopez-Martínez
- Instituto de Diagnóstico y Referencia Epidemiológico, Francisco de P. Miranda 177, Lomas de Plateros-Alvaro Obregon, Ciudad De México, 01480, Mexico
| | - José A Díaz-Quiñonez
- Instituto de Diagnóstico y Referencia Epidemiológico, Francisco de P. Miranda 177, Lomas de Plateros-Alvaro Obregon, Ciudad De México, 01480, Mexico
- División de Estudios de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad De México, Mexico
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9
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González MM, Fonseca MC, Rodríguez CA, Giraldo AM, Vila JJ, Castaño JC, Padilla L, Sarmiento L. Environmental Surveillance of Polioviruses in Armenia, Colombia before Trivalent Oral Polio Vaccine Cessation. Viruses 2019; 11:E775. [PMID: 31450757 PMCID: PMC6783851 DOI: 10.3390/v11090775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/17/2019] [Accepted: 08/18/2019] [Indexed: 11/16/2022] Open
Abstract
Although acute flaccid paralysis (AFP) surveillance is the "gold standard" for detecting cases of polio, environmental surveillance can provide supplementary information in the absence of paralytic poliomyelitis cases. This study aimed to detect the introduction and/or circulation of wild poliovirus or vaccine-derived polioviruses (VDPV) in wastewater, covering a significant population of Armenia, Colombia, before trivalent oral polio vaccine (OPV) cessation. Between March and September 2015, 24 wastewater samples were collected from eight study sites in eight communes of Armenia, Colombia. Virus detection and characterization were performed using both cell culture (i.e., RD or L20B cells) and RT-PCR. Polioviruses were isolated in 11 (45.8%) of 24 wastewater samples. All isolates were identified as Sabin strains (type 1 = 9, type 3 = 2) by intratypic differentiation. Type 2 poliovirus was not detected in any of the samples. No wild poliovirus or VDPV was detected among the isolates. Non-polio enterovirus was identified in 8.3% (2/24) of the samples. This study revealed the excretion of Sabin poliovirus from OPV-immunized individuals, as well as the absence of VDPV and wild poliovirus in wastewaters of Armenia, Colombia. This confirms that environmental surveillance is an effective method, as an additional support to AFP surveillance, to monitor poliovirus during the OPV-to-IPV (inactivated polio vaccine) transition period.
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Affiliation(s)
- María Mercedes González
- Center of Biomedical Research, Faculty of Health Sciences, Universidad del Quindío, Armenia 630003, Colombia.
| | - Magile C Fonseca
- Enterovirus Laboratory, Department of Virology, Pedro Kourí Institute of Tropical Medicine, Havana 11400, Cuba
| | - Carlos Andrés Rodríguez
- Center of Biomedical Research, Faculty of Health Sciences, Universidad del Quindío, Armenia 630003, Colombia
| | - Alejandra María Giraldo
- Center of Biomedical Research, Faculty of Health Sciences, Universidad del Quindío, Armenia 630003, Colombia
| | - José Joaquín Vila
- Center of Biomedical Research, Faculty of Health Sciences, Universidad del Quindío, Armenia 630003, Colombia
| | - Jhon Carlos Castaño
- Center of Biomedical Research, Faculty of Health Sciences, Universidad del Quindío, Armenia 630003, Colombia
| | - Leonardo Padilla
- Center of Biomedical Research, Faculty of Health Sciences, Universidad del Quindío, Armenia 630003, Colombia
| | - Luis Sarmiento
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Malmo 21428, Sweden.
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10
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Njile DK, Sadeuh-Mba SA, Endegue-Zanga MC, Mengouo MN, Djoumetio MD, Pouth FBB, Diop OM, Njouom R. Detection and characterization of polioviruses originating from urban sewage in Yaounde and Douala, Cameroon 2016-2017. BMC Res Notes 2019; 12:248. [PMID: 31046838 PMCID: PMC6498607 DOI: 10.1186/s13104-019-4280-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/25/2019] [Indexed: 01/06/2023] Open
Abstract
Objective Transmission of wild polioviruses (WPVs) and vaccine-derived polioviruses (VDPVs) have been interrupted in Cameroon since July 2014. Subsequently, Cameroon withdrew Sabin type 2 from routine immunization in April 2016. This study aimed to investigate the detection rates and overtime distribution of the types of PVs recovered from urban sewage in Cameroon. Results From January 2016 to December 2017, 517 sewage specimens originating from Yaounde (325 specimens) and Douala (192 specimens) were analyzed. No WPVs and VDPVs were isolated in this study. In contrast, vaccine strains of poliovirus were detected throughout the study period. Isolates Sabin types 1 and 3 were sporadically detected whereas Sabin 2 was found only from January to May 2016 both in Yaounde and Douala. The absence of Sabin 2 in sewage specimens since June 2016 indicates its rapid disappearance after withdrawal from routine immunization in April 2016. This study provides substantial support to the observation that WPV and VDPVs have been successfully eliminated in Cameroon. However, it remains essential to maintain and extend high quality environmental surveillance as long as WPV reservoirs and VDPV outbreaks are detected in Africa. Electronic supplementary material The online version of this article (10.1186/s13104-019-4280-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel Kamga Njile
- Virology Service, National Reference and Public Health Laboratory, Centre Pasteur of Cameroon, 451 Rue 2005, PO box 1274, Yaounde, Cameroon
| | - Serge Alain Sadeuh-Mba
- Virology Service, National Reference and Public Health Laboratory, Centre Pasteur of Cameroon, 451 Rue 2005, PO box 1274, Yaounde, Cameroon
| | - Marie-Claire Endegue-Zanga
- Virology Service, National Reference and Public Health Laboratory, Centre Pasteur of Cameroon, 451 Rue 2005, PO box 1274, Yaounde, Cameroon
| | | | | | | | - Ousmane Madiagne Diop
- The Polio Eradication Department, World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland
| | - Richard Njouom
- Virology Service, National Reference and Public Health Laboratory, Centre Pasteur of Cameroon, 451 Rue 2005, PO box 1274, Yaounde, Cameroon.
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11
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Sadeuh-Mba SA, Kavunga-Membo H, Joffret ML, Yogolelo R, Endegue-Zanga MC, Bessaud M, Njouom R, Muyembe-Tamfu JJ, Delpeyroux F. Genetic landscape and macro-evolution of co-circulating Coxsackieviruses A and Vaccine-derived Polioviruses in the Democratic Republic of Congo, 2008-2013. PLoS Negl Trop Dis 2019; 13:e0007335. [PMID: 31002713 PMCID: PMC6505894 DOI: 10.1371/journal.pntd.0007335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/06/2019] [Accepted: 03/27/2019] [Indexed: 02/06/2023] Open
Abstract
Enteroviruses (EVs) are among the most common viruses infecting humans worldwide
but only a few Non-Polio Enterovirus (NPEV) isolates have been characterized in
the Democratic Republic of Congo (DR Congo). Moreover, circulating
vaccine-derived polioviruses (PVs) [cVDPVs] isolated during multiple outbreaks
in DR Congo from 2004 to 2018 have been characterized so far only by the
sequences of their VP1 capsid coding gene. This study was carried to i)
investigate the circulation and genetic diversity of NPEV and polio vaccine
isolates recovered from healthy children and Acute Flaccid Paralysis (AFP)
patients, ii) evaluate the occurrence of genetic recombination among EVs
belonging to the Enterovirus C species (including PVs) and iii)
identify the virological factors favoring multiple emergences of cVDPVs in DR
Congo. The biological material considered in this study included i) a collection
of 91 Sabin-like PVs, 54 cVDPVs and 150 NPEVs isolated from AFP patients between
2008 and 2012 in DR Congo and iii) a collection of 330 stool specimens collected
from healthy children in 2013 in the Kasai Oriental and Maniema provinces of DR
Congo. Studied virus isolates were sequenced in four distinct sub-genomic
regions 5’-UTR, VP1, 2CATPase and 3Dpol. Resulting
sequences were compared through comparative phylogenetic analyses. Virus
isolation showed that 19.1% (63/330) healthy children were infected by EVs
including 17.9% (59/330) of NPEVs and 1.2% (4/330) of type 3 Sabin-like PVs.
Only one EV-C type, EV-C99 was identified among the NPEV collection from AFP
patients whereas 27.5% of the 69 NPEV isolates typed in healthy children
belonged to the EV-C species: CV-A13 (13/69), A20 (5/69) and A17 (1/69).
Interestingly, 50 of the 54 cVDPVs featured recombinant genomes containing
exogenous sequences in at least one of the targeted non-structural regions of
their genomes: 5’UTR, 2CATPase and 3Dpol. Some of these
non-vaccine sequences of the recombinant cVDPVs were strikingly related to
homologous sequences from co-circulating CV-A17 and A20 in the
2CATPase region as well as to those from co-circulating CV-A13,
A17 and A20 in the 3Dpol region. This study provided the first
evidence uncovering CV-A20 strains as major recombination partners of PVs. High
quality AFP surveillance, sensitive environmental surveillance and efficient
vaccination activities remain essential to ensure timely detection and efficient
response to recombinant cVDPVs outbreaks in DR Congo. Such needs are valid for
any epidemiological setting where high frequency and genetic diversity of
Coxsackieviruses A13, A17 and A20 provide a conducive viral ecosystem for the
emergence of virulent recombinant cVDPVs. The strategy of the Global Polio Eradication Initiative is based on the
surveillance of patients suffering from Acute Flaccid Paralysis (AFP) and mass
vaccination with live-attenuated vaccine strains of polioviruses (PVs) in
endemic areas. However, vaccine strains of PVs can circulate and replicate for a
long time when the vaccine coverage of the population is low. Such prolonged
circulation and replication of vaccine strains of PVs can result to the
emergence of circulating vaccine-derived polioviruses [cVDPVs] that are as
virulent as wild PVs. In this study, we performed the molecular characterization
of a large collection of 377 virus isolates recovered from paralyzed patients
between 2008 and 2012 in DR Congo and healthy children in 2013 in the Kasai
Oriental and Maniema provinces of DR Congo. We found that the genetic diversity
of enteroviruses of the species Enterovirus C is more important
than previously reported. Interestingly, 50 of the 54 cVDPVs featured
recombinant genomes containing exogenous sequences of the 2C ATPase and/or 3D
polymerase coding genes acquired from co-circulating Coxsackieviruses A13, A17
and A20. Coxsackieviruses A20 strains were identified for the first time as
major partners of genetic recombination with co-circulating live-attenuated
polio vaccine strains. Our findings highlight the need to reinforce and maintain high quality
surveillance of PVs and efficient immunization activities in order to ensure
early detection and control of emerging cVDPVs in all settings where high
frequency and diversity of Coxsackieviruses A13, A17 and A20 have been
documented.
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Affiliation(s)
- Serge Alain Sadeuh-Mba
- Virology Service, Centre Pasteur of Cameroon, Yaounde, Centre region,
Cameroon
- * E-mail: ,
| | - Hugo Kavunga-Membo
- Virology Department, Institut National de Recherche Biomédicale,
Kinshasa, Democratic Republic of Congo
| | - Marie-Line Joffret
- Biology of Enteric Viruses Unit, Institut Pasteur, Paris,
France
- INSERM U994 Unit, INSERM, Paris, France
| | - Riziki Yogolelo
- Virology Department, Institut National de Recherche Biomédicale,
Kinshasa, Democratic Republic of Congo
| | | | - Maël Bessaud
- Biology of Enteric Viruses Unit, Institut Pasteur, Paris,
France
- INSERM U994 Unit, INSERM, Paris, France
| | - Richard Njouom
- Virology Service, Centre Pasteur of Cameroon, Yaounde, Centre region,
Cameroon
| | | | - Francis Delpeyroux
- Biology of Enteric Viruses Unit, Institut Pasteur, Paris,
France
- INSERM U994 Unit, INSERM, Paris, France
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Nanteza MB, Bakamutumaho B, Kisakye A, Namuwulya P, Bukenya H, Katushabe E, Bwogi J, Byabamazima CR, Williams R, Gumede N. The detection of 3 ambiguous type 2 vaccine-derived polioviruses (VDPV2s) in Uganda. Virol J 2018; 15:77. [PMID: 29699577 PMCID: PMC5922010 DOI: 10.1186/s12985-018-0990-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Oral Polio Vaccine (OPV or Sabin) is genetically unstable and may mutate to form vaccine-derived polioviruses (VDPVs). METHODS In 2014, two VDPVs type 2 were identified during routine surveillance of acute flaccid paralysis (AFP) cases. Consequently, a retrospective VDPV survey was conducted to ensure that there was no circulating VDPV in the country. All Sabin poliovirus isolates identified in Uganda 6 months before and 6 months after were re-screened; Sabin 1 and 3 polioviruses were re-screened for Sabin 2 and Sabin 2 polioviruses were re-screened for VDPVs type 2. The Poliovirus rRT-PCR ITD/VDPV 4.0 assay and sequencing were used respectively. RESULTS The first two VDPVs type2 were identified in Eastern Uganda and the third was identified during the survey from South-western Uganda. These regions had low OPV coverage and poor AFP surveillance indicators. CONCLUSION The retrospective VDPV survey was a useful strategy to screen for VDPVs more exhaustively. Supplementary surveillance methods need to be encouraged.
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Affiliation(s)
- Mary Bridget Nanteza
- Uganda Virus Research Institute (UVRI), Plot 51 - 59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda.
| | - Barnabas Bakamutumaho
- Uganda Virus Research Institute (UVRI), Plot 51 - 59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Annet Kisakye
- World Health Organization (WHO), Plot 60 Prince Charles Avenue, Kololo, P.O. Box 24578, Kampala, Uganda
| | - Prossy Namuwulya
- Uganda Virus Research Institute (UVRI), Plot 51 - 59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Henry Bukenya
- Uganda Virus Research Institute (UVRI), Plot 51 - 59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Edson Katushabe
- World Health Organization (WHO), Plot 60 Prince Charles Avenue, Kololo, P.O. Box 24578, Kampala, Uganda
| | - Josephine Bwogi
- Uganda Virus Research Institute (UVRI), Plot 51 - 59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | | | - Raffaella Williams
- National Institute for Communicable Diseases (NICD), 1 Modderfontein Road Sandringham Johannesburg. Private Bag x4, Sandringham, 2131, South Africa.,NSW HIV State Reference Laboratory, St Vicent's Hospital, Darlinghurst, NSW, 2010, Australia
| | - Nicksy Gumede
- World Health Organization, Regional Office for Africa, P.O. Box 06, Brazzaville, Republic of Congo
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13
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Diagnostic Assay Development for Poliovirus Eradication. J Clin Microbiol 2018; 56:JCM.01624-17. [PMID: 29212703 DOI: 10.1128/jcm.01624-17] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/01/2017] [Indexed: 02/07/2023] Open
Abstract
With poliovirus eradication nearing, few pockets of active wild poliovirus (WPV) transmission remain in the world. Intratypic differentiation (ITD) plays a crucial part in laboratory surveillance as the molecular detection method that can identify and distinguish wild and vaccine-like polioviruses isolated from acute flaccid paralysis cases or environmental sources. The need to detect new variants of WPV serotype 1 (WPV1) and the containment of all serotype 2 polioviruses (PV2) in 2015 required changes to the previous version of the method. The ITD version 5.0 is a set of six real-time reverse transcription-PCR (rRT-PCR) assays that serve as accurate diagnostic tools to easily detect and differentiate PV serotypes and genotypes. We describe the creation and properties of quantitation standards, including 16 control RNA transcripts and nine plaque-isolated viruses. All ITD rRT-PCR assays were validated using these standards, and the limits of detection were determined for each assay. We designed and pilot tested two new assays targeting recently circulating WPV1 genotypes and all PV2 viruses. The WPV1 assay had 99.1% specificity and 100% sensitivity, and the PV2 assay had 97.7% specificity and 92% sensitivity. Before proceeding to the next step in the global poliovirus eradication program, we needed to gain a better understanding of the performance of the ITD 5.0 suite of molecular assays and their limits of detection and specificities. The findings and conclusions in this evaluation serve as building blocks for future development work.
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14
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Fernandez-Garcia MD, Majumdar M, Kebe O, Fall AD, Kone M, Kande M, Dabo M, Sylla MS, Sompare D, Howard W, Faye O, Martin J, Ndiaye K. Emergence of Vaccine-Derived Polioviruses during Ebola Virus Disease Outbreak, Guinea, 2014-2015. Emerg Infect Dis 2017; 24:65-74. [PMID: 29260690 PMCID: PMC5749474 DOI: 10.3201/eid2401.171174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
During the 2014-2015 outbreak of Ebola virus disease in Guinea, 13 type 2 circulating vaccine-derived polioviruses (cVDPVs) were isolated from 6 polio patients and 7 healthy contacts. To clarify the genetic properties of cVDPVs and their emergence, we combined epidemiologic and virologic data for polio cases in Guinea. Deviation of public health resources to the Ebola outbreak disrupted polio vaccination programs and surveillance activities, which fueled the spread of neurovirulent VDPVs in an area of low vaccination coverage and immunity. Genetic properties of cVDPVs were consistent with their capacity to cause paralytic disease in humans and capacity for sustained person-to-person transmission. Circulation ceased when coverage of oral polio vaccine increased. A polio outbreak in the context of the Ebola virus disease outbreak highlights the need to consider risks for polio emergence and spread during complex emergencies and urges awareness of the challenges in polio surveillance, vaccination, and diagnosis.
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15
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Diop OM, Kew OM, de Gourville EM, Pallansch MA. The Global Polio Laboratory Network as a Platform for the Viral Vaccine-Preventable and Emerging Diseases Laboratory Networks. J Infect Dis 2017; 216:S299-S307. [PMID: 28838192 PMCID: PMC5853949 DOI: 10.1093/infdis/jix092] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Global Polio Laboratory Network (GPLN) began building in the late 1980s on a 3-tiered structure of 146 laboratories with different and complementary technical and support capacities (poliovirus isolation, molecular strain characterization including sequencing, quality assurance, and research). The purpose of this network is to provide timely and accurate laboratory results to the Global Polio Eradication Initiative. Deeply integrated with field case-based surveillance, it ultimately provides molecular epidemiological data from polioviruses used to inform programmatic and immunization activities. This network of global coverage requires substantial investments in laboratory infrastructure, equipment, supplies, reagents, quality assurance, staffing and training, often in resource-limited settings. The GPLN has not only developed country capacities, but it also serves as a model to other global laboratory networks for vaccine-preventable diseases that will endure after the polio eradication goal is achieved. Leveraging lessons learned during past 27 years, the authors discuss options for transitioning GPLN assets to support control of other viral vaccine-preventable, emerging, and reemerging diseases.
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16
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Kaundal N, Sarkate P, Prakash C, Rishi N. Comparison of ELISA and dual stage real time RT-PCR to differentiate Sabin like and non-Sabin like poliovirus isolates. Virusdisease 2017; 28:141-145. [PMID: 28770239 PMCID: PMC5510635 DOI: 10.1007/s13337-017-0378-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/20/2017] [Indexed: 10/19/2022] Open
Abstract
Environmental surveillance of polioviruses has been used as an important tool in monitoring circulation of wild polioviruses and/or Vaccine derived polioviruses in sewage samples. It is important to distinguish Sabin like isolates from non-Sabin like; ELISA & dual stage real time RT-PCR have been used for the same. Current study was carried out on sewage isolates to compare ELISA & RT-PCR with sequencing to distinguish Sabin like from non-Sabin like. Out of 468 sewage specimens, 91 (19.44%) were non-polio enteroviruses positive and 377 (80.56%) were polio positive by virus isolation method. A total of 488 polio virus isolates were detected by L20B and RD route which were further subjected to ELISA and RT-PCR. The results were compared with sequencing. On comparison, the specificity of ELISA was only 66.67% in spite of very low sensitivity (3.43%). The sensitivity of RT-PCR was 97.71% which makes it a good primary screening test for detection of non-Sabin like viruses. However, the specificity was only 33.33%. RT-PCR appears to be a sensitive tool for detecting non-Sabin like viruses however; the isolates which are non-Sabin like by RT-PCR may not necessarily be mutated viruses. ELISA cannot be used for differentiation of Sabin likes from non-Sabin likes due to low sensitivity.
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Affiliation(s)
- Nirmal Kaundal
- Virology-1 Laboratory, Microbiology Division, National Centre for Disease Control, 22-Shamnath Marg, Delhi, 110054 India
| | - Purva Sarkate
- Microbiology Division, National Centre for Disease Control, 22-Shamnath Marg, Delhi, 110054 India
| | - Charu Prakash
- Microbiology Division, National Centre for Disease Control, 22-Shamnath Marg, Delhi, 110054 India
| | - Narayan Rishi
- Amity Institute of Virology and Immunology, Amity University Uttar Pradesh, Sector 125, Distt. Gautam BudhaNagar, Noida, Uttar Pradesh 201313 India
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17
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Farra A, Gonofio EC, Manirakiza A, Mazitchi A, Mbaïlao R, Manengu C, Gouandjika-Vasilache I. Epidemiological Surveillance of Poliomyelitis During the Military and Political Conflict in the Central African Republic, 2013 and 2014. Open Forum Infect Dis 2017; 4:ofw279. [PMID: 28480271 PMCID: PMC5414109 DOI: 10.1093/ofid/ofw279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 01/05/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since December 2012, the Central African Republic (CAR) has been undergoing a severe military and political conflict. This situation has resulted in general insecurity and total disorganization of surveillance activities, including those for acute flaccid paralysis (AFP). In this study, we used laboratory data to evaluate surveillance of AFP in 2013 and 2014, the most critical period of the conflict. METHODS The laboratory data on AFP were analyzed retrospectively for the age, sex, vaccination status (oral poliovirus vaccines), and geographical origin of the samples. The χ2 test was used, with P < .05 as the threshold for significance. RESULTS Decreased activity of AFP surveillance of 57% was registered in 2013 and 36% in 2014 compared with previous years. Only 37.3% and 49.7% of children with AFP were vaccinated in 2013 and 2014, respectively, but no wild poliovirus or vaccine-derived poliovirus (VDPV) was isolated. Laboratory performance concerning the timeliness of cell culture and intratypic differentiation/VDPV results was only 65.5% and 66.7% of the target in 2013 but reached 95.5% and 100% in 2014. CONCLUSIONS All personnel involved in the monitoring of AFP must be mobilized to improve vaccination coverage and surveillance activities in the CAR.
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Affiliation(s)
- Alain Farra
- Enteric Viruses and Measles Laboratory, Institut Pasteur de Bangui
| | - Ella C Gonofio
- Enteric Viruses and Measles Laboratory, Institut Pasteur de Bangui
| | | | - Arthur Mazitchi
- Enteric Viruses and Measles Laboratory, Institut Pasteur de Bangui
| | - Raphaël Mbaïlao
- Expanded Programme on Immunization, Ministry of Health, Bangui
| | - Casimir Manengu
- Focal Point for Immunization, Vaccines and Emergencies, World Health Organization, Bangui
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Detection of Emerging Vaccine-Related Polioviruses by Deep Sequencing. J Clin Microbiol 2017; 55:2162-2171. [PMID: 28468861 PMCID: PMC5483918 DOI: 10.1128/jcm.00144-17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/19/2017] [Indexed: 12/13/2022] Open
Abstract
Oral poliovirus vaccine can mutate to regain neurovirulence. To date, evaluation of these mutations has been performed primarily on culture-enriched isolates by using conventional Sanger sequencing. We therefore developed a culture-independent, deep-sequencing method targeting the 5′ untranslated region (UTR) and P1 genomic region to characterize vaccine-related poliovirus variants. Error analysis of the deep-sequencing method demonstrated reliable detection of poliovirus mutations at levels of <1%, depending on read depth. Sequencing of viral nucleic acids from the stool of vaccinated, asymptomatic children and their close contacts collected during a prospective cohort study in Veracruz, Mexico, revealed no vaccine-derived polioviruses. This was expected given that the longest duration between sequenced sample collection and the end of the most recent national immunization week was 66 days. However, we identified many low-level variants (<5%) distributed across the 5′ UTR and P1 genomic region in all three Sabin serotypes, as well as vaccine-related viruses with multiple canonical mutations associated with phenotypic reversion present at high levels (>90%). These results suggest that monitoring emerging vaccine-related poliovirus variants by deep sequencing may aid in the poliovirus endgame and efforts to ensure global polio eradication.
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19
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Romero JR. Human Enteroviruses. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00164-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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20
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Sharma DK, Nalavade UP, Deshpande JM. Real-time reverse transcription-polymerase chain reaction assays for identification of wild poliovirus 1 & 3. Indian J Med Res 2016; 142:471-8. [PMID: 26609040 PMCID: PMC4683833 DOI: 10.4103/0971-5916.169216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background & objectives: The poliovirus serotype identification and intratypic differentiation by real-time reverse transcription-polymerase chain reaction (rRT-PCR) assay is suitable for serotype mixtures but not for intratypic mixtures of wild and vaccine poliovirus strains. This study was undertaken to develop wild poliovirus 1 and 3 (WPV1 and WPV3) specific rRT-PCR assays for use. Methods: Specific primers and probes for rRT-PCR were designed based on VP1 sequences of WPV1 and WPV3 isolated in India since 2000. The specificity of the rRT-PCR assays was evaluated using WPV1 and WPV3 of different genetic lineages, non-polio enteroviruses (NPEVs) and mixtures of wild/wild and wild/Sabin vaccine strains. The sensitivity of the assays was determined by testing serial 10-fold dilutions of wild poliovirus 1 and 3 stock suspensions of known titre. Results: No cross-reactivity with Sabin strains, intertypic wild poliovirus isolates or 27 types of NPEVs across all the four Enterovirus species was found for both the wild poliovirus 1 and 3 rRT-PCR assays. All WPV1 and WPV3 strains isolated since 2000 were successfully amplified. The rRT-PCR assays detected 104.40CCID50/ml of WPV1 and 104.00CCID50/ml of WPV3, respectively either as single isolate or mixture with Sabin vaccine strains or intertypic wild poliovirus. Interpretation & conclusions: rRT-PCR assays for WPV1 and WPV3 have been validated to detect all the genetic variations of the WPV1 and WPV3 isolated in India for the last decade. When used in combination with the current rRT-PCR assay testing was complete for confirmation of the presence of wild poliovirus in intratypic mixtures.
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Jorba J, Diop OM, Iber J, Sutter RW, Wassilak SG, Burns CC. Update on Vaccine-Derived Polioviruses — Worldwide, January 2015–May 2016. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2016; 65:763-9. [DOI: 10.15585/mmwr.mm6530a3] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Membo HK, Mweene A, Sadeuh-Mba SA, Masumu J, Yogolelo R, Ngendabanyikwa N, Sokolua E, Sagamiko F, Simulundu E, Ahuka S, Muyembe JJ. Acute flaccid paralysis surveillance indicators in the Democratic Republic of Congo during 2008-2014. Pan Afr Med J 2016; 24:154. [PMID: 27642491 PMCID: PMC5012780 DOI: 10.11604/pamj.2016.24.154.8747] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 05/18/2016] [Indexed: 12/31/2022] Open
Abstract
Introduction The last wild poliovirus (WPV) case in Africa was reported in July 2014, thus underscoring the tremendous progress towards polio eradication worldwide. This study aimed to analyze the results of a seven-year surveillance of Acute Flaccid Paralysis (AFP) in the Democratic Republic of Congo (DRC) and to identify potential gaps that need to be addressed. Methods Epidemiological and virological data obtained from AFP surveillance among AFP cases less than 15 years from January 2008 to December 2014 in DRC were retrospectively considered and analyzed in this study. Results Of the 13,749 AFP cases investigated, 58.9% received at least three doses of oral polio vaccine (OPV), 7.3% never received OPV, while the status of 18.3% was unknown. Analysis of surveillance performances showed that all, but two, indicators were below the required WHO-specified targets. Non-polio enterovirus (NPEV) isolation rate was consistently below the minimum requirement at ≥10% and the proportions of stool specimens that reached the laboratory within 72 hours of being sent were always below 15% (WHO target is ≥80%). Virus isolation and differentiation showed that 1.5% of AFP cases were infected by WPVs, 5.5% by Sabin strains, 0.5% by vaccine-derived polioviruses (VDPVs) and 7.2% by NPEVs. Conclusion Our findings indicate that additional efforts are needed to address the timeliness of adequate stool specimens’ arrival to the laboratory. It remains essential to maintain high polio vaccine coverage and high AFP surveillance standards to ensure rapid detection and containment of either WPV importation or VDPV re-emergence in DRC.
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Affiliation(s)
- Hugo Kavunga Membo
- Institut National de Recherche Biomédicale (INRB), P.O Box 1197 Kinshasa 1, Kinshasa, Democratic Republic of Congo; Department of Disease Control, School of Veterinary Medicine, University of Zambia, P.O Box 32379, Lusaka, Zambia
| | - Aaron Mweene
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, P.O Box 32379, Lusaka, Zambia
| | - Serge Alain Sadeuh-Mba
- Service de Virologie, Centre Pasteur du Cameroun (CPC), rue Henri Dunant P.O Box 1274, Yaoundé, Cameroun
| | - Justin Masumu
- Institut National de Recherche Biomédicale (INRB), P.O Box 1197 Kinshasa 1, Kinshasa, Democratic Republic of Congo
| | - Riziki Yogolelo
- Institut National de Recherche Biomédicale (INRB), P.O Box 1197 Kinshasa 1, Kinshasa, Democratic Republic of Congo
| | | | - Eddy Sokolua
- World Heath Organization (WHO), Central African Inter-country Bureau, Libreville, Gabon
| | - Fred Sagamiko
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, P.O Box 32379, Lusaka, Zambia
| | - Edgar Simulundu
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, P.O Box 32379, Lusaka, Zambia
| | - Steve Ahuka
- Institut National de Recherche Biomédicale (INRB), P.O Box 1197 Kinshasa 1, Kinshasa, Democratic Republic of Congo
| | - Jean Jacques Muyembe
- Institut National de Recherche Biomédicale (INRB), P.O Box 1197 Kinshasa 1, Kinshasa, Democratic Republic of Congo
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Sharma DK, Nalavade UP, Varose SY, Deshpande JM. Vaccine-Derived Polioviruses Not Detected by Global Surveillance Screening Assay. Emerg Infect Dis 2016; 21:1880-1. [PMID: 26402584 PMCID: PMC4593449 DOI: 10.3201/eid2110.150702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Endegue-Zanga MC, Sadeuh-Mba SA, Iber J, Burns CC, Moeletsi NG, Baba M, Bukbuk D, Delpeyroux F, Mengouo MN, Demanou M, Vernet G, Etoa FX, Njouom R. Importation and outbreak of wild polioviruses from 2000 to 2014 and interruption of transmission in Cameroon. J Clin Virol 2016; 79:18-24. [PMID: 27045455 DOI: 10.1016/j.jcv.2016.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/22/2016] [Accepted: 03/27/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Efficient implementation of the global eradication strategies consisting of Acute Flaccid Paralysis (AFP) surveillance and mass immunization campaigns led to interruption of indigenous wild poliovirus transmission in Cameroon in 1999. OBJECTIVES This study describes type 1 and type 3 wild poliovirus (WPV) importation, incidence, geographic distribution and control since the original interruption of transmission in Cameroon. STUDY DESIGN Stool samples from AFP patients under the age of 15 years in Cameroon were collected nationwide and subjected to virus isolation on RD and L20B cell cultures. Resulting virus isolates were typed by intratypic differentiation (ITD) and analysis of the VP1 coding sequence of the viral genome. Surveillance data originating from Cameroon between 2000 and 2014 were considered for retrospective descriptive analyses. RESULTS From 2003 to 2009, multiple WPV importation events from neighboring countries affected mainly in the northern regions of Cameroon but did not led to sustained local transmission. Throughout this period, 16 WPV1 and 5 WPV3 were detected and identified as members of multiple clusters within type-specific West Africa B genotypes (WEAF-B). In 2013-2014, a polio outbreak associated to a highly evolved ("orphan") WPV1 affected four southern regions of Cameroon. CONCLUSIONS The appearance of highly evolved lineage of type 1 WPV suggests potential surveillance gap and underscore the need to maintain comprehensive polio immunization activities and sensitive surveillance systems in place as long as any country in the world remains endemic for WPV.
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Affiliation(s)
| | | | - Jane Iber
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cara C Burns
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Marycelin Baba
- Department of Medical Laboratory Science, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - David Bukbuk
- Department of Microbiology, University of Maiduguri, Bama Road, P.M.B. 1069, Maiduguri, Nigeria
| | - Francis Delpeyroux
- Institut Pasteur, Biologie des Virus Entériques, INSERM U994, 75724 Paris, Cedex 15, France
| | | | - Maurice Demanou
- Virology Service, Centre Pasteur of Cameroon, P.O. Box 1274, Yaoundé, Cameroon
| | - Guy Vernet
- Virology Service, Centre Pasteur of Cameroon, P.O. Box 1274, Yaoundé, Cameroon
| | | | - Richard Njouom
- Virology Service, Centre Pasteur of Cameroon, P.O. Box 1274, Yaoundé, Cameroon.
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Cassemiro KMSDM, Burlandy FM, Barbosa MRF, Chen Q, Jorba J, Hachich EM, Sato MIZ, Burns CC, da Silva EE. Molecular and Phenotypic Characterization of a Highly Evolved Type 2 Vaccine-Derived Poliovirus Isolated from Seawater in Brazil, 2014. PLoS One 2016; 11:e0152251. [PMID: 27019095 PMCID: PMC4809597 DOI: 10.1371/journal.pone.0152251] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 03/11/2016] [Indexed: 02/06/2023] Open
Abstract
A type 2 vaccine-derived poliovirus (VDPV), differing from the Sabin 2 strain at 8.6% (78/903) of VP1 nucleotide positions, was isolated from seawater collected from a seaport in São Paulo State, Brazil. The P1/capsid region is related to the Sabin 2 strain, but sequences within the 5'-untranslated region and downstream of the P1 region were derived from recombination with other members of Human Enterovirus Species C (HEV-C). The two known attenuating mutations had reverted to wild-type (A481G in the 5'-UTR and Ile143Thr in VP1). The VDPV isolate had lost the temperature sensitive phenotype and had accumulated amino acid substitutions in neutralizing antigenic (NAg) sites 3a and 3b. The date of the initiating OPV dose, estimated from the number of synonymous substitutions in the capsid region, was approximately 8.5 years before seawater sampling, a finding consistent with a long time of virus replication and possible transmission among several individuals. Although no closely related type 2 VDPVs were detected in Brazil or elsewhere, this VDPV was found in an area with a mobile population, where conditions may favor both viral infection and spread. Environmental surveillance serves as an important tool for sensitive and early detection of circulating poliovirus in the final stages of global polio eradication.
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Affiliation(s)
| | - Fernanda M. Burlandy
- Enterovirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mikaela R. F. Barbosa
- Environmental Analysis Department, Environmental Company of São Paulo State, São Paulo, São Paulo, Brazil
| | - Qi Chen
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of Americaa
| | - Jaume Jorba
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of Americaa
| | - Elayse M. Hachich
- Environmental Analysis Department, Environmental Company of São Paulo State, São Paulo, São Paulo, Brazil
| | - Maria I. Z. Sato
- Environmental Analysis Department, Environmental Company of São Paulo State, São Paulo, São Paulo, Brazil
| | - Cara C. Burns
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of Americaa
| | - Edson E. da Silva
- Enterovirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
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Burns CC, Kilpatrick DR, Iber JC, Chen Q, Kew OM. Molecular Properties of Poliovirus Isolates: Nucleotide Sequence Analysis, Typing by PCR and Real-Time RT-PCR. Methods Mol Biol 2016; 1387:177-212. [PMID: 26983735 DOI: 10.1007/978-1-4939-3292-4_9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Virologic surveillance is essential to the success of the World Health Organization initiative to eradicate poliomyelitis. Molecular methods have been used to detect polioviruses in tissue culture isolates derived from stool samples obtained through surveillance for acute flaccid paralysis. This chapter describes the use of realtime PCR assays to identify and serotype polioviruses. In particular, a degenerate, inosine-containing, panpoliovirus (panPV) PCR primer set is used to distinguish polioviruses from NPEVs. The high degree of nucleotide sequence diversity among polioviruses presents a challenge to the systematic design of nucleic acid-based reagents. To accommodate the wide variability and rapid evolution of poliovirus genomes, degenerate codon positions on the template were matched to mixed-base or deoxyinosine residues on both the primers and the TaqMan™ probes. Additional assays distinguish between Sabin vaccine strains and non-Sabin strains. This chapter also describes the use of generic poliovirus specific primers, along with degenerate and inosine-containing primers, for routine VP1 sequencing of poliovirus isolates. These primers, along with nondegenerate serotype-specific Sabin primers, can also be used to sequence individual polioviruses in mixtures.
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Affiliation(s)
- Cara C Burns
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, 1600 Clifton Rd., NE MS G-10, Atlanta, GA, 30333, USA.
| | - David R Kilpatrick
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, National Center for Immunizationand Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jane C Iber
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, National Center for Immunizationand Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Qi Chen
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, National Center for Immunizationand Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Olen M Kew
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, National Center for Immunizationand Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Sabin Vaccine Reversion in the Field: a Comprehensive Analysis of Sabin-Like Poliovirus Isolates in Nigeria. J Virol 2015; 90:317-31. [PMID: 26468545 DOI: 10.1128/jvi.01532-15] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/07/2015] [Indexed: 02/05/2023] Open
Abstract
UNLABELLED To assess the dynamics of genetic reversion of live poliovirus vaccine in humans, we studied molecular evolution in Sabin-like poliovirus isolates from Nigerian acute flaccid paralysis cases obtained from routine surveillance. We employed a novel modeling approach to infer substitution and recombination rates from whole-genome sequences and information about poliovirus infection dynamics and the individual vaccination history. We confirmed observations from a recent vaccine trial that VP1 substitution rates are increased for Sabin-like isolates relative to the rate for the wild type due to increased nonsynonymous substitution rates. We also inferred substitution rates for attenuating nucleotides and confirmed that reversion can occur in days to weeks after vaccination. We combine our observations for Sabin-like virus evolution with the molecular clock for VP1 of circulating wild-type strains to infer that the mean time from the initiating vaccine dose to the earliest detection of circulating vaccine-derived poliovirus (cVDPV) is 300 days for Sabin-like virus type 1, 210 days for Sabin-like virus type 2, and 390 days for Sabin-like virus type 3. Phylogenetic relationships indicated transient local transmission of Sabin-like virus type 3 and, possibly, Sabin-like virus type 1 during periods of low wild polio incidence. Comparison of Sabin-like virus recombinants with known Nigerian vaccine-derived poliovirus recombinants shows that while recombination with non-Sabin enteroviruses is associated with cVDPV, the recombination rates are similar for Sabin isolate-Sabin isolate and Sabin isolate-non-Sabin enterovirus recombination after accounting for the time from dosing to the time of detection. Our study provides a comprehensive picture of the evolutionary dynamics of the oral polio vaccine in the field. IMPORTANCE The global polio eradication effort has completed its 26th year. Despite success in eliminating wild poliovirus from most of the world, polio persists in populations where logistical, social, and political factors have not allowed vaccination programs of sustained high quality. One issue of critical importance is eliminating circulating vaccine-derived polioviruses (cVDPVs) that have properties indistinguishable from those of wild poliovirus and can cause paralytic disease. cVDPV emerges due to the genetic instability of the Sabin viruses used in the oral polio vaccine (OPV) in populations that have low levels of immunity to poliovirus. However, the dynamics responsible are incompletely understood because it has historically been difficult to gather and interpret data about evolution of the Sabin viruses used in OPV in regions where cVDPV has occurred. This study is the first to combine whole-genome sequencing of poliovirus isolates collected during routine surveillance with knowledge about the intrahost dynamics of poliovirus to provide quantitative insight into polio vaccine evolution in the field.
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Alam MM, Sharif S, Shaukat S, Angez M, Khurshid A, Rehman L, Zaidi SSZ. Genomic Surveillance Elucidates Persistent Wild Poliovirus Transmission During 2013-2015 in Major Reservoir Areas of Pakistan. Clin Infect Dis 2015; 62:190-198. [PMID: 26417032 DOI: 10.1093/cid/civ831] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/28/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite tremendous efforts in the fight against polio, Pakistan bears the highest proportion of poliomyelitis cases among the 3 endemic countries including Afghanistan and Nigeria. Apart from insecurity and inaccessibility challenges, the substantial shift of unimmunized children from North Waziristan due to recent military operations was presumed to favor the widespread poliovirus infection in Pakistan. METHODS To better understand the current epidemiological situation, we analyzed the virologic data of wild poliovirus type 1 (WPV1) strains detected in Pakistan during 2013-2015. RESULTS Five genetic clusters (A-E) were identified with at least 5% nucleotide divergence in the viral protein 1 (VP1) coding region. Peshawar, Quetta, and Karachi were found to be the major endemic foci where multiple discrete genetic lineages of WPV1 were detected. Phylogenetic analysis suggests that wild poliovirus strains from endemic regions were genetically distant (with 5%-15% VP1 nucleotide divergence) from those detected in North Waziristan cases, excluding the possibility of a recent progenitor of WPV1 instigating single-source transmission across the country. Orphan lineages detected in Rawalpindi, Lahore, Hyderabad, Sukkur, and Jacobabad revealed silent transmission and the need for vigilant surveillance. Sustenance of analogous genetic lineages over a period of 3 years highlights multiple unimmunized foci present to maintain viral genetic diversity. CONCLUSIONS Our findings are inconsistent with the hypothesis that impoverished populations from North Waziristan serve as a possible determinant of widespread poliomyelitis infection in Pakistan and further emphasize the need to scale-up clinical and environmental surveillance as well as immunization activities.
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Affiliation(s)
- Muhammad Masroor Alam
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Salmaan Sharif
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Shahzad Shaukat
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Mehar Angez
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Adnan Khurshid
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Lubna Rehman
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
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Diop OM, Burns CC, Sutter RW, Wassilak SG, Kew OM. Update on Vaccine-Derived Polioviruses - Worldwide, January 2014-March 2015. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2015; 64:640-6. [PMID: 26086635 PMCID: PMC4584736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Since the World Health Assembly's 1988 resolution to eradicate poliomyelitis, one of the main tools of the World Health Organization (WHO) Global Polio Eradication Initiative (GPEI) has been the live, attenuated oral poliovirus vaccine (OPV). OPV might require several doses to induce immunity but provides long-term protection against paralytic disease. Through effective use of OPV, GPEI has brought polio to the threshold of eradication. Wild poliovirus type 2 (WPV2) was eliminated in 1999, WPV3 has not been detected since November 2012, and WPV1 circulation appears to be restricted to parts of Pakistan and Afghanistan. However, continued use of OPV carries two key risks. The first, vaccine-associated paralytic poliomyelitis (VAPP) has been recognized since the early 1960s. VAPP is a very rare event that occurs sporadically when an administered dose of OPV reverts to neurovirulence and causes paralysis in the vaccine recipient or a nonimmune contact. VAPP can occur among immunologically normal vaccine recipients and their contacts as well as among persons who have primary immunodeficiencies (PIDs) manifested by defects in antibody production; it is not associated with outbreaks. The second, the emergence of genetically divergent, neurovirulent vaccine-derived polioviruses (VDPVs) was recognized more recently. Circulating VDPVs (cVDPVs) resemble WPVs and, in areas with low OPV coverage, can cause polio outbreaks. Immunodeficiency-associated VDPVs (iVDPVs) can replicate and be excreted for years in some persons with PIDs; GPEI maintains a registry of iVDPV cases. Ambiguous VDPVs (aVDPVs) are isolates that cannot be classified definitively. This report updates previous surveillance summaries and describes VDPVs detected worldwide during January 2014-March 2015. Those include new cVDPV outbreaks in Madagascar and South Sudan, and sharply reduced type 2 cVDPV (cVDPV2) circulation in Nigeria and Pakistan during the latter half of 2014. Eight newly identified persons in six countries were found to excrete iVDPVs, and a patient in the United Kingdom was still excreting iVDPV2 in 2014 after more than 28 years. Ambiguous VDPVs were found among immunocompetent persons and environmental samples in 16 countries. Because the large majority of VDPV case-isolates are type 2, WHO has developed a plan for coordinated worldwide withdrawal of trivalent (types 1, 2, and 3) OPV (tOPV) and replacement with bivalent (types 1 and 3) OPV (bOPV) in April 2016, preceded by introduction of at least 1 dose of injectable inactivated poliovirus vaccine (IPV) into routine immunization schedules worldwide to maintain immunity to type 2 viruses.
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Affiliation(s)
- Ousmane M. Diop
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - Cara C. Burns
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Roland W. Sutter
- Polio Operations and Research Department, World Health Organization, Geneva, Switzerland
| | | | - Olen M. Kew
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC,Corresponding author: Olen M. Kew, , 404-639-3940
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Endegue-Zanga MC, Sadeuh-Mba SA, Iber J, Burns C, Nimpa-Mengouo M, Demanou M, Vernet G, Etoa FX, Njouom R. Circulating vaccine-derived polioviruses in the Extreme North region of Cameroon. J Clin Virol 2015; 62:80-3. [DOI: 10.1016/j.jcv.2014.11.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 11/21/2014] [Accepted: 11/23/2014] [Indexed: 12/23/2022]
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Abstract
The attenuated oral poliovirus vaccine (OPV) has many properties favoring its use in polio eradication: ease of administration, efficient induction of intestinal immunity, induction of durable humoral immunity, and low cost. Despite these advantages, OPV has the disadvantage of genetic instability, resulting in rare and sporadic cases of vaccine-associated paralytic poliomyelitis (VAPP) and the emergence of genetically divergent vaccine-derived polioviruses (VDPVs). Whereas VAPP is an adverse event following exposure to OPV, VDPVs are polioviruses whose genetic properties indicate prolonged replication or transmission. Three categories of VDPVs are recognized: (1) circulating VDPVs (cVDPVs) from outbreaks in settings of low OPV coverage, (2) immunodeficiency-associated VDPVs (iVDPVs) from individuals with primary immunodeficiencies, and (3) ambiguous VDPVs (aVDPVs), which cannot be definitively assigned to either of the first 2 categories. Because most VDPVs are type 2, the World Health Organization's plans call for coordinated worldwide replacement of trivalent OPV with bivalent OPV containing poliovirus types 1 and 3.
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Affiliation(s)
- Cara C Burns
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Olen M Kew
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Development of an efficient entire-capsid-coding-region amplification method for direct detection of poliovirus from stool extracts. J Clin Microbiol 2014; 53:73-8. [PMID: 25339406 DOI: 10.1128/jcm.02384-14] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Laboratory diagnosis has played a critical role in the Global Polio Eradication Initiative since 1988, by isolating and identifying poliovirus (PV) from stool specimens by using cell culture as a highly sensitive system to detect PV. In the present study, we aimed to develop a molecular method to detect PV directly from stool extracts, with a high efficiency comparable to that of cell culture. We developed a method to efficiently amplify the entire capsid coding region of human enteroviruses (EVs) including PV. cDNAs of the entire capsid coding region (3.9 kb) were obtained from as few as 50 copies of PV genomes. PV was detected from the cDNAs with an improved PV-specific real-time reverse transcription-PCR system and nucleotide sequence analysis of the VP1 coding region. For assay validation, we analyzed 84 stool extracts that were positive for PV in cell culture and detected PV genomes from 100% of the extracts (84/84 samples) with this method in combination with a PV-specific extraction method. PV could be detected in 2/4 stool extract samples that were negative for PV in cell culture. In PV-positive samples, EV species C viruses were also detected with high frequency (27% [23/86 samples]). This method would be useful for direct detection of PV from stool extracts without using cell culture.
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Diop OM, Burns CC, Wassilak SG, Kew OM. Update on vaccine-derived polioviruses - worldwide, July 2012-December 2013. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2014; 63:242-8. [PMID: 24647401 PMCID: PMC4584635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In 1988, the World Health Assembly resolved to eradicate poliomyelitis worldwide. One of the main tools used in polio eradication efforts has been live, attenuated oral poliovirus vaccine (OPV), an inexpensive vaccine easily administered by trained volunteers. OPV might require several doses to induce immunity, but then it provides long-term protection against paralytic disease through durable humoral immunity. Rare cases of vaccine-associated paralytic poliomyelitis can occur among immunologically normal OPV recipients, their contacts, and persons who are immunodeficient. In addition, vaccine-derived polioviruses (VDPVs) can emerge in areas with low OPV coverage to cause polio outbreaks and can replicate for years in persons who have primary, B-cell immunodeficiencies. This report updates previous surveillance summaries and describes VDPVs detected worldwide during July 2012-December 2013. Those include a new circulating VDPV (cVDPV) outbreak identified in Pakistan in 2012, with spread to Afghanistan; an outbreak in Afghanistan previously identified in 2009 that continued into 2013; a new outbreak in Chad that spread to Cameroon, Niger, and northeastern Nigeria; and an outbreak that began in Somalia in 2008 that continued and spread to Kenya in 2013. A large outbreak in Nigeria that was identified in 2005 was nearly stopped by the end of 2013. Additionally, 10 newly identified persons in eight countries were found to excrete immunodeficiency-associated VDPVs (iVDPVs), and VDPVs were found among immunocompetent persons and environmental samples in 13 countries. Because the majority of VDPV isolates are type 2, the World Health Organization has developed a plan for coordinated worldwide replacement of trivalent OPV (tOPV) with bivalent OPV (bOPV; types 1 and 3) by 2016, preceded by introduction of at least 1 dose of inactivated poliovirus vaccine (IPV) containing all three poliovirus serotypes into routine immunization schedules worldwide to ensure high population immunity to all polioviruses.
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Affiliation(s)
- Ousmane M. Diop
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - Cara C. Burns
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
| | | | - Olen M. Kew
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases,Corresponding author: Olen M. Kew, , 404-639-3940
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