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Lehto KM, Länsivaara A, Hyder R, Luomala O, Lipponen A, Hokajärvi AM, Heikinheimo A, Pitkänen T, Oikarinen S. Wastewater-based surveillance is an efficient monitoring tool for tracking influenza A in the community. WATER RESEARCH 2024; 257:121650. [PMID: 38692254 DOI: 10.1016/j.watres.2024.121650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/03/2024]
Abstract
Around the world, influenza A virus has caused severe pandemics, and the risk of future pandemics remains high. Currently, influenza A virus surveillance is based on the clinical diagnosis and reporting of disease cases. In this study, we apply wastewater-based surveillance to monitor the amount of the influenza A virus RNA at the population level. We report the influenza A virus RNA levels in 10 wastewater treatment plant catchment areas covering 40 % of the Finnish population. Altogether, 251 monthly composite influent wastewater samples (collected between February 2021 and February 2023) were analysed from supernatant fraction using influenza A virus specific RT-qPCR method. During the study period, an influenza A virus epidemic occurred in three waves in Finland. This study shows that the influenza A virus RNA can be detected from the supernatant fraction of 24 h composite influent wastewater samples. The influenza A virus RNA gene copy number in wastewater correlated with the number of confirmed disease cases in the Finnish National Infectious Diseases Register. The median Kendall's τ correlation strength was 0.636 (min= 0.486 and max=0.804) and it was statistically significant in all 10 WTTPs. Wastewater-based surveillance of the influenza A virus RNA is an independent from individual testing method and cost-efficiently reflects the circulation of the virus in the entire population. Thus, wastewater monitoring complements the available, but often too sparse, information from individual testing and improves health care and public health preparedness for influenza A virus pandemics.
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Affiliation(s)
- Kirsi-Maarit Lehto
- Tampere University, Faculty of Medicine and Health Technology, Arvo Ylpön katu 34, Tampere 33520, Finland
| | - Annika Länsivaara
- Tampere University, Faculty of Medicine and Health Technology, Arvo Ylpön katu 34, Tampere 33520, Finland
| | - Rafiqul Hyder
- Tampere University, Faculty of Medicine and Health Technology, Arvo Ylpön katu 34, Tampere 33520, Finland
| | - Oskari Luomala
- Finnish Institute for Health and Welfare, THL, Department of Health Security, Neulaniementie 4, Kuopio 70210, Finland
| | - Anssi Lipponen
- Finnish Institute for Health and Welfare, THL, Department of Health Security, Neulaniementie 4, Kuopio 70210, Finland
| | - Anna-Maria Hokajärvi
- Finnish Institute for Health and Welfare, THL, Department of Health Security, Neulaniementie 4, Kuopio 70210, Finland
| | - Annamari Heikinheimo
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Agnes Sjöbergin katu 2, FI00014, Finland; Finnish Food Authority, Ruokavirasto, Alvar Aallon katu 5, Seinäjoki 60100, Finland
| | - Tarja Pitkänen
- Finnish Institute for Health and Welfare, THL, Department of Health Security, Neulaniementie 4, Kuopio 70210, Finland; Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Agnes Sjöbergin katu 2, FI00014, Finland
| | - Sami Oikarinen
- Tampere University, Faculty of Medicine and Health Technology, Arvo Ylpön katu 34, Tampere 33520, Finland.
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Powell EA, Greninger AL, Marlowe EM, Naccache SN, Doern CD. Proceedings of the Clinical Microbiology Open 2023: discussions about pandemic preparedness. J Clin Microbiol 2024; 62:e0014424. [PMID: 38775470 PMCID: PMC11237618 DOI: 10.1128/jcm.00144-24] [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] [Indexed: 05/31/2024] Open
Abstract
The 4th Clinical Microbiology Open (CMO) took place in Carlsbad, California, on 10 and 11 February 2023. This event facilitated discussion between clinical and public health laboratory directors, government agencies, and industry representatives from the companies that make up ASM's Corporate Council. While many topics were discussed, much of the discussion focused on pandemic preparedness. There were four major questions addressed: (i) When is the perfect the enemy of good in pandemic testing? (ii) What other types of pathogens might cause another pandemic and how would this affect laboratory response? (iii) What research is needed to better understand the effectiveness of the pandemic response? (iv) What have we learned about the utility of self and at-home testing in future pandemics? This review serves as a summary of these discussions.
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Affiliation(s)
- Eleanor A. Powell
- Department of Pathology and Laboratory Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alexander L. Greninger
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, Washington, USA
| | | | | | - Christopher D. Doern
- Department of Pathology, Virginia Commonwealth University Health System, Richmond, Virginia, USA
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3
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Tiwari A, Lehto KM, Paspaliari DK, Al-Mustapha AI, Sarekoski A, Hokajärvi AM, Länsivaara A, Hyder R, Luomala O, Lipponen A, Oikarinen S, Heikinheimo A, Pitkänen T. Developing wastewater-based surveillance schemes for multiple pathogens: The WastPan project in Finland. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 926:171401. [PMID: 38467259 DOI: 10.1016/j.scitotenv.2024.171401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
Wastewater comprises multiple pathogens and offers a potential for wastewater-based surveillance (WBS) to track the prevalence of communicable diseases. The Finnish WastPan project aimed to establish wastewater-based pandemic preparedness for multiple pathogens (viruses, bacteria, parasites, fungi), including antimicrobial resistance (AMR). This article outlines WastPan's experiences in this project, including the criteria for target selection, sampling locations, frequency, analysis methods, and results communication. Target selection relied on epidemiological and microbiological evidence and practical feasibility. Within the WastPan framework, wastewater samples were collected between 2021 and 2023 from 10 wastewater treatment plants (WWTPs) covering 40 % of Finland's population. WWTP selection was validated for reported cases of Extended Spectrum Beta-lactamase-producing bacterial pathogens (Escherichia coli and Klebsiella pneumoniae) from the National Infectious Disease Register. The workflow included 24-h composite influent samples, with one fraction for culture-based analysis (bacteria and fungi) and the rest of the sample was reserved for molecular analysis (viruses, bacteria, antibiotic resistance genes, and parasites). The reproducibility of the monitoring workflow was assessed for SARS-CoV-2 through inter-laboratory comparisons using the N2 and N1 assays. Identical protocols were applied to same-day samples, yielding similar positivity trends in the two laboratories, but the N2 assay achieved a significantly higher detection rate (Laboratory 1: 91.5 %; Laboratory 2: 87.4 %) than the N1 assay (76.6 %) monitored only in Laboratory 2 (McNemar, p < 0.001 Lab 1, = 0.006 Lab 2). This result indicates that the selection of monitoring primers and assays may impact monitoring sensitivity in WBS. Overall, the current study recommends that the selection of sampling frequencies and population coverage of the monitoring should be based on pathogen-specific epidemiological characteristics. For example, pathogens that are stable over time may need less frequent annual sampling, while those that are occurring across regions may require reduced sample coverage. Here, WastPan successfully piloted WBS for monitoring multiple pathogens, highlighting the significance of one-litre community composite wastewater samples for assessing community health. The infrastructure established for COVID-19 WBS is valuable for monitoring various pathogens. The prioritization of the monitoring targets optimizes resource utilization. In the future legislative support in target selection, coverage determination, and sustained funding for WBS is recomended.
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Affiliation(s)
- Ananda Tiwari
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio and Helsinki, Finland.
| | - Kirsi-Maarit Lehto
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
| | - Dafni K Paspaliari
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio and Helsinki, Finland; ECDC Fellowship Programme, Public Health Microbiology path (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Ahmad I Al-Mustapha
- University of Helsinki, Faculty of Veterinary Medicine, Helsinki, Finland; Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Anniina Sarekoski
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio and Helsinki, Finland; University of Helsinki, Faculty of Veterinary Medicine, Helsinki, Finland.
| | - Anna-Maria Hokajärvi
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio and Helsinki, Finland.
| | - Annika Länsivaara
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
| | - Rafiqul Hyder
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
| | - Oskari Luomala
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio and Helsinki, Finland.
| | - Anssi Lipponen
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio and Helsinki, Finland.
| | - Sami Oikarinen
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
| | - Annamari Heikinheimo
- University of Helsinki, Faculty of Veterinary Medicine, Helsinki, Finland; Finnish Food Authority, Seinäjoki, Finland.
| | - Tarja Pitkänen
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio and Helsinki, Finland; University of Helsinki, Faculty of Veterinary Medicine, Helsinki, Finland.
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4
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Yu Q, Olesen SW, Duvallet C, Grad YH. Assessment of sewer connectivity in the United States and its implications for equity in wastewater-based epidemiology. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003039. [PMID: 38630670 PMCID: PMC11023481 DOI: 10.1371/journal.pgph.0003039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 02/28/2024] [Indexed: 04/19/2024]
Abstract
Wastewater-based epidemiology is a promising public health tool that can yield a more representative view of the population than case reporting. However, only about 80% of the U.S. population is connected to public sewers, and the characteristics of populations missed by wastewater-based epidemiology are unclear. To address this gap, we used publicly available datasets to assess sewer connectivity in the U.S. by location, demographic groups, and economic groups. Data from the U.S. Census' American Housing Survey revealed that sewer connectivity was lower than average when the head of household was American Indian and Alaskan Native, White, non-Hispanic, older, and for larger households and those with higher income, but smaller geographic scales revealed local variations from this national connectivity pattern. For example, data from the U.S. Environmental Protection Agency showed that sewer connectivity was positively correlated with income in Minnesota, Florida, and California. Data from the U.S. Census' American Community Survey and Environmental Protection Agency also revealed geographic areas with low sewer connectivity, such as Alaska, the Navajo Nation, Minnesota, Michigan, and Florida. However, with the exception of the U.S. Census data, there were inconsistencies across datasets. Using mathematical modeling to assess the impact of wastewater sampling inequities on inferences about epidemic trajectory at a local scale, we found that in some situations, even weak connections between communities may allow wastewater monitoring in one community to serve as a reliable proxy for an interacting community with no wastewater monitoring, when cases are widespread. A systematic, rigorous assessment of sewer connectivity will be important for ensuring an equitable and informed implementation of wastewater-based epidemiology as a public health monitoring system.
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Affiliation(s)
- QinQin Yu
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Scott W. Olesen
- Biobot Analytics, Inc., Cambridge, Massachusetts, United States of America
| | - Claire Duvallet
- Biobot Analytics, Inc., Cambridge, Massachusetts, United States of America
| | - Yonatan H. Grad
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
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5
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Bubba L, Benschop KSM, Blomqvist S, Duizer E, Martin J, Shaw AG, Bailly JL, Rasmussen LD, Baicus A, Fischer TK, Harvala H. Wastewater Surveillance in Europe for Non-Polio Enteroviruses and Beyond. Microorganisms 2023; 11:2496. [PMID: 37894154 PMCID: PMC10608818 DOI: 10.3390/microorganisms11102496] [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: 09/11/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Wastewater surveillance (WWS) was developed in the early 1960s for the detection of poliovirus (PV) circulation in the population. It has been used to monitor several pathogens, including non-polio enteroviruses (NPEVs), which are increasingly recognised as causes of morbidity in children. However, when applying WWS to a new pathogen, it is important to consider the purpose of such a study as well as the suitability of the chosen methodology. With this purpose, the European Non-Polio Enterovirus Network (ENPEN) organised an expert webinar to discuss its history, methods, and applications; its evolution from a culture-based method to molecular detection; and future implementation of next generation sequencing (NGS). The first simulation experiments with PV calculated that a 400 mL sewage sample is sufficient for the detection of viral particles if 1:10,000 people excrete poliovirus in a population of 700,000 people. If the method is applied correctly, several NPEV types are detected. Despite culture-based methods remaining the gold standard for WWS, direct methods followed by molecular-based and sequence-based assays have been developed, not only for enterovirus but for several pathogens. Along with case-based sentinel and/or syndromic surveillance, WWS for NPEV and other pathogens represents an inexpensive, flexible, anonymised, reliable, population-based tool for monitoring outbreaks and the (re)emergence of these virus types/strains within the general population.
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Affiliation(s)
- Laura Bubba
- European Non-Polio Enterovirus Network (E.N.P.E.N.), 1207 Geneva, Switzerland
| | - Kimberley S. M. Benschop
- National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands; (K.S.M.B.); (E.D.)
| | - Soile Blomqvist
- Finnish Institute for Health and Welfare, P.O. Box 95, 70701 Kuopio, Finland;
| | - Erwin Duizer
- National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands; (K.S.M.B.); (E.D.)
| | - Javier Martin
- Division of Vaccines, Medicines and Healthcare Products Regulatory Agency, Potters Bar EN6 3QG, UK;
| | - Alexander G. Shaw
- MRC Centre for Global Infectious Disease Analysis, London SW7 2AZ, UK;
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London SW7 2BX, UK
| | - Jean-Luc Bailly
- Laboratoire Micro-Organismes Genome Environnement (LMGE), Université Clermont Auvergne CNRS, 63001 Clermont-Ferrand, France;
| | - Lasse D. Rasmussen
- Virus Surveillance and Research Section Department of Virus and Microbiological Special Diagnostics Statens Serum Institut, DK-2300 Copenhagen, Denmark;
| | - Anda Baicus
- Enteric Viral Infections Laboratory, Cantacuzino National Institute for Medical-Military Research and Development, 020123 Bucharest, Romania;
| | - Thea K. Fischer
- Department of Clinical Research, University Hospital of Nordsjaelland, 3400 Hilleroed, Denmark
- Department of Public Health, University of Copenhagen, 1172 Copenhagen, Denmark
| | - Heli Harvala
- Microbiology Services National Health Service (NHS) Blood and Transplant, London NW9 5BG, UK;
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
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6
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Rioux MD, Guillemette F, Lemarchand K, Doiron K, Lemay JF, Maere T, Dolcé P, Quessy P, Abonnenc N, Vanrolleghem PA, Frigon D. Wastewater-based epidemiology: the crucial role of viral shedding dynamics in small communities. Front Public Health 2023; 11:1141837. [PMID: 37601171 PMCID: PMC10433918 DOI: 10.3389/fpubh.2023.1141837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/30/2023] [Indexed: 08/22/2023] Open
Abstract
Background Wastewater surveillance (WWS) of pathogens is a rapidly evolving field owing to the 2019 coronavirus disease pandemic, which brought about a paradigm shift in public health authorities for the management of pathogen outbreaks. However, the interpretation of WWS in terms of clinical cases remains a challenge, particularly in small communities where large variations in pathogen concentrations are routinely observed without a clear relation to clinical incident cases. Methods Results are presented for WWS from six municipalities in the eastern part of Canada during the spring of 2021. We developed a numerical model based on viral kinetics reduction functions to consider both prevalent and incident cases to interpret the WWS data in light of the reported clinical cases in the six surveyed communities. Results The use of the proposed numerical model with a viral kinetics reduction function drastically increased the interpretability of the WWS data in terms of the clinical cases reported for the surveyed community. In line with our working hypothesis, the effects of viral kinetics reduction modeling were more important in small communities than in larger communities. In all but one of the community cases (where it had no effect), the use of the proposed numerical model led to a change from a +1.5% (for the larger urban center, Quebec City) to a +48.8% increase in the case of a smaller community (Drummondville). Conclusion Consideration of prevalent and incident cases through the proposed numerical model increases the correlation between clinical cases and WWS data. This is particularly the case in small communities. Because the proposed model is based on a biological mechanism, we believe it is an inherent part of any wastewater system and, hence, that it should be used in any WWS analysis where the aim is to relate WWS measurement to clinical cases.
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Affiliation(s)
- Marc-Denis Rioux
- Department of Mathematics and Engineering, Université du Québec à Rimouski, Quebec, QC, Canada
| | - François Guillemette
- Department of Environmental Science, Université du Québec à Trois-Rivière, Quebec, QC, Canada
| | - Karine Lemarchand
- Institut des Sciences de la Mer, Université du Québec à Rimouski, Quebec, QC, Canada
| | - Kim Doiron
- Northern Institute for Research in Environment and Occupational Health and Safety, Quebec, QC, Canada
| | - Jean-François Lemay
- Centre National en Électrochimie et Technologies Environnementales, Cegep of Shawinigan, Quebec, QC, Canada
| | - Thomas Maere
- modelEAU, Département de génie civil et de génie des eaux, Université Laval, Quebec, QC, Canada
| | - Patrick Dolcé
- Centre Intégré de Santé et de services sociaux du Bas-Saint-Laurent, Quebec, QC, Canada
| | - Patrik Quessy
- Centre National en Électrochimie et Technologies Environnementales, Cegep of Shawinigan, Quebec, QC, Canada
| | - Nanouk Abonnenc
- Centre National en Électrochimie et Technologies Environnementales, Cegep of Shawinigan, Quebec, QC, Canada
| | - Peter A. Vanrolleghem
- modelEAU, Département de génie civil et de génie des eaux, Université Laval, Quebec, QC, Canada
| | - Dominic Frigon
- Department of Civil Engineering, McGill University, Quebec, QC, Canada
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7
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Pell B, Brozak S, Phan T, Wu F, Kuang Y. The emergence of a virus variant: dynamics of a competition model with cross-immunity time-delay validated by wastewater surveillance data for COVID-19. J Math Biol 2023; 86:63. [PMID: 36988621 PMCID: PMC10054223 DOI: 10.1007/s00285-023-01900-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/28/2022] [Accepted: 03/12/2023] [Indexed: 03/30/2023]
Abstract
We consider the dynamics of a virus spreading through a population that produces a mutant strain with the ability to infect individuals that were infected with the established strain. Temporary cross-immunity is included using a time delay, but is found to be a harmless delay. We provide some sufficient conditions that guarantee local and global asymptotic stability of the disease-free equilibrium and the two boundary equilibria when the two strains outcompete one another. It is shown that, due to the immune evasion of the emerging strain, the reproduction number of the emerging strain must be significantly lower than that of the established strain for the local stability of the established-strain-only boundary equilibrium. To analyze the unique coexistence equilibrium we apply a quasi steady-state argument to reduce the full model to a two-dimensional one that exhibits a global asymptotically stable established-strain-only equilibrium or global asymptotically stable coexistence equilibrium. Our results indicate that the basic reproduction numbers of both strains govern the overall dynamics, but in nontrivial ways due to the inclusion of cross-immunity. The model is applied to study the emergence of the SARS-CoV-2 Delta variant in the presence of the Alpha variant using wastewater surveillance data from the Deer Island Treatment Plant in Massachusetts, USA.
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Affiliation(s)
- Bruce Pell
- Mathematics and Computer Science Department, Lawrence Technological University, 21000 W. 10 Mile Rd, Southfield, MI, 48075, USA.
| | - Samantha Brozak
- School of Mathematical and Statistical Sciences, Arizona State University, 901 S. Palm Walk, Tempe, AZ, 85287-1804, USA
| | - Tin Phan
- Theoretical Biology and Biophysics Group, Houston, Los Alamos, NM, 87545, USA
| | - Fuqing Wu
- Texas Epidemic Public Health Institute, Houston, TX, 77030, USA
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, 77030, USA
| | - Yang Kuang
- School of Mathematical and Statistical Sciences, Arizona State University, 901 S. Palm Walk, Tempe, AZ, 85287-1804, USA
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8
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Markt R, Stillebacher F, Nägele F, Kammerer A, Peer N, Payr M, Scheffknecht C, Dria S, Draxl-Weiskopf S, Mayr M, Rauch W, Kreuzinger N, Rainer L, Bachner F, Zuba M, Ostermann H, Lackner N, Insam H, Wagner AO. Expanding the Pathogen Panel in Wastewater Epidemiology to Influenza and Norovirus. Viruses 2023; 15:263. [PMID: 36851479 PMCID: PMC9966704 DOI: 10.3390/v15020263] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/01/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Since the start of the 2019 pandemic, wastewater-based epidemiology (WBE) has proven to be a valuable tool for monitoring the prevalence of SARS-CoV-2. With methods and infrastructure being settled, it is time to expand the potential of this tool to a wider range of pathogens. We used over 500 archived RNA extracts from a WBE program for SARS-CoV-2 surveillance to monitor wastewater from 11 treatment plants for the presence of influenza and norovirus twice a week during the winter season of 2021/2022. Extracts were analyzed via digital PCR for influenza A, influenza B, norovirus GI, and norovirus GII. Resulting viral loads were normalized on the basis of NH4-N. Our results show a good applicability of ammonia-normalization to compare different wastewater treatment plants. Extracts originally prepared for SARS-CoV-2 surveillance contained sufficient genomic material to monitor influenza A, norovirus GI, and GII. Viral loads of influenza A and norovirus GII in wastewater correlated with numbers from infected inpatients. Further, SARS-CoV-2 related non-pharmaceutical interventions affected subsequent changes in viral loads of both pathogens. In conclusion, the expansion of existing WBE surveillance programs to include additional pathogens besides SARS-CoV-2 offers a valuable and cost-efficient possibility to gain public health information.
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Affiliation(s)
- Rudolf Markt
- Department of Microbiology, Universität Innsbruck, 6020 Innsbruck, Austria
- Department of Health Sciences and Social Work, Carinthia University of Applied Sciences, 9020 Klagenfurt, Austria
| | | | - Fabiana Nägele
- Department of Microbiology, Universität Innsbruck, 6020 Innsbruck, Austria
| | - Anna Kammerer
- Department of Microbiology, Universität Innsbruck, 6020 Innsbruck, Austria
| | - Nico Peer
- Department of Microbiology, Universität Innsbruck, 6020 Innsbruck, Austria
| | - Maria Payr
- Department of Microbiology, Universität Innsbruck, 6020 Innsbruck, Austria
| | - Christoph Scheffknecht
- Institut für Umwelt und Lebensmittelsicherheit des Landes Vorarlberg, 6900 Bregenz, Austria
| | - Silvina Dria
- Institut für Umwelt und Lebensmittelsicherheit des Landes Vorarlberg, 6900 Bregenz, Austria
| | | | - Markus Mayr
- Department of Microbiology, Universität Innsbruck, 6020 Innsbruck, Austria
| | - Wolfgang Rauch
- Department of Infrastructure, Universität Innsbruck, 6020 Innsbruck, Austria
| | - Norbert Kreuzinger
- Institute for Water Quality and Resource Management, Technische Universität Wien, 1040 Vienna, Austria
| | - Lukas Rainer
- Austrian National Public Health Institute, 1010 Vienna, Austria
| | - Florian Bachner
- Austrian National Public Health Institute, 1010 Vienna, Austria
| | - Martin Zuba
- Austrian National Public Health Institute, 1010 Vienna, Austria
| | | | - Nina Lackner
- Department of Health Sciences and Social Work, Carinthia University of Applied Sciences, 9020 Klagenfurt, Austria
| | - Heribert Insam
- Department of Microbiology, Universität Innsbruck, 6020 Innsbruck, Austria
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9
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Ryan BJ, Muehlenbein MP, Allen J, Been J, Boyd K, Brickhouse M, Brooks BW, Burchett M, Chambliss CK, Cook JD, Ecklund A, Fogleman L, Granick P, Hynes S, Hudson T, Huse M, Lamb M, Lowe T, Marsh J, Nixon N, Nolan D, Nuñez G, Matthews W“S, Stern S, Wheelis M, Brickhouse N. Sustaining University Operations During the COVID-19 Pandemic. Disaster Med Public Health Prep 2022; 16:1901-1909. [PMID: 33678211 PMCID: PMC8134892 DOI: 10.1017/dmp.2021.69] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/01/2021] [Indexed: 12/19/2022]
Abstract
Colleges and universities around the world engaged diverse strategies during the COVID-19 pandemic. Baylor University, a community of ˜22,700 individuals, was 1 of the institutions which resumed and sustained operations. The key strategy was establishment of multidisciplinary teams to develop mitigation strategies and priority areas for action. This population-based team approach along with implementation of a "Swiss Cheese" risk mitigation model allowed small clusters to be rapidly addressed through testing, surveillance, tracing, isolation, and quarantine. These efforts were supported by health protocols including face coverings, social distancing, and compliance monitoring. As a result, activities were sustained from August 1 to December 8, 2020. There were 62,970 COVID-19 tests conducted with 1435 people testing positive for a positivity rate of 2.28%. A total of 1670 COVID-19 cases were identified with 235 self-reports. The mean number of tests per week was 3500 with approximately 80 of these positive (11/d). More than 60 student tracers were trained with over 120 personnel available to contact trace, at a ratio of 1 per 400 university members. The successes and lessons learned provide a framework and pathway for similar institutions to mitigate the ongoing impacts of COVID-19 and sustain operations during a global pandemic.
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Affiliation(s)
- Benjamin J. Ryan
- Department of Environmental Science, Environmental Health Science Program, Baylor University, Waco, TX, USA
| | | | - Jon Allen
- Information Technology Services, Baylor University, Waco, TX, USA
| | - Joshua Been
- Data and Digital Scholarship, Baylor University, Waco, TX, USA
| | - Kenneth Boyd
- Student-Athlete Health and Wellness, Baylor University, Waco, TX, USA
| | - Mark Brickhouse
- Environmental Health and Safety, Baylor University, Waco, TX, USA
| | - Bryan W. Brooks
- Department of Environmental Science, Environmental Health Science Program, Baylor University, Waco, TX, USA
| | | | - C. Kevin Chambliss
- Department of Chemistry and Biochemistry, Baylor University, Waco, TX, USA
| | - Jason D. Cook
- Marketing and Communications, Baylor University, Waco, TX, USA
| | - Adam Ecklund
- Health Services, Baylor University, Waco, TX, USA
| | - Lori Fogleman
- Media and Public Relations, Baylor University, Waco, TX, USA
| | - Peter Granick
- Operations, Finance and Administration, Baylor University, Waco, TX, USA
| | - Sharra Hynes
- Campus Living and Learning, Baylor University, Waco, TX, USA
| | - Tonya Hudson
- Media and Public Relations, Baylor University, Waco, TX, USA
| | | | - Micah Lamb
- IT Projects and Governance, Baylor University, Waco, TX, USA
| | - Tiffany Lowe
- Campus Living and Learning, Baylor University, Waco, TX, USA
| | - Jim Marsh
- Department of Counseling Services, Baylor University, Waco, TX, USA
| | - Niesha Nixon
- Health Services, Baylor University, Waco, TX, USA
| | - Dennis Nolan
- Environmental Health and Safety, Baylor University, Waco, TX, USA
| | - George Nuñez
- Office of Emergency Management, Baylor University, Waco, TX, USA
| | | | - Sharon Stern
- Health Services, Baylor University, Waco, TX, USA
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10
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Lanrewaju AA, Enitan-Folami AM, Sabiu S, Edokpayi JN, Swalaha FM. Global public health implications of human exposure to viral contaminated water. Front Microbiol 2022; 13:981896. [PMID: 36110296 PMCID: PMC9468673 DOI: 10.3389/fmicb.2022.981896] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/05/2022] [Indexed: 01/08/2023] Open
Abstract
Enteric viruses are common waterborne pathogens found in environmental water bodies contaminated with either raw or partially treated sewage discharge. Examples of these viruses include adenovirus, rotavirus, noroviruses, and other caliciviruses and enteroviruses like coxsackievirus and polioviruses. They have been linked with gastroenteritis, while some enteric viruses have also been implicated in more severe infections such as encephalitis, meningitis, hepatitis (hepatitis A and E viruses), cancer (polyomavirus), and myocarditis (enteroviruses). Therefore, this review presents information on the occurrence of enteric viruses of public health importance, diseases associated with human exposure to enteric viruses, assessment of their presence in contaminated water, and their removal in water and wastewater sources. In order to prevent illnesses associated with human exposure to viral contaminated water, we suggest the regular viral monitoring of treated wastewater before discharging it into the environment. Furthermore, we highlight the need for more research to focus on the development of more holistic disinfection methods that will inactivate waterborne viruses in municipal wastewater discharges, as this is highly needed to curtail the public health effects of human exposure to contaminated water. Moreover, such a method must be devoid of disinfection by-products that have mutagenic and carcinogenic potential.
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Affiliation(s)
| | - Abimbola Motunrayo Enitan-Folami
- Department of Biotechnology and Food Science, Durban University of Technology, Durban, South Africa
- *Correspondence: Abimbola Motunrayo Enitan-Folami,
| | - Saheed Sabiu
- Department of Biotechnology and Food Science, Durban University of Technology, Durban, South Africa
| | - Joshua Nosa Edokpayi
- Water and Environmental Management Research Group, Engineering and Agriculture, University of Venda, Thohoyandou, South Africa
| | - Feroz Mahomed Swalaha
- Department of Biotechnology and Food Science, Durban University of Technology, Durban, South Africa
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11
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Belgasmi H, Miles SJ, Sayyad L, Wong K, Harrington C, Gerloff N, Coulliette-Salmond AD, Guntapong R, Tacharoenmuang R, Ayutthaya AIN, Apostol LNG, Valencia MLD, Burns CC, Benito GR, Vega E. CaFÉ: A Sensitive, Low-Cost Filtration Method for Detecting Polioviruses and Other Enteroviruses in Residual Waters. FRONTIERS IN ENVIRONMENTAL SCIENCE 2022; 10:10.3389/fenvs.2022.914387. [PMID: 35928599 PMCID: PMC9344547 DOI: 10.3389/fenvs.2022.914387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Acute flaccid paralysis (AFP) surveillance has been used to identify polio cases and target vaccination campaigns since the inception of the Global Poliovirus Eradication Initiative (GPEI) in 1988. To date, only Afghanistan and Pakistan have failed to interrupt wild poliovirus transmission. Circulation of vaccine-derived polioviruses (VDPV) continues to be a problem in high-risk areas of the Eastern Mediterranean, African, and Southeast Asian regions. Environmental surveillance (ES) is an important adjunct to AFP surveillance, helping to identify circulating polioviruses in problematic areas. Stools from AFP cases and contacts (>200,000 specimens/year) and ES samples (>642 sites) are referred to 146 laboratories in the Global Polio Laboratory Network (GPLN) for testing. Although most World Health Organization supported laboratories use the two-phase separation method due to its simplicity and effectiveness, alternative simple, widely available, and cost-effective methods are needed. The CAFÉ (Concentration and Filtration Elution) method was developed from existing filtration methods to handle any type of sewage or residual waters. At $10-20 US per sample for consumable materials, CAFÉ is cost effective, and all equipment and reagents are readily available from markets and suppliers globally. The report describes the results from a parallel study of CAFÉ method with the standard two-phase separation method. The study was performed with samples collected from five countries (Guatemala, Haïti, Thailand, Papua New Guinea, and the Philippines), run in three laboratories-(United States, Thailand and in the Philippines) to account for regional and sample-to-sample variability. Samples from each site were divided into two 500 ml aliquots and processed by both methods, with no other additional concentration or manipulation. The results of 338 parallel-tested samples show that the CAFÉ method is more sensitive than the two-phase separation method for detection of non-polio enteroviruses (p-value < 0.0001) and performed as well as the two-phase separation method for polioviruses detection with no significant difference (p-value > 0.05). The CAFÉ method is a robust, sensitive, and cost-effective method for isolating enteroviruses from residual waters.
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Affiliation(s)
- Hanen Belgasmi
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Stacey Jeffries Miles
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | - Chelsea Harrington
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Nancy Gerloff
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Angela D Coulliette-Salmond
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
- U.S Public Health Service, Rockville, MD, United States
| | - Ratigorn Guntapong
- Department of Medical Science, Enteric Viruses Section, National Institute of Health, Nonthaburi, Thailand
| | - Ratana Tacharoenmuang
- Department of Medical Science, Enteric Viruses Section, National Institute of Health, Nonthaburi, Thailand
| | | | | | | | - Cara C. Burns
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Gloria-Rey Benito
- Pan American Health Organization, World Health Organization, Washington, DC, United States
| | - Everardo Vega
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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12
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Liu G, Qu J, Rose J, Medema G. Roadmap for Managing SARS-CoV-2 and Other Viruses in the Water Environment for Public Health. ENGINEERING (BEIJING, CHINA) 2022; 12:139-144. [PMID: 33654547 PMCID: PMC7909608 DOI: 10.1016/j.eng.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/15/2020] [Accepted: 09/24/2020] [Indexed: 05/25/2023]
Abstract
The water sector needs to address viral-related public health issues, because water is a virus carrier, which not only spreads viruses (e.g., via drinking water), but also provides information about the circulation of viruses in the community (e.g., via sewage). It has been widely reported that waterborne viral pathogens are abundant, diverse, complex, and threatening the public health in both developed and developing countries. Meanwhile, there is great potential for viral monitoring that can indicate biosafety, treatment performance and community health. New developments in technology have been rising to meet the emerging challenges over the past decades. Under the current coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the world's attention is directed to the urgent need to tackle the most challenging public health issues related to waterborne viruses. Based on critical analysis of the water viral knowledge progresses and gaps, this article offers a roadmap for managing COVID-19 and other viruses in the water environments for ensuring public health.
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Affiliation(s)
- Gang Liu
- Key Laboratory of Drinking Water Science and Technology, Research Centre for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
| | - Jiuhui Qu
- Key Laboratory of Drinking Water Science and Technology, Research Centre for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
| | - Joan Rose
- Department of Fisheries and Wildlife, Michigan State University, East Lansing, MI 48823, USA
| | - Gertjan Medema
- Department of Fisheries and Wildlife, Michigan State University, East Lansing, MI 48823, USA
- KWR Water Research Institute, Nieuwegein 3433 PE, Netherlands
- Sanitary Engineering, Department of Water Management, Faculty of Civil Engineering and Geosciences, Delft University of Technology, Delft 2628 CN, Netherlands
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13
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Toledo DM, Robbins AA, Gallagher TL, Hershberger KC, Barney RE, Salmela SM, Pilcher D, Cervinski MA, Nerenz RD, Szczepiorkowski ZM, Tsongalis GJ, Lefferts JA, Martin IW, Hubbard JA. Wastewater-Based SARS-CoV-2 Surveillance in Northern New England. Microbiol Spectr 2022; 10:e0220721. [PMID: 35412387 PMCID: PMC9045146 DOI: 10.1128/spectrum.02207-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/03/2022] [Indexed: 12/02/2022] Open
Abstract
SARS-CoV-2 viral RNA is shed in the stool of 55-70% of infected individuals and can be detected in community wastewater up to 7 days before people present with COVID-19 symptoms. The detection of SARS-CoV-2 RNA in wastewater may serve as a lead indicator of increased community transmission. Here, we monitored viral concentrations in samples collected from nine municipal wastewater facilities in New Hampshire (NH) and Vermont (VT).Twenty-four-h composite primary influent wastewater samples were collected from nine municipal wastewater treatment facilities twice per week for 5 months (late September 2020 to early February 2021). Wastewater was centrifuged for 30 min at 4600 × g, then the supernatant was frozen until further analysis. Once thawed, samples were concentrated, extracted, and tested for SARS-CoV-2 RNA using reverse transcriptase-quantitative PCR (RT-qPCR) and reverse transcriptase-droplet digital PCR (RT-ddPCR) detection methods. Active case counts for each municipality were tracked from the NH and VT state COVID-19 dashboards. We received a total of 283 wastewater samples from all sites during the study period. Viral RNA was detected in 175/283 (61.8%) samples using RT-qPCR and in 195/283 (68.9%) samples using RT-ddPCR. All nine sites showed positivity in the wastewater, with 8/9 (88.8%) sites having over 50% of their samples test positive over the course of the study. Larger municipalities, such as Nashua, Concord, and Lebanon, NH, showed that SARS-CoV-2 positivity in the wastewater can precede spikes in active COVID-19 case counts by as much as 7 days. Smaller municipalities, such as Woodsville, NH and Hartford, VT, showed sporadic SARS-COV-2 detection and did not always precede a rise in active case counts. We detected SARS-CoV-2 RNA in samples from all 9 municipalities tested, including cities and small towns within this region, and showed wastewater positivity as an early indicator of active case count increases in some regions. Some of the smaller rural municipalities with low case counts may require more frequent sampling to detect SARS-CoV-2 in wastewater before a case surge. With timely collection and analysis of wastewater samples, a community could potentially respond to results by increasing public health initiatives, such as tightening mask mandates and banning large indoor gatherings, to mitigate community transmission of SARS-CoV-2. IMPORTANCE Despite vaccination efforts, the delta and omicron variants of SARS-CoV-2 have caused global surges of COVID-19. As the COVID-19 pandemic continues, it is important to find new ways of tracking early signs of SARS-CoV-2 outbreaks. The manuscript outlines how to collect wastewater from treatment facilities, concentrate the virus in a dilute wastewater sample, and detect it using two sensitive PCR-based methods. It also describes important trends in SARS-CoV-2 concentration in wastewater of a rural region of the United States from Fall 2020 - Winter 2021 and demonstrates the utility of wastewater monitoring as a leading indicator of active SARS-CoV-2 cases. Monitoring changes in concentration of SARS-CoV-2 virus in wastewater may offer an early indicator of increased case counts and enable appropriate public health actions to be taken.
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Affiliation(s)
- Diana M. Toledo
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- The Broad Institute at MIT and Harvard, Cambridge, Massachusetts, USA
| | - Ashlee A. Robbins
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Torrey L. Gallagher
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Kenneth Chase Hershberger
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Rachael E. Barney
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Sabrina M. Salmela
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Davey Pilcher
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Mark A. Cervinski
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Robert D. Nerenz
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Zbigniew M. Szczepiorkowski
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Gregory J. Tsongalis
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Joel A. Lefferts
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Isabella W. Martin
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Jacqueline A. Hubbard
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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14
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Kline A, Dean K, Kossik AL, Harrison JC, Januch JD, Beck NK, Zhou NA, Shirai JH, Boyle DS, Mitchell J, Meschke JS. Persistence of poliovirus types 2 and 3 in waste-impacted water and sediment. PLoS One 2022; 17:e0262761. [PMID: 35081146 PMCID: PMC8791527 DOI: 10.1371/journal.pone.0262761] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/04/2022] [Indexed: 11/19/2022] Open
Abstract
Eradication of poliovirus (PV) is a global public health priority, and as clinical cases decrease, the role of environmental surveillance becomes more important. Persistence of PV and the environmental factors that influence it (such as temperature and sample type) are an important part of understanding and interpreting positive environmental surveillance samples. The objective of this study was to evaluate the persistence of poliovirus type 2 (PV2) and type 3 (PV3) in wastewater and sediment. Microcosms containing either 1) influent wastewater or 2) influent wastewater with a sediment matrix were seeded with either PV2 or PV3, and stored for up to 126 days at three temperatures (4°C, room temperature [RT], and 30°C). Active PV in the liquid of (1), and the sediment and liquid portions of (2) were sampled and quantified at up to 10 time points via plaque assay and RT-qPCR. A suite of 17 models were tested for best fit to characterize decay of PV2 and PV3 over time and determine the time points at which >90% (T90) and >99% (T99) reduction was reached. Linear models assessed the influence of experimental factors (matrix, temperature, virus type and method of detection) on the predicted T90 and T99 values. Results showed that when T90 was the dependent variable, virus type, matrix, and temperature significantly affected decay, and there was a clear interaction between the sediment matrix and temperature. When T99 was the dependent variable, only temperature and matrix type significantly influenced the decay metric. This study characterizes the persistence of both active and molecular PV2 and PV3 in relevant environmental conditions, and demonstrates that temperature and sediment both play important roles in PV viability. As eradication nears and clinical cases decrease, environmental surveillance and knowledge of PV persistence will play a key role in understanding the silent circulation in endemic countries.
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Affiliation(s)
- Allison Kline
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
| | - Kara Dean
- Biosystems & Agricultural Engineering, Michigan State University, East Lansing, Michigan, United States of America
| | - Alexandra L. Kossik
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
| | - Joanna Ciol Harrison
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
| | - James D. Januch
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
| | - Nicola K. Beck
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
| | - Nicolette A. Zhou
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
| | - Jeffry H. Shirai
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
| | | | - Jade Mitchell
- Biosystems & Agricultural Engineering, Michigan State University, East Lansing, Michigan, United States of America
| | - John Scott Meschke
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
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15
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Pulicharla R, Kaur G, Brar SK. A year into the COVID-19 pandemic: Rethinking of wastewater monitoring as a preemptive approach. JOURNAL OF ENVIRONMENTAL CHEMICAL ENGINEERING 2021; 9:106063. [PMID: 34307017 PMCID: PMC8282934 DOI: 10.1016/j.jece.2021.106063] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/29/2021] [Accepted: 07/13/2021] [Indexed: 05/10/2023]
Abstract
Under the current pandemic situation caused by the novel coronavirus SARS-CoV-2, wastewater monitoring has been increasingly investigated as a surveillance tool for community-wide disease prevalence. After a year into the pandemic, this review critically discusses the real progress made in the detection of SARS-CoV-2 using wastewater monitoring. The limitations and the key challenges faced in improving the detection methods are highlighted. As per the literature, the complex nature of the wastewater matrix poses problems in processing the samples and achieving high sensitivity at low loads of viral RNA using the current detection methods. Furthermore, in the absence of a gold standard analytical method for wastewater, the validation of the generated data for use in wastewater-based epidemiological modeling of the disease becomes practically difficult. However, research is advancing in adopting clinical methods to the wastewater by using appropriate processing controls, and recovery methods. Besides, the technological advances made by the industry including the development of PCR kits with improved detection limits, easy-to-use viral RNA concentration methods, ability to detect the coronavirus variants, and artificial intelligence and advanced data modeling for continuous and remote monitoring greatly help to debottleneck some of these problems. Currently, these technologies are limited to healthcare systems, however, their use for wastewater monitoring is expected to provide opportunities for wide-scale applications of wastewater-based epidemiology (WBE). Moreover, the data from wastewater monitoring act as the initial checkpoint for human health even before the appearance of symptoms, hence WBE needs more attention to manage current and future infectious transmissions.
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Affiliation(s)
- Rama Pulicharla
- Department of Civil Engineering, Lassonde School of Engineering, York University, Toronto, Ontario M3J 1P3, Canada
| | - Guneet Kaur
- Department of Civil Engineering, Lassonde School of Engineering, York University, Toronto, Ontario M3J 1P3, Canada
| | - Satinder K Brar
- Department of Civil Engineering, Lassonde School of Engineering, York University, Toronto, Ontario M3J 1P3, Canada
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16
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Comparison of Detecting and Quantitating SARS-CoV-2 in Wastewater Using Moderate-Speed Centrifuged Solids versus an Ultrafiltration Method. WATER 2021. [DOI: 10.3390/w13162166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mounting evidence suggests that solids are a reliable matrix for SARS-CoV-2 detection in wastewater, yet studies comparing solids-based methods and common concentration methods using the liquid fraction remain limited. In this study, we developed and optimized a method for SARS-CoV-2 detection in wastewater using moderate-speed centrifuged solids and evaluated it against an ultrafiltration reference method. SARS-CoV-2 was quantified in samples from 12 wastewater treatment plants from Alberta, Canada, using RT-qPCR targeting the N2 and E genes. PCR inhibition was examined by spiking salmon DNA. The effects of using different amounts of solids, adjusting the sample pH to 9.6–10, and modifying the elution volume at the final step of RNA extraction were evaluated. SARS-CoV-2 detection rate in solids from 20 mL of wastewater showed no statistically significant difference compared to the ultrafiltration method (97/139 versus 90/139, p = 0.26, McNemar’s mid-p test). The optimized wastewater solids-based method had a significantly lower rate of samples with PCR inhibition versus ultrafiltration (3% versus 9.5%, p = 0.014, Chi-square test). Our optimized moderate-speed centrifuged solids-based method had similar sensitivity when compared to the ultrafiltration reference method but had the added advantages of lower costs, fewer processing steps, and a shorter turnaround time.
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17
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Li B, Di DYW, Saingam P, Jeon MK, Yan T. Fine-Scale Temporal Dynamics of SARS-CoV-2 RNA Abundance in Wastewater during A COVID-19 Lockdown. WATER RESEARCH 2021; 197:117093. [PMID: 33826985 PMCID: PMC8006545 DOI: 10.1016/j.watres.2021.117093] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/22/2021] [Accepted: 03/25/2021] [Indexed: 05/19/2023]
Abstract
Wastewater is a pooled sampling instrument that may provide rapid and even early disease signals in the surveillance of COVID-19 disease at the community level, yet the fine-scale temporal dynamics of SARS-CoV-2 RNA in wastewater remains poorly understood. This study tracked the daily dynamics of SARS-CoV-2 RNA in the wastewater from two wastewater treatment plants (WWTPs) in Honolulu during a rapidly expanding COVID-19 outbreak and a responding four-week lockdown that resulted in a rapid decrease of daily clinical COVID-19 new cases. The wastewater SARS-CoV-2 RNA concentration from both WWTPs, as measured by three quantification assays (N1, N2, and E), exhibited both significant inter-day fluctuations (101.2-105.1 gene copies or GC/L in wastewater liquid fractions, or 101.4-106.2 GC/g in solid fractions) and an overall downward trend over the lockdown period. Strong and significant correlation was observed in measured SARS-CoV-2 RNA concentrations between the solid and liquid wastewater fractions, with the solid fraction containing majority (82.5%-92.5%) of the SARS-CoV-2 RNA mass and the solid-liquid SARS-CoV-2 RNA concentration ratios ranging from 103.6 to 104.3 mL/g. The measured wastewater SARS-CoV-2 RNA concentration was normalized by three endogenous fecal RNA viruses (F+ RNA coliphages Group II and III, and pepper mild mottle virus) to account for variations that may occur during the multi-step wastewater processing and molecular quantification, and the normalized abundance also exhibited similar daily fluctuations and overall downward trend over the sampling period.
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Affiliation(s)
- Bo Li
- Department of Civil and Environmental Engineering, University of Hawaii at Manoa, Honolulu, HI 96822
| | - Doris Yoong Wen Di
- Department of Civil and Environmental Engineering, University of Hawaii at Manoa, Honolulu, HI 96822
| | - Prakit Saingam
- Department of Civil and Environmental Engineering, University of Hawaii at Manoa, Honolulu, HI 96822
| | - Min Ki Jeon
- Department of Civil and Environmental Engineering, University of Hawaii at Manoa, Honolulu, HI 96822
| | - Tao Yan
- Department of Civil and Environmental Engineering, University of Hawaii at Manoa, Honolulu, HI 96822.
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18
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Fagnant‐Sperati C, Ren Y, Zhou N, Komen E, Mwangi B, Hassan J, Chepkurui A, Nzunza R, Nyangao J, van Zyl W, Wolfaardt M, Matsapola P, Ngwana F, Jeffries‐Miles S, Coulliette‐Salmond A, Peñaranda S, Vega E, Shirai J, Kossik A, Beck N, Boyle D, Burns C, Taylor M, Borus P, Meschke J. Validation of the bag-mediated filtration system for environmental surveillance of poliovirus in Nairobi, Kenya. J Appl Microbiol 2021; 130:971-981. [PMID: 32743931 PMCID: PMC7854911 DOI: 10.1111/jam.14807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/23/2020] [Accepted: 07/25/2020] [Indexed: 01/15/2023]
Abstract
AIMS This study compared the bag-mediated filtration system (BMFS) and standard WHO two-phase separation methods for poliovirus (PV) environmental surveillance, examined factors impacting PV detection and monitored Sabin-like (SL) PV type 2 presence with withdrawal of oral polio vaccine type 2 (OPV2) in April 2016. METHODS AND RESULTS Environmental samples were collected in Nairobi, Kenya (Sept 2015-Feb 2017), concentrated via BMFS and two-phase separation methods, then assayed using the WHO PV isolation algorithm and intratypic differentiation diagnostic screening kit. SL1, SL2 and SL3 were detected at higher rates in BMFS than two-phase samples (P < 0·05). In BMFS samples, SL PV detection did not significantly differ with volume filtered, filtration time or filter shipment time (P > 0·05), while SL3 was detected less frequently with higher shipment temperatures (P = 0·027). SL2 was detected more frequently before OPV2 withdrawal in BMFS and two-phase samples (P < 1 × 10-5 ). CONCLUSIONS Poliovirus was detected at higher rates with the BMFS, a method that includes a secondary concentration step, than using the standard WHO two-phase method. SL2 disappearance from the environment was commensurate with OPV2 withdrawal. SIGNIFICANCE AND IMPACT OF THE STUDY The BMFS offers comparable or improved PV detection under the conditions in this study, relative to the two-phase method.
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Affiliation(s)
- C.S. Fagnant‐Sperati
- Department of Environmental and Occupational Health SciencesUniversity of WashingtonSeattleWAUSA
| | - Y. Ren
- Department of BiostatisticsUniversity of WashingtonSeattleWAUSA
| | - N.A. Zhou
- Department of Environmental and Occupational Health SciencesUniversity of WashingtonSeattleWAUSA
| | - E. Komen
- Centre for Viral ResearchKenya Medical Research InstituteNairobiKenya
| | - B. Mwangi
- Centre for Viral ResearchKenya Medical Research InstituteNairobiKenya
| | - J. Hassan
- Centre for Viral ResearchKenya Medical Research InstituteNairobiKenya
| | - A. Chepkurui
- Centre for Viral ResearchKenya Medical Research InstituteNairobiKenya
| | - R. Nzunza
- Centre for Viral ResearchKenya Medical Research InstituteNairobiKenya
| | - J. Nyangao
- Centre for Viral ResearchKenya Medical Research InstituteNairobiKenya
| | - W.B. van Zyl
- Department of Medical VirologyUniversity of PretoriaPretoriaSouth Africa
| | - M. Wolfaardt
- Department of Medical VirologyUniversity of PretoriaPretoriaSouth Africa
| | - P.N. Matsapola
- Department of Medical VirologyUniversity of PretoriaPretoriaSouth Africa
| | - F.B. Ngwana
- Department of Medical VirologyUniversity of PretoriaPretoriaSouth Africa
| | - S. Jeffries‐Miles
- Cherokee Nation Assurance a contracting agency to the Division of Viral DiseasesCenters for Disease Control and PreventionAtlantaGAUSA
| | | | - S. Peñaranda
- Division of Viral DiseasesCenters for Disease Control and PreventionAtlantaGAUSA
| | - E. Vega
- Division of Viral DiseasesCenters for Disease Control and PreventionAtlantaGAUSA
| | - J.H. Shirai
- Department of Environmental and Occupational Health SciencesUniversity of WashingtonSeattleWAUSA
| | - A.L. Kossik
- Department of Environmental and Occupational Health SciencesUniversity of WashingtonSeattleWAUSA
| | - N.K. Beck
- Department of Environmental and Occupational Health SciencesUniversity of WashingtonSeattleWAUSA
| | | | - C.C. Burns
- Division of Viral DiseasesCenters for Disease Control and PreventionAtlantaGAUSA
| | - M.B. Taylor
- Department of Medical VirologyUniversity of PretoriaPretoriaSouth Africa
| | - P. Borus
- Centre for Viral ResearchKenya Medical Research InstituteNairobiKenya
| | - J.S. Meschke
- Department of Environmental and Occupational Health SciencesUniversity of WashingtonSeattleWAUSA
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19
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Zahedi A, Monis P, Deere D, Ryan U. Wastewater-based epidemiology-surveillance and early detection of waterborne pathogens with a focus on SARS-CoV-2, Cryptosporidium and Giardia. Parasitol Res 2021; 120:4167-4188. [PMID: 33409629 PMCID: PMC7787619 DOI: 10.1007/s00436-020-07023-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/14/2020] [Indexed: 12/21/2022]
Abstract
Waterborne diseases are a major global problem, resulting in high morbidity and mortality, and massive economic costs. The ability to rapidly and reliably detect and monitor the spread of waterborne diseases is vital for early intervention and preventing more widespread disease outbreaks. Pathogens are, however, difficult to detect in water and are not practicably detectable at acceptable concentrations that need to be achieved in treated drinking water (which are of the order one per million litre). Furthermore, current clinical-based surveillance methods have many limitations such as the invasive nature of the testing and the challenges in testing large numbers of people. Wastewater-based epidemiology (WBE), which is based on the analysis of wastewater to monitor the emergence and spread of infectious disease at a population level, has received renewed attention in light of the current coronavirus disease 2019 (COVID-19) pandemic. The present review will focus on the application of WBE for the detection and surveillance of pathogens with a focus on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the waterborne protozoan parasites Cryptosporidium and Giardia. The review highlights the benefits and challenges of WBE and the future of this tool for community-wide infectious disease surveillance.
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Affiliation(s)
- Alireza Zahedi
- Harry Butler Institute, Murdoch University, Perth, Australia
| | - Paul Monis
- South Australian Water Corporation, Adelaide, Australia
| | - Daniel Deere
- Water Futures and Water Research Australia, Sydney, Australia
| | - Una Ryan
- Harry Butler Institute, Murdoch University, Perth, Australia.
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20
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Peccia J, Zulli A, Brackney DE, Grubaugh ND, Kaplan EH, Casanovas-Massana A, Ko AI, Malik AA, Wang D, Wang M, Warren JL, Weinberger DM, Arnold W, Omer SB. Measurement of SARS-CoV-2 RNA in wastewater tracks community infection dynamics. Nat Biotechnol 2020. [PMID: 32948856 DOI: 10.1101/2020.05.19.20105999] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
We measured severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA concentrations in primary sewage sludge in the New Haven, Connecticut, USA, metropolitan area during the Coronavirus Disease 2019 (COVID-19) outbreak in Spring 2020. SARS-CoV-2 RNA was detected throughout the more than 10-week study and, when adjusted for time lags, tracked the rise and fall of cases seen in SARS-CoV-2 clinical test results and local COVID-19 hospital admissions. Relative to these indicators, SARS-CoV-2 RNA concentrations in sludge were 0-2 d ahead of SARS-CoV-2 positive test results by date of specimen collection, 0-2 d ahead of the percentage of positive tests by date of specimen collection, 1-4 d ahead of local hospital admissions and 6-8 d ahead of SARS-CoV-2 positive test results by reporting date. Our data show the utility of viral RNA monitoring in municipal wastewater for SARS-CoV-2 infection surveillance at a population-wide level. In communities facing a delay between specimen collection and the reporting of test results, immediate wastewater results can provide considerable advance notice of infection dynamics.
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Affiliation(s)
- Jordan Peccia
- Department of Chemical and Environmental Engineering, School of Engineering and Applied Science, Yale University, New Haven, CT, USA.
| | - Alessandro Zulli
- Department of Chemical and Environmental Engineering, School of Engineering and Applied Science, Yale University, New Haven, CT, USA
| | - Doug E Brackney
- Connecticut Agricultural Experimental Station, State of Connecticut, New Haven, CT, USA
| | - Nathan D Grubaugh
- Department of Epidemiology of Microbial Disease, School of Public Health, Yale University, New Haven, CT, USA
| | - Edward H Kaplan
- Department of Chemical and Environmental Engineering, School of Engineering and Applied Science, Yale University, New Haven, CT, USA
- Public Health Modeling, Yale School of Public Health, New Haven, CT, USA
- School of Management, Yale University, New Haven, CT, USA
| | - Arnau Casanovas-Massana
- Department of Epidemiology of Microbial Disease, School of Public Health, Yale University, New Haven, CT, USA
| | - Albert I Ko
- Department of Epidemiology of Microbial Disease, School of Public Health, Yale University, New Haven, CT, USA
| | - Amyn A Malik
- Yale School of Medicine, New Haven, CT, USA
- Yale Institute for Global Health, New Haven, CT, USA
| | | | - Mike Wang
- Yale School of Medicine, New Haven, CT, USA
| | - Joshua L Warren
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Disease, School of Public Health, Yale University, New Haven, CT, USA
| | - Wyatt Arnold
- Department of Chemical and Environmental Engineering, School of Engineering and Applied Science, Yale University, New Haven, CT, USA
| | - Saad B Omer
- Department of Epidemiology of Microbial Disease, School of Public Health, Yale University, New Haven, CT, USA.
- Yale School of Medicine, New Haven, CT, USA.
- Yale Institute for Global Health, New Haven, CT, USA.
- Yale School of Nursing, Orange, CT, USA.
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21
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Peccia J, Zulli A, Brackney DE, Grubaugh ND, Kaplan EH, Casanovas-Massana A, Ko AI, Malik AA, Wang D, Wang M, Warren JL, Weinberger DM, Arnold W, Omer SB. Measurement of SARS-CoV-2 RNA in wastewater tracks community infection dynamics. Nat Biotechnol 2020. [PMID: 32948856 DOI: 10.1038/s41587-020-0684-zpmid-32948856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
We measured severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA concentrations in primary sewage sludge in the New Haven, Connecticut, USA, metropolitan area during the Coronavirus Disease 2019 (COVID-19) outbreak in Spring 2020. SARS-CoV-2 RNA was detected throughout the more than 10-week study and, when adjusted for time lags, tracked the rise and fall of cases seen in SARS-CoV-2 clinical test results and local COVID-19 hospital admissions. Relative to these indicators, SARS-CoV-2 RNA concentrations in sludge were 0-2 d ahead of SARS-CoV-2 positive test results by date of specimen collection, 0-2 d ahead of the percentage of positive tests by date of specimen collection, 1-4 d ahead of local hospital admissions and 6-8 d ahead of SARS-CoV-2 positive test results by reporting date. Our data show the utility of viral RNA monitoring in municipal wastewater for SARS-CoV-2 infection surveillance at a population-wide level. In communities facing a delay between specimen collection and the reporting of test results, immediate wastewater results can provide considerable advance notice of infection dynamics.
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Affiliation(s)
- Jordan Peccia
- Department of Chemical and Environmental Engineering, School of Engineering and Applied Science, Yale University, New Haven, CT, USA.
| | - Alessandro Zulli
- Department of Chemical and Environmental Engineering, School of Engineering and Applied Science, Yale University, New Haven, CT, USA
| | - Doug E Brackney
- Connecticut Agricultural Experimental Station, State of Connecticut, New Haven, CT, USA
| | - Nathan D Grubaugh
- Department of Epidemiology of Microbial Disease, School of Public Health, Yale University, New Haven, CT, USA
| | - Edward H Kaplan
- Department of Chemical and Environmental Engineering, School of Engineering and Applied Science, Yale University, New Haven, CT, USA
- Public Health Modeling, Yale School of Public Health, New Haven, CT, USA
- School of Management, Yale University, New Haven, CT, USA
| | - Arnau Casanovas-Massana
- Department of Epidemiology of Microbial Disease, School of Public Health, Yale University, New Haven, CT, USA
| | - Albert I Ko
- Department of Epidemiology of Microbial Disease, School of Public Health, Yale University, New Haven, CT, USA
| | - Amyn A Malik
- Yale School of Medicine, New Haven, CT, USA
- Yale Institute for Global Health, New Haven, CT, USA
| | | | - Mike Wang
- Yale School of Medicine, New Haven, CT, USA
| | - Joshua L Warren
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Disease, School of Public Health, Yale University, New Haven, CT, USA
| | - Wyatt Arnold
- Department of Chemical and Environmental Engineering, School of Engineering and Applied Science, Yale University, New Haven, CT, USA
| | - Saad B Omer
- Department of Epidemiology of Microbial Disease, School of Public Health, Yale University, New Haven, CT, USA.
- Yale School of Medicine, New Haven, CT, USA.
- Yale Institute for Global Health, New Haven, CT, USA.
- Yale School of Nursing, Orange, CT, USA.
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22
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Peccia J, Zulli A, Brackney DE, Grubaugh ND, Kaplan EH, Casanovas-Massana A, Ko AI, Malik AA, Wang D, Wang M, Warren JL, Weinberger DM, Arnold W, Omer SB. Measurement of SARS-CoV-2 RNA in wastewater tracks community infection dynamics. Nat Biotechnol 2020; 38:1164-1167. [PMID: 32948856 PMCID: PMC8325066 DOI: 10.1038/s41587-020-0684-z] [Citation(s) in RCA: 592] [Impact Index Per Article: 148.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/28/2020] [Indexed: 12/13/2022]
Abstract
We measured severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA concentrations in primary sewage sludge in the New Haven, Connecticut, USA, metropolitan area during the Coronavirus Disease 2019 (COVID-19) outbreak in Spring 2020. SARS-CoV-2 RNA was detected throughout the more than 10-week study and, when adjusted for time lags, tracked the rise and fall of cases seen in SARS-CoV-2 clinical test results and local COVID-19 hospital admissions. Relative to these indicators, SARS-CoV-2 RNA concentrations in sludge were 0-2 d ahead of SARS-CoV-2 positive test results by date of specimen collection, 0-2 d ahead of the percentage of positive tests by date of specimen collection, 1-4 d ahead of local hospital admissions and 6-8 d ahead of SARS-CoV-2 positive test results by reporting date. Our data show the utility of viral RNA monitoring in municipal wastewater for SARS-CoV-2 infection surveillance at a population-wide level. In communities facing a delay between specimen collection and the reporting of test results, immediate wastewater results can provide considerable advance notice of infection dynamics.
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Affiliation(s)
- Jordan Peccia
- Department of Chemical and Environmental Engineering, School of Engineering and Applied Science, Yale University, New Haven, CT, USA.
| | - Alessandro Zulli
- Department of Chemical and Environmental Engineering, School of Engineering and Applied Science, Yale University, New Haven, CT, USA
| | - Doug E Brackney
- Connecticut Agricultural Experimental Station, State of Connecticut, New Haven, CT, USA
| | - Nathan D Grubaugh
- Department of Epidemiology of Microbial Disease, School of Public Health, Yale University, New Haven, CT, USA
| | - Edward H Kaplan
- Department of Chemical and Environmental Engineering, School of Engineering and Applied Science, Yale University, New Haven, CT, USA
- Public Health Modeling, Yale School of Public Health, New Haven, CT, USA
- School of Management, Yale University, New Haven, CT, USA
| | - Arnau Casanovas-Massana
- Department of Epidemiology of Microbial Disease, School of Public Health, Yale University, New Haven, CT, USA
| | - Albert I Ko
- Department of Epidemiology of Microbial Disease, School of Public Health, Yale University, New Haven, CT, USA
| | - Amyn A Malik
- Yale School of Medicine, New Haven, CT, USA
- Yale Institute for Global Health, New Haven, CT, USA
| | | | - Mike Wang
- Yale School of Medicine, New Haven, CT, USA
| | - Joshua L Warren
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Disease, School of Public Health, Yale University, New Haven, CT, USA
| | - Wyatt Arnold
- Department of Chemical and Environmental Engineering, School of Engineering and Applied Science, Yale University, New Haven, CT, USA
| | - Saad B Omer
- Department of Epidemiology of Microbial Disease, School of Public Health, Yale University, New Haven, CT, USA.
- Yale School of Medicine, New Haven, CT, USA.
- Yale Institute for Global Health, New Haven, CT, USA.
- Yale School of Nursing, Orange, CT, USA.
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23
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Sen-Crowe B, Boneva D, Elkbuli A. Municipal Sewage COVID-19 Testing: A Much Needed Public Health Community Prevention Intervention. Am Surg 2020; 86:1518-1519. [PMID: 32856943 DOI: 10.1177/0003134820951428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Brendon Sen-Crowe
- 14506 Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Dessy Boneva
- 14506 Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Adel Elkbuli
- 14506 Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
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24
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Coulliette-Salmond AD, Alleman MM, Wilnique P, Rey-Benito G, Wright HB, Hecker JW, Miles S, Peñaranda S, Lafontant D, Corvil S, Francois J, Rossignol E, Stanislas M, Gue E, Faye PC, Castro CJ, Schmidt A, Ng TFF, Burns CC, Vega E. Haiti Poliovirus Environmental Surveillance. Am J Trop Med Hyg 2020; 101:1240-1248. [PMID: 31701857 DOI: 10.4269/ajtmh.19-0469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Poliovirus (PV) environmental surveillance was established in Haiti in three sites each in Port-au-Prince and Gonaïves, where sewage and fecal-influenced environmental open water channel samples were collected monthly from March 2016 to February 2017. The primary objective was to monitor for the emergence of vaccine-derived polioviruses (VDPVs) and the importation and transmission of wild polioviruses (WPVs). A secondary objective was to compare two environmental sample processing methods, the gold standard two-phase separation method and a filter method (bag-mediated filtration system [BMFS]). In addition, non-polio enteroviruses (NPEVs) were characterized by next-generation sequencing using Illumina MiSeq to provide insight on surrogates for PVs. No WPVs or VDPVs were detected at any site with either concentration method. Sabin (vaccine) strain PV type 2 and Sabin strain PV type 1 were found in Port-au-Prince, in March and April samples, respectively. Non-polio enteroviruses were isolated in 75-100% and 0-58% of samples, by either processing method during the reporting period in Port-au-Prince and Gonaïves, respectively. Further analysis of 24 paired Port-au-Prince samples confirmed the detection of a human NPEV and echovirus types E-3, E-6, E-7, E-11, E-19, E-20, and E-29. The comparison of the BMFS filtration method to the two-phase separation method found no significant difference in sensitivity between the two methods (mid-P-value = 0.55). The experience of one calendar year of sampling has informed the appropriateness of the initially chosen sampling sites, importance of an adequate PV surrogate, and robustness of two processing methods.
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Affiliation(s)
- Angela D Coulliette-Salmond
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary M Alleman
- Polio Eradication Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pierre Wilnique
- Division of Epidemiology, Laboratory and Research, Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Gloria Rey-Benito
- Pan American Health Organization, World Health Organization, Washington, District of Columbia
| | | | | | | | - Silvia Peñaranda
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Donald Lafontant
- Division of Epidemiology, Laboratory and Research, Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Salomon Corvil
- Division of Epidemiology, Laboratory and Research, Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Jeannot Francois
- Expanded Programme on Immunization, Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Emmanuel Rossignol
- National Public Health Laboratory, Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Magalie Stanislas
- National Public Health Laboratory, Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Edmond Gue
- Pan American Health Organization, World Health Organization Region of the Americas, Port-au-Prince, Haiti
| | - Papa C Faye
- Pan American Health Organization, World Health Organization Region of the Americas, Port-au-Prince, Haiti
| | - Christina J Castro
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee.,Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Terry Fei Fan Ng
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cara C Burns
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Everardo Vega
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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25
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Majumdar M, Klapsa D, Wilton T, Akello J, Anscombe C, Allen D, Mee ET, Minor PD, Martin J. Isolation of Vaccine-Like Poliovirus Strains in Sewage Samples From the United Kingdom. J Infect Dis 2019; 217:1222-1230. [PMID: 29309594 DOI: 10.1093/infdis/jix667] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 12/20/2017] [Indexed: 12/25/2022] Open
Abstract
Background Environmental surveillance (ES) is a sensitive method for detecting human enterovirus (HEV) circulation, and it is used worldwide to support global polio eradication. We describe a novel ES approach using next-generation sequencing (NGS) to identify HEVs in sewage samples collected in London, United Kingdom, from June 2016 to May 2017. Methods Two different methods were used to process raw sewage specimens: a 2-phase aqueous separation system and size exclusion by filtration and centrifugation. HEVs were isolated using cell cultures and analyzed using NGS. Results Type 1 and 3 vaccine-like poliovirus (PV) strains were detected in samples collected from September 2016 through January 2017. NGS analysis allowed us to rapidly obtain whole-genome sequences of PV and non-PV HEV strains. As many as 6 virus strains from different HEV serotypes were identified in a single cell culture flask. PV isolates contained only a small number of mutations from vaccine strains commonly seen in early isolates from vaccinees. Conclusions Our ES setup has high sensitivity for polio and non-PV HEV detection, generating nearly whole-genome sequence information. Such ES systems provide critical information to assist the polio eradication endgame and contribute to the improvement of our understanding of HEV circulation patterns in humans.
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Affiliation(s)
- Manasi Majumdar
- Division of Virology, National Institute for Biological Standards and Control, South Mimms
| | - Dimitra Klapsa
- Division of Virology, National Institute for Biological Standards and Control, South Mimms
| | - Thomas Wilton
- Division of Virology, National Institute for Biological Standards and Control, South Mimms
| | - Joyce Akello
- Enterovirus Unit, Public Health England, London, United Kingdom
| | | | - David Allen
- Enterovirus Unit, Public Health England, London, United Kingdom
| | - Edward T Mee
- Division of Virology, National Institute for Biological Standards and Control, South Mimms
| | - Philip D Minor
- Division of Virology, National Institute for Biological Standards and Control, South Mimms
| | - Javier Martin
- Division of Virology, National Institute for Biological Standards and Control, South Mimms
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26
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Kroiss SJ, Ahmadzai M, Ahmed J, Alam MM, Chabot-Couture G, Famulare M, Mahamud A, McCarthy KA, Mercer LD, Muhammad S, Safdar RM, Sharif S, Shaukat S, Shukla H, Lyons H. Assessing the sensitivity of the polio environmental surveillance system. PLoS One 2018; 13:e0208336. [PMID: 30592720 PMCID: PMC6310268 DOI: 10.1371/journal.pone.0208336] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 11/15/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The polio environmental surveillance (ES) system has been an incredible tool for advancing polio eradication efforts because of its ability to highlight the spatial and temporal extent of poliovirus circulation. While ES often outperforms, or is more sensitive than AFP surveillance, the sensitivity of the ES system has not been well characterized. Fundamental uncertainty of ES site sensitivity makes it difficult to interpret results from ES, particularly negative results. METHODS AND FINDINGS To study ES sensitivity, we used data from Afghanistan and Pakistan to examine the probability that each ES site detected the Sabin 1, 2, or 3 components of the oral polio vaccine (OPV) as a function of virus prevalence within the same district (estimated from AFP data). Accounting for virus prevalence is essential for estimating site sensitivity because Sabin detection rates should vary with prevalence-high immediately after supplemental immunization activities (SIAs), but low in subsequent months. We found that most ES sites in Pakistan and Afghanistan are highly sensitive for detecting poliovirus relative to AFP surveillance in the same districts. For example, even when Sabin poliovirus is at low prevalence of ~0.5-3% in AFP surveillance, most ES sites have ~34-50% probability of detecting Sabin. However, there was considerable variation in ES site sensitivity and we flagged several sites for re-evaluation based on low sensitivity rankings and low wild polio virus detection rates. In these areas, adding new sites or modifying collection methods in current sites could improve sensitivity of environmental surveillance. CONCLUSIONS Relating ES detections to virus prevalence significantly improved our ability to evaluate site sensitivity compared to evaluations based solely on ES detection rates. To extend our approach to new sites and regions, we provide a preliminary framework for relating ES and AFP detection rates, and descriptions of how detection rates might relate to SIAs and natural seasonality.
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Affiliation(s)
- Steve J. Kroiss
- Institute for Disease Modeling, Bellevue, WA, United States of America
| | - Maiwand Ahmadzai
- National Emergency Operations Centre for Polio Eradication, Kabul, Afghanistan
| | - Jamal Ahmed
- World Health Organization, Geneva, Switzerland
| | - Muhammad Masroor Alam
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
- World Health Organization, Islamabad, Pakistan
| | | | - Michael Famulare
- Institute for Disease Modeling, Bellevue, WA, United States of America
| | - Abdirahman Mahamud
- World Health Organization, Islamabad, Pakistan
- National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan
| | - Kevin A. McCarthy
- Institute for Disease Modeling, Bellevue, WA, United States of America
| | - Laina D. Mercer
- Institute for Disease Modeling, Bellevue, WA, United States of America
| | - Salman Muhammad
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Rana M. Safdar
- National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan
| | - Salmaan Sharif
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
- World Health Organization, Islamabad, Pakistan
| | - Shahzad Shaukat
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
- World Health Organization, Islamabad, Pakistan
| | - Hemant Shukla
- National Emergency Operations Centre for Polio Eradication, Kabul, Afghanistan
| | - Hil Lyons
- Institute for Disease Modeling, Bellevue, WA, United States of America
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27
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Tiwari S, Dhole TN. Assessment of enteroviruses from sewage water and clinical samples during eradication phase of polio in North India. Virol J 2018; 15:157. [PMID: 30326921 PMCID: PMC6192295 DOI: 10.1186/s12985-018-1075-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/04/2018] [Indexed: 11/14/2022] Open
Abstract
Background The Enterovirus (EV) surveillance system is inadequate in densely populated cities in India. EV can be shed in feces for several weeks; these viruses are not easily inactivated and may persist in sewage for long periods. Surveillance and epidemiological study of EV-related disease is necessary. Methods In this study, we compare the EV found in sewage with clinically isolated samples. Tissue culture was used for isolation of the virus and serotype confirmed by enterovirus neutralization tests. Results We found positive cases for enterovirus from clinical and sewage samples and identified additional isolates as echovirus 9, 11, 25 & 30 by sequencing. Conclusion There is a close relation among the serotypes of enterovirus shed in stools and isolated from the environment but few serotypes which were detected in sewage samples were not found clinically and the few which were detected clinically not found in sewage because some viruses are difficult to detect by the cell culture method.This study will be helpful for the researchers who are working on polio and nonpolio enterovirus especially in the countries which are struggling for polio eradication.
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Affiliation(s)
- Sarika Tiwari
- Department of Microbiology (Virology Section), Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, 226014, India. .,Department of Microbiology (Virology lab), Rajendra Institute of Medical Sciences (RIMS), Ranchi, JH, India.
| | - Tapan N Dhole
- Department of Microbiology (Virology Section), Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, 226014, India
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28
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Ma Y, Wang X, Zhou X, Lv P, Wang H, Song J, Song C, Sun Z. Poliovirus Detection and Genetic Characteristic from Sewage in Heilongjiang Province from 2013 to 2016. Jpn J Infect Dis 2018; 71:442-447. [PMID: 30068885 DOI: 10.7883/yoken.jjid.2017.338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
By monitoring the sewage system in Heilongjiang province from 2013 to 2016, this study aimed to analyze the epidemiological tendency and genetic mutation of poliovirus (PV) found in the environment in order to setup a warning system for vaccine-derived poliovirus (VDPV) and the spread of wild poliovirus. In this study, we collected 139 sewage samples from 8 regions in Heilongjiang province. Poliovirus was identified from 72 samples, and the positivity rate was 51%. A total of 263 PV strains were isolated, including 22 strains of type 1 PV, 104 strains of type 2 PV, and 137 strains of type 3 PV. As a result of intratypic differentiation, using real-time PCR and nucleotide sequencing, 3 type 1 pre-VDPV, one type 2 VDPV, and 2 type 3 pre-VDPV strains were isolated. Interestingly, one type 1 strain with 5 nucleotide deletions and one type 3 recombinant on VP1 were isolated. By continuously monitoring the poliovirus in the environment, we aimed to recognize the VDPV or wild poliovirus with high neurovirulence from large-scale circulation and set up a warning system to avoid morbidity and virus transmission.
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Affiliation(s)
- Yujie Ma
- Institute of Planned Immunity, Heilongjiang Center for Disease Control and Prevention
| | - Xiaoyu Wang
- Institute of Planned Immunity, Heilongjiang Center for Disease Control and Prevention
| | - Xue Zhou
- Institute of Planned Immunity, Heilongjiang Center for Disease Control and Prevention
| | - Po Lv
- Institute of Planned Immunity, Heilongjiang Center for Disease Control and Prevention
| | - Han Wang
- Institute of Planned Immunity, Heilongjiang Center for Disease Control and Prevention
| | - Jing Song
- Institute of Planned Immunity, Heilongjiang Center for Disease Control and Prevention
| | - Changjiang Song
- Institute of Planned Immunity, Heilongjiang Center for Disease Control and Prevention
| | - Zhaodan Sun
- Institute of Planned Immunity, Heilongjiang Center for Disease Control and Prevention
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Duizer E, Ruijs WL, van der Weijden CP, Timen A. Response to a wild poliovirus type 2 (WPV2)-shedding event following accidental exposure to WPV2, the Netherlands, April 2017. ACTA ACUST UNITED AC 2018; 22:30542. [PMID: 28597830 PMCID: PMC5479986 DOI: 10.2807/1560-7917.es.2017.22.21.30542] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/18/2017] [Indexed: 11/20/2022]
Abstract
On 3 April 2017, a wild poliovirus type 2 (WPV2) spill occurred in a Dutch vaccine manufacturing plant. Two fully vaccinated operators with risk of exposure were advised on stringent personal hygiene and were monitored for virus shedding. Poliovirus (WPV2-MEF1) was detected in the stool of one, 4 days after exposure, later also in sewage samples. The operator was isolated at home and followed up until shedding stopped 29 days after exposure. No further transmission was detected.
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Affiliation(s)
- Erwin Duizer
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Wilhelmina Lm Ruijs
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - Aura Timen
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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Duintjer Tebbens RJ, Zimmermann M, Pallansch M, Thompson KM. Insights from a Systematic Search for Information on Designs, Costs, and Effectiveness of Poliovirus Environmental Surveillance Systems. FOOD AND ENVIRONMENTAL VIROLOGY 2017; 9:361-382. [PMID: 28687986 PMCID: PMC7879701 DOI: 10.1007/s12560-017-9314-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/30/2017] [Indexed: 05/20/2023]
Abstract
Poliovirus surveillance plays a critical role in achieving and certifying eradication and will play a key role in the polio endgame. Environmental surveillance can provide an opportunity to detect circulating polioviruses prior to the observation of any acute flaccid paralysis cases. We completed a systematic review of peer-reviewed publications on environmental surveillance for polio including the search terms "environmental surveillance" or "sewage," and "polio," "poliovirus," or "poliomyelitis," and compared characteristics of the resulting studies. The review included 146 studies representing 101 environmental surveillance activities from 48 countries published between 1975 and 2016. Studies reported taking samples from sewage treatment facilities, surface waters, and various other environmental sources, although they generally did not present sufficient details to thoroughly evaluate the sewage systems and catchment areas. When reported, catchment areas varied from 50 to over 7.3 million people (median of 500,000 for the 25% of activities that reported catchment areas, notably with 60% of the studies not reporting this information and 16% reporting insufficient information to estimate the catchment area population size). While numerous studies reported the ability of environmental surveillance to detect polioviruses in the absence of clinical cases, the review revealed very limited information about the costs and limited information to support quantitative population effectiveness of conducting environmental surveillance. This review motivates future studies to better characterize poliovirus environmental surveillance systems and the potential value of information that they may provide in the polio endgame.
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Affiliation(s)
| | - Marita Zimmermann
- Kid Risk, Inc., 10524 Moss Park Rd., Ste. 204-364, Orlando, FL 32832
- Correspondence to: Radboud J. Duintjer Tebbens, Kid Risk, Inc., 10524 Moss Park Rd., Ste. 204-364, Orlando, FL 32832, USA,
| | - Mark Pallansch
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA 30333
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Kroiss SJ, Famulare M, Lyons H, McCarthy KA, Mercer LD, Chabot-Couture G. Evaluating cessation of the type 2 oral polio vaccine by modeling pre- and post-cessation detection rates. Vaccine 2017; 35:5674-5681. [DOI: 10.1016/j.vaccine.2017.08.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/02/2017] [Accepted: 08/19/2017] [Indexed: 11/26/2022]
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Cowger TL, Burns CC, Sharif S, Gary HE, Iber J, Henderson E, Malik F, Zahoor Zaidi SS, Shaukat S, Rehman L, Pallansch MA, Orenstein WA. The role of supplementary environmental surveillance to complement acute flaccid paralysis surveillance for wild poliovirus in Pakistan - 2011-2013. PLoS One 2017; 12:e0180608. [PMID: 28742803 PMCID: PMC5526532 DOI: 10.1371/journal.pone.0180608] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 06/19/2017] [Indexed: 02/04/2023] Open
Abstract
Background More than 99% of poliovirus infections are non-paralytic and therefore, not detected by acute flaccid paralysis (AFP) surveillance. Environmental surveillance (ES) can detect circulating polioviruses from sewage without relying on clinical presentation. With extensive ES and continued circulation of polioviruses, Pakistan presents a unique opportunity to quantify the impact of ES as a supplement to AFP surveillance on overall completeness and timeliness of poliovirus detection. Methods Genetic, geographic and temporal data were obtained for all wild poliovirus (WPV) isolates detected in Pakistan from January 2011 through December 2013. We used viral genetics to assess gaps in AFP surveillance and ES as measured by detection of ‘orphan viruses’ (≥1.5% different in VP1 capsid nucleotide sequence). We compared preceding detection of closely related circulating isolates (≥99% identity) detected by AFP surveillance or ES to determine which surveillance system first detected circulation before the presentation of each polio case. Findings A total of 1,127 WPV isolates were detected by AFP surveillance and ES in Pakistan from 2011–2013. AFP surveillance and ES combined exhibited fewer gaps (i.e., % orphan viruses) in detection than AFP surveillance alone (3.3% vs. 7.7%, respectively). ES detected circulation before AFP surveillance in nearly 60% of polio cases (200 of 346). For polio cases reported from provinces conducting ES, ES detected circulation nearly four months sooner on average (117.6 days) than did AFP surveillance. Interpretation Our findings suggest ES in Pakistan is providing earlier, more sensitive detection of wild polioviruses than AFP surveillance alone. Overall, targeted ES through strategic selection of sites has important implications in the eradication endgame strategy.
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Affiliation(s)
- Tori L. Cowger
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Cara C. Burns
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
- * E-mail:
| | - Salmaan Sharif
- WHO Regional Reference Laboratory for Polio Eradication Initiative, Department of Virology, National Institute of Health (NIH), Islamabad, Pakistan
| | - Howard E. Gary
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Jane Iber
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Elizabeth Henderson
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Farzana Malik
- WHO Regional Reference Laboratory for Polio Eradication Initiative, Department of Virology, National Institute of Health (NIH), Islamabad, Pakistan
| | | | - Shahzad Shaukat
- WHO Regional Reference Laboratory for Polio Eradication Initiative, Department of Virology, National Institute of Health (NIH), Islamabad, Pakistan
| | - Lubna Rehman
- WHO Regional Reference Laboratory for Polio Eradication Initiative, Department of Virology, National Institute of Health (NIH), Islamabad, Pakistan
| | - Mark A. Pallansch
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Walter A. Orenstein
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
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Derrough T, Salekeen A. Lessons learnt to keep Europe polio-free: a review of outbreaks in the European Union, European Economic Area, and candidate countries, 1973 to 2013. ACTA ACUST UNITED AC 2017; 21:30210. [PMID: 27123992 DOI: 10.2807/1560-7917.es.2016.21.16.30210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 04/21/2016] [Indexed: 11/20/2022]
Abstract
Between 1973 and 2013, 12 outbreaks of paralytic poliomyelitis with a cumulative total of 660 cases were reported in the European Union, European Economic Area and candidate countries. Outbreaks lasted seven to 90 weeks (median: 24 weeks) and were identified through the diagnosis of cases of acute flaccid paralysis, for which infection with wild poliovirus was subsequently identified. In two countries, environmental surveillance was in place before the outbreaks, but did not detect any wild strain before the occurrence of clinical cases. This surveillance nonetheless provided useful information to monitor the outbreaks and their geographical spread. Outbreaks were predominantly caused by poliovirus type 1 and typically involved unvaccinated or inadequately vaccinated groups within highly immunised communities. Oral polio vaccine was primarily used to respond to the outbreaks with catch-up campaigns implemented either nationwide or in restricted geographical areas or age groups. The introduction of supplementary immunisation contained the outbreaks. In 2002, the European region of the World Health Organization was declared polio-free and it has maintained this status since. However, as long as there are non-vaccinated or under-vaccinated groups in European countries and poliomyelitis is not eradicated, countries remain continuously at risk of reintroduction and establishment of the virus. Continued efforts to reach these groups are needed in order to ensure a uniform and high vaccination coverage.
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Affiliation(s)
- Tarik Derrough
- European Centre of Disease Prevention and Control (ECDC), Stockholm, Sweden
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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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Wieczorek M, Ciąćka A, Witek A, Kuryk Ł, Żuk-Wasek A. Environmental Surveillance of Non-polio Enteroviruses in Poland, 2011. FOOD AND ENVIRONMENTAL VIROLOGY 2015; 7:224-231. [PMID: 25862480 DOI: 10.1007/s12560-015-9195-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 04/02/2015] [Indexed: 06/04/2023]
Abstract
The aim of this study was to apply environmental surveillance to evaluate circulation of non-polio enteroviruses (NPEVs) in sewage in Poland. Samples of raw sewage were collected in 14 sewage disposal systems from January to December, 2011. Sewage samples were concentrated prior to analysis by RT-PCR and isolation in cells (RD, L20B and Caco-2). Out of the 165 analysed samples, 127 (77%) were positive for enteroviruses using RT-PCR and 109 (66%) were positive for enteroviruses using cell culture methods and the highest detection rate was observed in the summer and autumn. In total, 141 enteroviruses were identified using neutralization test (107 NPEVs and 34 polioviruses). Accounting for 52% of all the detected NPEVs, E11 and E3 were the predominant serotypes identified in raw sewage. Retrospectively, E11 was the known aetiology for the past aseptic meningitis outbreaks in Poland, as E3 being rarely associated with any outbreak prior to 2013. In conclusion, the environmental surveillance provides data which may help in understanding the epidemiology of enteroviruses in humans.
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Affiliation(s)
- Magdalena Wieczorek
- Department of Virology, National Institute of Public Health - National Institute of Hygiene, Chocimska 24 Str., 00-791, Warsaw, Poland,
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36
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Ayukekbong JA. Current goals and prospects of the global polio eradication initiative. J Epidemiol Community Health 2015; 69:1133-4. [DOI: 10.1136/jech-2015-205529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/21/2015] [Indexed: 11/04/2022]
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Kalkowska DA, Duintjer Tebbens RJ, Pallansch MA, Cochi SL, Wassilak SGF, Thompson KM. Modeling undetected live poliovirus circulation after apparent interruption of transmission: implications for surveillance and vaccination. BMC Infect Dis 2015; 15:66. [PMID: 25886823 PMCID: PMC4344758 DOI: 10.1186/s12879-015-0791-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/30/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Most poliovirus infections occur with no symptoms and this leads to the possibility of silent circulation, which complicates the confirmation of global goals to permanently end poliovirus transmission. Previous simple models based on hypothetical populations assumed perfect detection of symptomatic cases and suggested the need to observe no paralytic cases from wild polioviruses (WPVs) for approximately 3-4 years to achieve 95% confidence about eradication, but the complexities in real populations and the imperfect nature of surveillance require consideration. METHODS We revisit the probability of undetected poliovirus circulation using a more comprehensive model that reflects the conditions in a number of places with different characteristics related to WPV transmission, and we model the actual environmental WPV detection that occurred in Israel in 2013. We consider the analogous potential for undetected transmission of circulating vaccine-derived polioviruses. The model explicitly accounts for the impact of different vaccination activities before and after the last detected case of paralytic polio, different levels of surveillance, variability in transmissibility and neurovirulence among serotypes, and the possibility of asymptomatic participation in transmission by previously-vaccinated or infected individuals. RESULTS We find that prolonged circulation in the absence of cases and thus undetectable by case-based surveillance may occur if vaccination keeps population immunity close to but not over the threshold required for the interruption of transmission, as may occur in northwestern Nigeria for serotype 2 circulating vaccine-derived poliovirus in the event of insufficient tOPV use. Participation of IPV-vaccinated individuals in asymptomatic fecal-oral transmission may also contribute to extended transmission undetectable by case-based surveillance, as occurred in Israel. We also find that gaps or quality issues in surveillance could significantly reduce confidence about actual disruption. Maintaining high population immunity and high-quality surveillance for several years after the last detected polio cases will remain critical elements of the polio end game. CONCLUSIONS Countries will need to maintain vigilance in their surveillance for polioviruses and recognize that their risks of undetected circulation may differ as a function of their efforts to manage population immunity and to identify cases or circulating live polioviruses.
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Affiliation(s)
- Dominika A Kalkowska
- Kid Risk, Inc., 10524 Moss Park Road, Site 204-364, Orlando, FL, 32832, USA.
- Delft University of Technology, Delft, Netherlands.
| | | | - Mark A Pallansch
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Stephen L Cochi
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Steven G F Wassilak
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Kimberly M Thompson
- Kid Risk, Inc., 10524 Moss Park Road, Site 204-364, Orlando, FL, 32832, USA.
- College of Medicine, University of Central Florida, Orlando, FL, USA.
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Kalkowska DA, Duintjer Tebbens RJ, Pallansch MA, Cochi SL, Wassilak SGF, Thompson KM. Modeling undetected live poliovirus circulation after apparent interruption of transmission: implications for surveillance and vaccination. BMC Infect Dis 2015. [PMID: 25886823 DOI: 10.1186/s12879-12015-10791-12875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Most poliovirus infections occur with no symptoms and this leads to the possibility of silent circulation, which complicates the confirmation of global goals to permanently end poliovirus transmission. Previous simple models based on hypothetical populations assumed perfect detection of symptomatic cases and suggested the need to observe no paralytic cases from wild polioviruses (WPVs) for approximately 3-4 years to achieve 95% confidence about eradication, but the complexities in real populations and the imperfect nature of surveillance require consideration. METHODS We revisit the probability of undetected poliovirus circulation using a more comprehensive model that reflects the conditions in a number of places with different characteristics related to WPV transmission, and we model the actual environmental WPV detection that occurred in Israel in 2013. We consider the analogous potential for undetected transmission of circulating vaccine-derived polioviruses. The model explicitly accounts for the impact of different vaccination activities before and after the last detected case of paralytic polio, different levels of surveillance, variability in transmissibility and neurovirulence among serotypes, and the possibility of asymptomatic participation in transmission by previously-vaccinated or infected individuals. RESULTS We find that prolonged circulation in the absence of cases and thus undetectable by case-based surveillance may occur if vaccination keeps population immunity close to but not over the threshold required for the interruption of transmission, as may occur in northwestern Nigeria for serotype 2 circulating vaccine-derived poliovirus in the event of insufficient tOPV use. Participation of IPV-vaccinated individuals in asymptomatic fecal-oral transmission may also contribute to extended transmission undetectable by case-based surveillance, as occurred in Israel. We also find that gaps or quality issues in surveillance could significantly reduce confidence about actual disruption. Maintaining high population immunity and high-quality surveillance for several years after the last detected polio cases will remain critical elements of the polio end game. CONCLUSIONS Countries will need to maintain vigilance in their surveillance for polioviruses and recognize that their risks of undetected circulation may differ as a function of their efforts to manage population immunity and to identify cases or circulating live polioviruses.
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Affiliation(s)
- Dominika A Kalkowska
- Kid Risk, Inc., 10524 Moss Park Road, Site 204-364, Orlando, FL, 32832, USA.
- Delft University of Technology, Delft, Netherlands.
| | | | - Mark A Pallansch
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Stephen L Cochi
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Steven G F Wassilak
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Kimberly M Thompson
- Kid Risk, Inc., 10524 Moss Park Road, Site 204-364, Orlando, FL, 32832, USA.
- College of Medicine, University of Central Florida, Orlando, FL, USA.
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Alam MM, Shaukat S, Sharif S, Angez M, Khurshid A, Malik F, Rehman L, Zaidi SSZ. Detection of multiple cocirculating wild poliovirus type 1 lineages through environmental surveillance: impact and progress during 2011-2013 in Pakistan. J Infect Dis 2014; 210 Suppl 1:S324-32. [PMID: 25316851 DOI: 10.1093/infdis/jiu160] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The environmental surveillance has proven to be a useful tool to identify poliovirus circulation in different countries and was started in Pakistan during July 2009 to support the acute flaccid paralysis (AFP) surveillance system. METHODS Sewage samples were collected from 27 environmental sampling (ENV) sites and processed for poliovirus isolation through 2-phase separation method. Poliovirus isolates were identified as Sabin-like or wild type through real-time polymerase chain reaction (PCR). Wild-type strains were subjected to VP1 gene sequencing and phylogenetic analysis performed using MEGA 5.0. RESULTS During 2011-2013, a total of 668 samples were collected from 4 provinces that resulted in 40% of samples positive for wild poliovirus type-1 (WPV-1). None of the samples were positive for WPV-3. The areas with high frequency of WPV-1 detection were Karachi-Gadap (69%), Peshawar (82%), and Rawalpindi (65%), whereas the samples from Quetta and Sukkur remained negative for WPV during 2013. Phylogenetic analysis revealed 3 major clusters with multiple poliovirus lineages circulating across different country areas as well as in bordering areas of Afghanistan. CONCLUSIONS Environmental surveillance in Pakistan has been proven to be a powerful tool to detect WPV circulation in the absence of poliomyelitis cases in many communities. Our findings emphasize the need to continue and expand such surveillance activities to other high-risk areas in the country.
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Affiliation(s)
- Muhammad Masroor Alam
- WHO Regional Reference Laboratory for Polio Eradication Initiative, Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Shahzad Shaukat
- WHO Regional Reference Laboratory for Polio Eradication Initiative, Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Salmaan Sharif
- WHO Regional Reference Laboratory for Polio Eradication Initiative, Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Mehar Angez
- WHO Regional Reference Laboratory for Polio Eradication Initiative, Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Adnan Khurshid
- WHO Regional Reference Laboratory for Polio Eradication Initiative, Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Farzana Malik
- WHO Regional Reference Laboratory for Polio Eradication Initiative, Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Lubna Rehman
- WHO Regional Reference Laboratory for Polio Eradication Initiative, Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Syed Sohail Zahoor Zaidi
- WHO Regional Reference Laboratory for Polio Eradication Initiative, Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
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Ndiaye AK, Diop PAM, Diop OM. Environmental surveillance of poliovirus and non-polio enterovirus in urban sewage in Dakar, Senegal (2007-2013). Pan Afr Med J 2014; 19:243. [PMID: 25848458 PMCID: PMC4377292 DOI: 10.11604/pamj.2014.19.243.3538] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 07/23/2014] [Indexed: 11/16/2022] Open
Abstract
Introduction Global poliomyelitis eradication initiative relies on (i) laboratory based surveillance of acute flaccid surveillance (AFP) to monitor the circulation of wild poliovirus in a population, and (ii) vaccination to prevent its diffusion. However, as poliovirus can survive in the environment namely in sewage, environmental surveillance (ES) is of growing importance as the eradication target is close. This study aimed to assess polioviruses and non polio enteroviruses circulation in sewage drains covering a significant population of Dakar. Methods From April 2007 to May 2013, 271 specimens of raw sewage were collected using the grab method in 6 neighborhoods of Dakar. Samples were processed to extract and concentrate viruses using polyethylene glycol and Dextran (two-phase separation method). Isolation of enteroviruses was attempted in RD, L20B and Hep2 cell lines. Polioviruses were identified by RT-PCR and Elisa. Non Polio Enteroviruses (NPEVs) were identified by RT-PCR and microneutralisation tests. Results Polioviruses and NPEVs were respectively detected in 34,3% and 42,8% sewage samples. No wild poliovirus neither circulating vaccine-derived Poliovirus (cVDPV) was detected. Neutralization assays have identified 49 non polio enteroviruses that were subsequently classified in 13 serotypes belonging to HEV-A (22, 4%), HEV-B (12, 24%), HEV-C (26, 53%) and HEV-D (6, 12%) species. Conclusion This study is the first documentation of enteroviruses environmental detection in Senegal. It shows the usefulness of environmental surveillance for indirect monitoring of the circulation and distribution of enteroviruses in the community.
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Affiliation(s)
- Abdou Kader Ndiaye
- National Reference Center for Enteric Viruses, Medical Virology Unit, Institut Pasteur de Dakar, Senegal
| | - Pape Amadou Mbathio Diop
- National Reference Center for Enteric Viruses, Medical Virology Unit, Institut Pasteur de Dakar, Senegal
| | - Ousmane Madiagne Diop
- National Reference Center for Enteric Viruses, Medical Virology Unit, Institut Pasteur de Dakar, Senegal
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Esteves-Jaramillo A, Estívariz CF, Peñaranda S, Richardson VL, Reyna J, Coronel DL, Carrión V, Landaverde JM, Wassilak SGF, Pérez-Sánchez EE, López-Martínez I, Burns CC, Pallansch MA. Detection of vaccine-derived polioviruses in Mexico using environmental surveillance. J Infect Dis 2014; 210 Suppl 1:S315-23. [PMID: 25316850 PMCID: PMC10389690 DOI: 10.1093/infdis/jiu183] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Early detection and control of vaccine-derived poliovirus (VDPV) emergences are essential to secure the gains of polio eradication. METHODS Serial sewage samples were collected in 4 towns of Mexico before, throughout, and after the May 2010 oral poliovirus vaccine (OPV) mass immunization campaign. Isolation and molecular analysis of polioviruses from sewage specimens monitored the duration of vaccine-related strains in the environment and emergence of vaccine-derived polioviruses in a population partially immunized with inactivated poliovirus vaccine (IPV). RESULTS Sabin strains were identified up to 5-8 weeks after the campaign in all towns; in Aguascalientes, 1 Sabin 3 was isolated 16 weeks after the campaign, following 7 weeks with no Sabin strains detected. In Tuxtla Gutiérrez, type 2 VDPV was isolated from 4 samples collected before and during the campaign, and type 1 VDPV from 1 sample collected 19 weeks afterward. During 2009-2010, coverage in 4 OPV campaigns conducted averaged only 57% and surveillance for acute flaccid paralysis (AFP) was suboptimal (AFP rate<1 per 100,000 population<15 years of age) in Tuxtla Gutierrez. CONCLUSIONS VDPVs may emerge and spread in settings with inadequate coverage with IPV/OPV vaccination. Environmental surveillance can facilitate early detection in these settings.
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Affiliation(s)
| | - Concepción F. Estívariz
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Silvia Peñaranda
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Jesús Reyna
- Centro Nacional para la Salud de la Infancia y Adolescencia, México DF
| | - Diana L. Coronel
- Centro Nacional para la Salud de la Infancia y Adolescencia, México DF
| | - Veronica Carrión
- Pan American Health Organization, Washington, District of Columbia
| | | | - Steven G. F. Wassilak
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Cara C. Burns
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark A. Pallansch
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Kuryk Ł, Wieczorek M, Diedrich S, Böttcher S, Witek A, Litwińska B. Genetic analysis of poliovirus strains isolated from sewage in Poland. J Med Virol 2013; 86:1243-8. [PMID: 24123142 DOI: 10.1002/jmv.23803] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2013] [Indexed: 01/06/2023]
Abstract
The study describes genetic characterization of poliovirus (PV) strains isolated from sewage samples in Poland. The analyses were performed for the detection of any putative polio revertants and recombinants in three genomic regions by sequencing analysis. Thirty-six strains were analyzed. The analyzed strains were identified by neutralization assay as 7 strains of serotype P1, 10 strains of serotype P2, and 19 strains of serotype P3. Sewage isolates were sequenced in 5'UTR, VP1, and 3D genomic regions. All detected PVs were classified as vaccine strains on the basis of VP1 sequence. Mutational differences in the VP1 sequences of isolated viruses ranged from 0.0% to 0.4%, indicating a limited replication period. The genetic analysis of the 3D region showed that some strains have recombinant genomes. Nine strains were found as dipartite recombinants (seven strains--S3/S2, one strain--S2/S1, one strain--S3/S1), while one strain was found as tripartite recombinant (S3/S2/S1). No recombinants with non-PV enteroviruses were identified. None of wild-type PVs or vaccine-derived polioviruses (VDPVs) were detected. This study showed the absence of wild or VDPV circulation in the country and demonstrated the usefulness of environmental surveillance in addition to acute flaccid paralysis (AFP) surveillance in support of polio eradication initiatives.
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Affiliation(s)
- Ł Kuryk
- Department of Virology, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
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Hovi T, Paananen A, Blomqvist S, Savolainen-Kopra C, Al-Hello H, Smura T, Shimizu H, Nadova K, Sobotova Z, Gavrilin E, Roivainen M. Characteristics of an environmentally monitored prolonged type 2 vaccine derived poliovirus shedding episode that stopped without intervention. PLoS One 2013; 8:e66849. [PMID: 23935826 PMCID: PMC3729856 DOI: 10.1371/journal.pone.0066849] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 05/09/2013] [Indexed: 12/05/2022] Open
Abstract
Vaccine derived poliovirus (VDPV) type 2 strains strongly divergent from the corresponding vaccine strain, Sabin 2, were repeatedly isolated from sewage in Slovakia over a period of 22 months in 2003–2005. Cell cultures of stool specimens from known immune deficient patients and from an identified putative source population of 500 people failed to identify the potential excretor(s) of the virus. The occurrence of VDPV in sewage stopped without any intervention. No paralytic cases were reported in Slovakia during the episode. According to a GenBank search and similarity plotting-analysis, the closest known relative of the first isolate PV2/03/SVK/E783 through all main sections of the genome was the type 2 poliovirus Sabin strain, with nucleotide identities in 5′UTR, P1, P2, P3, and 3′UTR parts of the genome of 88.6, 85.9, 87.3, 88.5, and 94.0 percent, respectively. Phenotypic properties of selected Slovakian aVDPV strains resembled those of VDPV strains isolated from immune deficient individuals with prolonged PV infection (iVDPV), including antigenic changes and moderate neurovirulence in the transgenic mouse model. One hundred and two unique VP1 coding sequences were determined from VDPV strains isolated from 34 sewage specimens. Nucleotide differences from Sabin 2 in the VP1 coding region ranged from 12.5 to 15.6 percent, and reached a maximum of 9.6 percent between the VDPV strains under study. Most of the nucleotide substitutions were synonymous but as many as 93 amino acid positions out of 301 in VP1 showed substitutions. We conclude that (1) individuals with prolonged poliovirus infection are not as rare as suggested by the studies on immune deficient patients known to the health care systems and (2) genetic divergence of VDPV strains may remain extensive during years long replication in humans.
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Affiliation(s)
- Tapani Hovi
- Virology Unit, Department of Infectious Disease Surveillance and Control, National Institute for Health and Welfare, a WHO Collaborating Centre for Poliovirus Surveillance and Enterovirus Research, Helsinki, Finland.
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Sasaki A, Haraguchi Y, Yoshida H. Estimating the risk of re-emergence after stopping polio vaccination. Front Microbiol 2012; 3:178. [PMID: 22783231 PMCID: PMC3390584 DOI: 10.3389/fmicb.2012.00178] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 04/23/2012] [Indexed: 11/24/2022] Open
Abstract
Live vaccination against polio has effectively prevented outbreaks in most developed countries for more than 40 years, and there remain only a few countries where outbreaks of poliomyelitis by the wild strain still threaten the community. It is expected that worldwide eradication will be eventually achieved through careful surveillance and a well-managed immunization program. The present paper argues, however, that based on a simple stochastic model the risk of outbreak by a vaccine-derived strain after the cessation of vaccination is quite high, even if many years have passed since the last confirmed case. As vaccinated hosts are natural reservoirs for virulent poliovirus, the source of the risk is the vaccination itself, employed to prevent the outbreaks. The crisis after stopping vaccination will emerge when the following two conditions are met: the susceptible host density exceeds the threshold for epidemics and the vaccinated host density remains large enough to ensure the occurrence of virulent mutants in the population. Our estimates for transmission, recovery, and mutation rates, show that the probability of an outbreak of vaccine-derived virulent viruses easily exceeds 90%. Moreover, if a small fraction of hosts have a longer infectious period, as observed in individuals with innate immunodeficiency, the risk of an outbreak rises significantly. Under such conditions, successful global eradication of polio is restricted to a certain range of parameters even if inactivated polio vaccine (IPV) is extensively used after the termination of live vaccination.
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Affiliation(s)
- Akira Sasaki
- Department of Evolutionary Studies of Biosystems, The Graduate University for Advanced StudiesHayama, Kanagawa, Japan
- Evolution and Ecology Program, International Institute for Applied Systems AnalysisLaxenburg, Austria
| | - Yoshihiro Haraguchi
- Department of Biology, Faculty of Science, Kyushu University Graduate SchoolsFukuoka, Japan
| | - Hiromu Yoshida
- Department of Virology 2, National Institute of Infectious Diseases, MusashimurayamaTokyo, Japan
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Detection of imported wild polioviruses and of vaccine-derived polioviruses by environmental surveillance in Egypt. Appl Environ Microbiol 2012; 78:5406-9. [PMID: 22582070 DOI: 10.1128/aem.00491-12] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Systematic environmental surveillance for poliovirus circulation has been conducted in Egypt since 2000. The surveillance has revealed three independent importations of wild-type poliovirus. In addition, several vaccine-derived polioviruses have been detected in various locations in Egypt. In addition to acute flaccid paralysis (AFP) surveillance, environmental surveillance can be used to monitor the wild poliovirus and vaccine-derived poliovirus circulation in populations in support of polio eradication initiatives.
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Feasibility of quantitative environmental surveillance in poliovirus eradication strategies. Appl Environ Microbiol 2012; 78:3800-5. [PMID: 22447593 DOI: 10.1128/aem.07972-11] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The progress of the Global Polio Eradication Initiative is monitored by acute flaccid paralysis (AFP) surveillance supplemented with environmental surveillance in selected areas. To assess the sensitivity of environmental surveillance, stools from (re)vaccinated elderly persons with a low seroprevalence and from wastewater were concurrently collected and analyzed in the Netherlands over a prolonged period of time. A total number of 228 healthy individuals with different levels of immunity were challenged with monovalent oral polio vaccine serotype 1 or 3. Poliovirus concentrations were determined by the titration of fecal suspensions on poliovirus-sensitive L20B cells and of sewage concentrates by L20B monolayer plaque assay. Almost half of the individuals (45%) shed poliovirus on day 3 after challenge, which peaked (57%) on day 8 with an average poliovirus excretion of 1.3 × 10(5) TCID(50) per g of feces and gradually decreased to less than 5% on day 42. The virus concentrations in sewage peaked on days 6 to 8 at approximately 100 PFU per liter, remained high until day 14, and subsequently decreased to less than 10 PFU per liter on day 29. The estimated poliovirus concentration in sewage approximated the measured initial virus excretion in feces, within 1 log(10) variation, resulting in a sensitivity of detection of 100 infected but mostly asymptomatic individuals in tens of thousands of individuals. An additional second peak observed in sewage may indicate secondary transmission missed by enterovirus or AFP surveillance in patients. This enables the detection of circulating poliovirus by environmental surveillance, supporting its feasibility as an early warning system.
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Abstract
Poliovirus causes paralytic poliomyelitis, an ancient disease of humans that became a major public-health issue in the 20th century. The primary site of infection is the gut, where virus replication is entirely harmless; the two very effective vaccines developed in the 1950s (oral polio vaccine, or OPV, and inactivated polio vaccine, or IPV) induce humoral immunity, which prevents viraemic spread and disease. The success of vaccination in middle-income and developing countries encouraged the World Health Organization to commit itself to an eradication programme, which has made great advances. The features of the infection, including its largely silent nature and the ability of the live vaccine (OPV) to evolve and change in vaccine recipients and their contacts, make eradication particularly challenging. Understanding the pathogenesis and virology of the infection is of major significance as the programme reaches its conclusion.
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Affiliation(s)
- Philip D Minor
- National Institute of Biological Standards and Control, Health Protection Agency, Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, UK
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Role of environmental poliovirus surveillance in global polio eradication and beyond. Epidemiol Infect 2011; 140:1-13. [DOI: 10.1017/s095026881000316x] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
SUMMARYEnvironmental poliovirus surveillance (ENV) means monitoring of poliovirus (PV) transmission in human populations by examining environmental specimens supposedly contaminated by human faeces. The rationale is based on the fact that PV-infected individuals, whether presenting with disease symptoms or not, shed large amounts of PV in the faeces for several weeks. As the morbidity:infection ratio of PV infection is very low, this fact contributes to the sensitivity of ENV which under optimal conditions can be better than that of the standard acute flaccid paralysis (AFP) surveillance. The World Health Organization has included ENV in the new Strategic Plan of the Global Polio Eradication Initiative for years 2010–2012 to be increasingly used in PV surveillance, supplementing AFP surveillance. In this paper we review the feasibility of using ENV to monitor wild PV and vaccine-derived PV circulation in human populations, based on global experiences in defined epidemiological situations.
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Abstract
Poliovirus has been the subject of research for many virologists during the last 80 years. Research on the poliovirus biology has helped to understand the molecular basis of many biological processes, particularly RNA replication and virus-host cell interactions. Laboratory research has also been instrumental in the development of effective and safe vaccines against poliomyelitis and continues to be critical for the assessment of the quality of vaccines used in humans. The work carried out in diagnostic laboratories located in most countries of the world to isolate and characterize poliovirus from clinical samples is also essential to support the Global Polio Eradication Initiative, the most ambitious public health effort ever attempted by man. This chapter describes the most common techniques used in laboratories to isolate, identify, and characterize poliovirus isolates. They include cell culture isolation and typing techniques, virus purification methods, and molecular analyses of viral nucleic acids.
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Blomqvist S, Savolainen-Kopra C, Paananen A, El Bassioni L, El Maamoon Nasr EM, Firstova L, Zamiatina N, Kutateladze T, Roivainen M. Recurrent isolation of poliovirus 3 strains with chimeric capsid protein Vp1 suggests a recombination hot-spot site in Vp1. Virus Res 2010; 151:246-51. [PMID: 20493912 DOI: 10.1016/j.virusres.2010.05.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 05/12/2010] [Accepted: 05/14/2010] [Indexed: 11/17/2022]
Abstract
Five oral poliovirus vaccine (OPV) strains carrying an intertypic PV3/PV2 recombination in VP1 capsid protein were isolated during poliovirus surveillance. These five PV3 strains had altogether four diverse recombination crossover points near the 3' end of the VP1 coding region. The complete antigenic site IIIa was replaced by PV2-specific amino acids in four of the studied PV3 strains. Low overall number of nucleotide substitutions in VP1 indicated that the predicted replication time, "age", of the PV3 strains was short, 6 months or less. The nucleotide 472-T in the 5' non-coding region, associated to the attenuated phenotype of PV3/Sabin, was reverted to wild-type C in all studied PV3/PV2 recombinant strains. Three of the PV3 strains had at least a tripartite genome deduced from the partial 3D polymerase-coding region sequences. Our results suggest that there exists a PV3/PV2 recombination hot-spot site in the 3' partial region of the VP1 capsid protein and that the recombination may occur within weeks or a few months after the administration of OPV.
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Affiliation(s)
- Soile Blomqvist
- National Institute for Health and Welfare (THL), Department of Infectious Disease Surveillance and Control, Intestinal Viruses Unit, P.O. Box 30, 00271 Helsinki, Finland.
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