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Toizumi M, Takamatsu M, Toda K, Horikoshi Y. Progresses Toward Polio Eradication in Asian Countries: Its History and Japan's Contributions. Pediatr Infect Dis J 2024:00006454-990000000-00950. [PMID: 39037255 DOI: 10.1097/inf.0000000000004478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
Japan experienced a large outbreak of wild poliovirus in the 1960s. The government made an exceptional decision to import oral polio vaccines (OPVs) from the Soviet Union and Canada while bypassing the usual approval process for medical products. Mass vaccination and subsequent, routine immunization successfully contained the wild poliovirus; the last case in Japan was reported in 1980. Domestic OPV had been used to sustain Japan's polio-free state. In 2012, the world's first inactivated polio vaccine developed from the Sabin vaccine replaced OPVs. Domestic vaccines combined with Sabin-derived inactivated polio vaccine are currently used in Japan. When the World Health Assembly announced the Global Polio Eradication Initiative in 1988, the Japanese government made a commitment to support endemic countries. The Japan International Cooperation Agency supported the establishment of microbiological laboratories, surveillance, distribution of polio vaccines and capacity building. Vaccine-derived poliovirus emerged as a new, international risk in the early 2000s. Vaccine-derived poliovirus was also detected in several Asian countries and required an outbreak response with additional vaccinations and strengthened surveillance. Genetically stable, novel, oral polio vaccine type 2 became available for use in outbreak responses and was used in Indonesia. Japan maintains its commitment to work toward the eradication of the poliovirus.
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Affiliation(s)
- Michiko Toizumi
- From the Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Masamitsu Takamatsu
- World Health Organization Papua New Guinea, Port Moresby, Papua New Guinea
- Health and Global Policy Institute, Tokyo, Japan
| | - Kohei Toda
- Immunization Center, Akita Red Cross Hospital, Akita, Japan
| | - Yuho Horikoshi
- Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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Pomat W, Lopez Cavestany R, Jeyaseelan V, Ford R, Gare J, Avagyan T, Grabovac V, Bettels D, Mekonnen D, Jones KAV, Mainou BA, Mach O. Poliovirus serological assay after the cVDPV1 outbreak in Papua New Guinea: a cross-sectional study from 2020 to 2021. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 44:100986. [PMID: 38204497 PMCID: PMC10777103 DOI: 10.1016/j.lanwpc.2023.100986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/16/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024]
Abstract
Background In June 2018, a type 1 circulating vaccine-derived poliovirus (cVDPV1) outbreak was declared in Papua New Guinea (PNG), resulting in a total of 26 paralytic confirmed cases. Eight vaccination campaign rounds with bivalent oral poliovirus vaccine (bOPV) were carried out in response. Prevalence of neutralizing polio antibodies in children was assessed two years after the outbreak response was completed. Methods We conducted a cross-sectional serological survey among children aged 6 months-10 years selected from six provinces in PNG to evaluate seroprevalence of neutralizing polio antibodies to the three poliovirus serotypes and analyse sociodemographic risk factors. Findings We included 984 of 1006 enrolled children in the final analysis. The seroprevalence of neutralizing polio antibodies for serotype 1, 2 and 3 was 98.3% (95% CI: 97.4-98.9), 63.1% (95% CI: 60.1-66.1) and 95.0% (95% CI: 93.6-96.3), respectively. Children <1 year had significantly lower type 1 seroprevalence compared to older children (p < 0.001); there were no significant differences in seroprevalence among provinces. Interpretation PNG successfully interrupted transmission of cVDPV1 with several high coverage bOPV campaigns and seroprevalence remained high after two years. The emergence of cVDPV strains underscores the importance of maintaining high levels of routine immunization coverage and effective surveillance systems for early detection. Funding World Health Organization through a Rotary International IPPC grant.
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Affiliation(s)
- William Pomat
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Rocio Lopez Cavestany
- Polio Eradication Department, World Health Organization Headquarters, Geneva, Switzerland
| | - Visalakshi Jeyaseelan
- Polio Eradication Department, World Health Organization Headquarters, Geneva, Switzerland
| | - Rebecca Ford
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Janet Gare
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Tigran Avagyan
- World Health Organization, Western Pacific Regional Office, Manila, Philippines
| | - Varja Grabovac
- World Health Organization, Western Pacific Regional Office, Manila, Philippines
| | - Deborah Bettels
- World Health Organization, Papua New Guinea Country Office, Port Moresby, National Capital District, Papua New Guinea
| | - Dessie Mekonnen
- World Health Organization, Papua New Guinea Country Office, Port Moresby, National Capital District, Papua New Guinea
| | | | | | - Ondrej Mach
- Polio Eradication Department, World Health Organization Headquarters, Geneva, Switzerland
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Mekonnen DA, Bauri M, Pogo M, Shang M, Bettels D, Kabir SH, Edward W, Sibauk B, Dalton M, Miller G, Amarasinghe A, Takashima Y, Luo D, Huseynova S. Use of a catch-up programme to improve routine immunization in 13 provinces of Papua New Guinea, 2020-2022. Western Pac Surveill Response J 2023; 14:1-6. [PMID: 38230256 PMCID: PMC10789724 DOI: 10.5365/wpsar.2023.14.4.1055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024] Open
Abstract
Objective Routine immunization coverage in Papua New Guinea has decreased in the past 5 years. This persistently low routine immunization coverage has resulted in low population immunity and frequent outbreaks of vaccine-preventable disease across the country. We describe the use of a catch-up programme to improve routine immunization during the coronavirus disease pandemic in Papua New Guinea during 2020-2022. Methods In June 2020, 13 provinces of Papua New Guinea were selected to undergo a vaccination catch-up programme, with technical support from the World Health Organization (WHO) and the United Nations Children's Fund. Twelve provinces received financial and logistic support through the Accelerated Immunization and Health Systems Strengthening programme, and one received support from WHO. All stakeholders were involved in planning and implementing the catch-up programme. Results Between July 2020 and June 2022, about 340 health facilities conducted catch-up activities. The highest number of children aged under 1 year were vaccinated in 2022 (n = 33 652 for third dose of pentavalent vaccine). The national coverage of routine immunization (including the catch-up vaccinations) increased between 2019 and 2020 - by 5% for the third dose of pentavalent vaccine, 11% for the measles-rubella vaccine and 16% for the inactivated poliovirus vaccine. The coverage declined slightly in 2021 before increasing again in 2022. Discussion The catch-up programme was an instrumental tool to improve routine immunization coverage between 2020 and 2022 and during the pandemic in Papua New Guinea. With appropriate technical and logistic support, including financial and human resources, catch-up programmes can strengthen routine immunization coverage across the country.
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Affiliation(s)
- Dessie Ayalew Mekonnen
- World Health Organization Representative Office for Papua New Guinea, Port Moresby, PapuaNew Guinea
| | - Mathias Bauri
- National Department of Health, Port Moresby, PapuaNew Guinea
| | - Martha Pogo
- National Department of Health, Port Moresby, PapuaNew Guinea
| | - Mei Shang
- World Health Organization, Geneva, Switzerland
| | - Deborah Bettels
- World Health Organization Representative Office for Afghanistan, Kabul, Afghanistan
| | - Shaikh Humayun Kabir
- United Nations International Children’s Emergency Fund, New York City, New York, United States of America
| | - Waramin Edward
- National Department of Health, Port Moresby, PapuaNew Guinea
| | - Bieb Sibauk
- National Department of Health, Port Moresby, PapuaNew Guinea
| | | | - Geoff Miller
- Papua New Guinea–Australia Transition to Health, Department of Foreign Affairs and Trade, Barton, Australian Capital Territory, Australia
| | - Ananda Amarasinghe
- World Health Organization Representative Office for Papua New Guinea, Port Moresby, PapuaNew Guinea
| | - Yoshihiro Takashima
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Dapeng Luo
- World Health Organization Representative Office for Afghanistan, Kabul, Afghanistan
| | - Sevil Huseynova
- World Health Organization Representative Office for Papua New Guinea, Port Moresby, PapuaNew Guinea
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Snider CJ, Boualam L, Tallis G, Takashima Y, Abeyasinghe R, Lo YR, Grabovac V, Avagyan T, Aslam SK, Eltayeb AO, Aung KD, Wang X, Shrestha A, Ante-Orozco C, Silva MWT, Lapastora-Sucaldito N, Apostol LNG, Jikal MBH, Miraj W, Lodhi F, Kim HJ, Rusli N, Thorley BR, Kaye MB, Nishimura Y, Arita M, Sani JAM, Rundi C, Feldon K. Concurrent outbreaks of circulating vaccine-derived poliovirus types 1 and 2 affecting the Republic of the Philippines and Malaysia, 2019-2021. Vaccine 2023; 41 Suppl 1:A58-A69. [PMID: 35337673 PMCID: PMC10546869 DOI: 10.1016/j.vaccine.2022.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/17/2021] [Accepted: 02/02/2022] [Indexed: 01/26/2023]
Abstract
Concurrent outbreaks of circulating vaccine-derived poliovirus serotypes 1 and 2 (cVDPV1, cVDPV2) were confirmed in the Republic of the Philippines in September 2019 and were subsequently confirmed in Malaysia by early 2020. There is continuous population subgroup movement in specific geographies between the two countries. Outbreak response efforts focused on sequential supplemental immunization activities with monovalent Sabin strain oral poliovirus vaccine type 2 (mOPV2) and bivalent oral poliovirus vaccines (bOPV, containing Sabin strain types 1 and 3) as well as activities to enhance poliovirus surveillance sensitivity to detect virus circulation. A total of six cVDPV1 cases, 13 cVDPV2 cases, and one immunodeficiency-associated vaccine-derived poliovirus type 2 case were detected, and there were 35 cVDPV1 and 31 cVDPV2 isolates from environmental surveillance sewage collection sites. No further cVDPV1 or cVDPV2 have been detected in either country since March 2020. Response efforts in both countries encountered challenges, particularly those caused by the global COVID-19 pandemic. Important lessons were identified and could be useful for other countries that experience outbreaks of concurrent cVDPV serotypes.
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Affiliation(s)
- Cynthia J Snider
- Centers for Disease Control and Prevention, 1600 Clifton Road, MS H24-2, Atlanta, GA 30329, USA.
| | - Liliane Boualam
- World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland.
| | - Graham Tallis
- World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland.
| | - Yoshihiro Takashima
- World Health Organization Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines.
| | - Rabindra Abeyasinghe
- Office of the World Health Organization Representative to the Philippines, Building 3, San Lazaro Compound, Rizal Avenue, Santa Cruz, Manila 1003, Philippines.
| | - Ying-Ru Lo
- Office of the World Health Organization Representative to Malaysia, Brunei Darussalam and Singapore, 4th Floor, Prima 8, Block 3508, Jalan, Teknokrat 6, 63000 Cyberjaya, Selangor, Malaysia.
| | - Varja Grabovac
- World Health Organization Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines.
| | - Tigran Avagyan
- World Health Organization Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines.
| | - Syeda Kanwal Aslam
- World Health Organization Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines.
| | - Abu Obeida Eltayeb
- United Nations Children's Fund East Asia and Pacific Regional Office, 19 Pra Athit Rd, Chana Songkhram, Pra Nakhon, Bangkok 10200, Thailand.
| | - Khin Devi Aung
- United Nations Children's Fund East Asia and Pacific Regional Office, 19 Pra Athit Rd, Chana Songkhram, Pra Nakhon, Bangkok 10200, Thailand.
| | - Xiaojun Wang
- Office of the World Health Organization Representative to the Philippines, Building 3, San Lazaro Compound, Rizal Avenue, Santa Cruz, Manila 1003, Philippines.
| | - Achyut Shrestha
- Office of the World Health Organization Representative to the Philippines, Building 3, San Lazaro Compound, Rizal Avenue, Santa Cruz, Manila 1003, Philippines.
| | - Carla Ante-Orozco
- United Nations Children's Fund Philippines, 14th Floor- North Tower, Rockwell Business Center Sheridan, Sheridan Street Corner United Street, Highway Hills, Mandaluyong City, Philippines, 1550.
| | - Maria Wilda T Silva
- Republic of the Philippines Department of Health, Department of Health San Lazaro Compound, Rizal Ave., Santa Cruz, Manila, Philippines, 1003.
| | - Nemia Lapastora-Sucaldito
- Republic of the Philippines Department of Health, Department of Health San Lazaro Compound, Rizal Ave., Santa Cruz, Manila, Philippines, 1003.
| | - Lea Necitas G Apostol
- Republic of the Philippines Department of Health, Research Institute for Tropical Medicine, 9002 Research Drive, Filinvest Corporate City Alabang, Muntinlupa City, Philippines, 1781
| | - Muhammad Bin Hj Jikal
- Sabah State Health Department, Tingkat 3, Rumah Persekutuan, Jalan Mat Salleh, 88590 Kota Kinabalu, Sabah, Malaysia.
| | - Waheed Miraj
- Office of the World Health Organization Representative to Malaysia, Brunei Darussalam and Singapore, 4th Floor, Prima 8, Block 3508, Jalan, Teknokrat 6, 63000 Cyberjaya, Selangor, Malaysia
| | - Faisal Lodhi
- Office of the World Health Organization Representative to Malaysia, Brunei Darussalam and Singapore, 4th Floor, Prima 8, Block 3508, Jalan, Teknokrat 6, 63000 Cyberjaya, Selangor, Malaysia.
| | - Hyung Joon Kim
- United Nations Children's Fund Malaysia, Menara PJH, Level 10, No. 2, Jalan Tun Abdul Razak, Precinct 2, 62100 Putrajaya, Malaysia.
| | - Norhayati Rusli
- Ministry of Health Malaysia, Aras 3, Blok E10, Kompleks E, Pusat Pentadbiran Kerajaan Persekutuan, 62590 Wilayah Persekutuanm Putrajaya, Malaysia.
| | - Bruce R Thorley
- Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, Victoria, Australia, 3000.
| | - Matthew B Kaye
- Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, Victoria, Australia, 3000.
| | - Yorihiro Nishimura
- National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan.
| | - Minetaro Arita
- National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan.
| | - Jamiatul Aida Md Sani
- Ministry of Health Malaysia, Aras 3, Blok E10, Kompleks E, Pusat Pentadbiran Kerajaan Persekutuan, 62590 Wilayah Persekutuanm Putrajaya, Malaysia.
| | - Christina Rundi
- Sabah State Health Department, Tingkat 3, Rumah Persekutuan, Jalan Mat Salleh, 88590 Kota Kinabalu, Sabah, Malaysia.
| | - Keith Feldon
- Office of the World Health Organization Representative to the Philippines, Building 3, San Lazaro Compound, Rizal Avenue, Santa Cruz, Manila 1003, Philippines
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Kitamura K, Shimizu H. Outbreaks of Circulating Vaccine-derived Poliovirus in the World Health Organization Western Pacific Region, 2000-2021. Jpn J Infect Dis 2022; 75:431-444. [PMID: 36047174 DOI: 10.7883/yoken.jjid.2022.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The World Health Organization Western Pacific Region (WPR) has maintained the polio-free status for more than two decades. At the global level, there were only 6 confirmed polio cases due to wild type 1 poliovirus in Pakistan, Afghanistan, and Malawi in 2021, therefore, the risk of the importation of wild poliovirus from the endemic countries to the WPR is considerably lower than ever before. On the other hand, the risk of polio outbreaks associated with circulating vaccine-derived polioviruses (cVDPVs) still cannot be ignored even in the WPR. Since late 2010s, cVDPV outbreaks in the WPR have appeared to be more extensive in frequency and magnitude. Moreover, the emergence of concomitant polio outbreaks of type 1 and type 2 cVDPVs in the Philippines and Malaysia during 2019-2020 has highlighted the remaining risk of cVDPV outbreaks in high-risk areas and/or communities in the WPR. The previous cVDPV outbreaks in the WPR have been rapidly and effectively controlled, however, the future risk of polio outbreaks associated with cVDPVs needs to be reconsidered and polio immunization and surveillance strategies should be updated accordingly.
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Affiliation(s)
- Kouichi Kitamura
- Department of Virology II, National Institute of Infectious Diseases, Japan
| | - Hiroyuki Shimizu
- Department of Virology II, National Institute of Infectious Diseases, Japan
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Al-Qassimi MA, Al Amad M, Anam L, Almoayed K, Al-Dar A, Ezzadeen F. Circulating vaccine derived polio virus type 1 outbreak, Saadah governorate, Yemen, 2020. BMC Infect Dis 2022; 22:414. [PMID: 35488227 PMCID: PMC9052627 DOI: 10.1186/s12879-022-07397-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background Yemen has faced one of the worst humanitarian crises in the world since the start of the war in 2015. In 2020; 30 Vaccine Derived Polio Virus type 1 (VDPV1) isolates were detected in Saadah governorate. The aims are to characterize the outbreak and address the gaps predisposing the emergence and circulation of VDPV1 in Saadah governorate, Yemen. Method A retrospective descriptive study of confirmed cases of VDPV1 between January and December 2020 was performed. Surveillance staff collected data from patient cases, contacts, as well as stool specimens that shipped to WHO accredited polio labs. Data of population immunity was also reviewed. The difference in days between the date of sample collection, shipment, and receiving lab result was used to calculate the average of delayed days for lab confirmation. Results From January to December 2020, a total of 114 cases of acute flaccid paralysis (AFP) were reported from 87% (13/15) districts, and cVDPV1 was confirmed among 26% (30) AFP cases. 75% (21) were < 5 years, 73% (20) had zero doses of Oral Polio Vaccine (OPV). The first confirmed case (3%) was from Saadah city, with paralysis onset at the end of January 2020 followed by 5 cases (17%) in March from another four districts, 8 cases (27%) in April, and 13 (43%) up to December 2020 were from the same five districts in addition to 3 (10%) form three new districts. The lab confirmation was received after an average of 126 days (71–196) from sample collection. The isolates differ from the Sabin 1 type by 17- 30 VP1 nucleotides (nt) and were linked to VDPV1 with 13 (nt) divergence that isolated in July 2020 from stool specimens collected before one year from contacts of an inadequate AFP case reported from Sahar district. Conclusion The new emerging VDPV1 was retrospectively confirmed after one year of sample collection from Sahar district. Delayed lab confirmation, as well as the response and low immunization profile of children against polio, were the main predisposing factors for cVDPV1 outbreak. This outbreak highlights the need to maintain regular biweekly shipments to referral polio labs in the short-term, and the exploration of other options in the longer-term to enable the Yemen National Lab to fully process national samples itself. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07397-0.
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Affiliation(s)
| | - Mohammed Al Amad
- Field Epidemiology Training Program, Yemen Ministry of Public Health and Population, Sana'a, Yemen
| | - Labiba Anam
- Field Epidemiology Training Program, Yemen Ministry of Public Health and Population, Sana'a, Yemen
| | - Khaled Almoayed
- General Directorate for Diseases Control and Surveillance, Yemen Ministry of Public Health and Population, Sana'a, Yemen
| | - Ahmed Al-Dar
- National Polio Surveillance, Yemen Ministry of Public Health and Population, Sana'a, Yemen
| | - Faten Ezzadeen
- National Polio Surveillance, Yemen Ministry of Public Health and Population, Sana'a, Yemen
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Kitamura K, Shimizu H. The Molecular Evolution of Type 2 Vaccine-Derived Polioviruses in Individuals with Primary Immunodeficiency Diseases. Viruses 2021; 13:v13071407. [PMID: 34372613 PMCID: PMC8310373 DOI: 10.3390/v13071407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/17/2021] [Accepted: 07/17/2021] [Indexed: 12/28/2022] Open
Abstract
The oral poliovirus vaccine (OPV), which prevents person-to-person transmission of poliovirus by inducing robust intestinal immunity, has been a crucial tool for global polio eradication. However, polio outbreaks, mainly caused by type 2 circulating vaccine-derived poliovirus (cVDPV2), are increasing worldwide. Meanwhile, immunodeficiency-associated vaccine-derived poliovirus (iVDPV) is considered another risk factor during the final stage of global polio eradication. Patients with primary immunodeficiency diseases are associated with higher risks for long-term iVDPV infections. Although a limited number of chronic iVDPV excretors were reported, the recent identification of a chronic type 2 iVDPV (iVDPV2) excretor in the Philippines highlights the potential risk of inapparent iVDPV infection for expanding cVDPV outbreaks. Further research on the genetic characterizations and molecular evolution of iVDPV2, based on comprehensive iVDPV surveillance, will be critical for elucidating the remaining risk of iVDPV2 during the post-OPV era.
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Mbaeyi C, Moran T, Wadood Z, Ather F, Sykes E, Nikulin J, Al Safadi M, Stehling-Ariza T, Zomahoun L, Ismaili A, Abourshaid N, Asghar H, Korukluoglu G, Duizer E, Ehrhardt D, Burns CC, Sharaf M. Stopping a polio outbreak in the midst of war: Lessons from Syria. Vaccine 2021; 39:3717-3723. [PMID: 34053791 DOI: 10.1016/j.vaccine.2021.05.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/05/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Outbreaks of circulating vaccine-derived polioviruses (cVDPVs) pose a threat to the eventual eradication of all polioviruses. In 2017, an outbreak of cVDPV type 2 (cVDPV2) occurred in the midst of a war in Syria. We describe vaccination-based risk factors for and the successful response to the outbreak. METHODS We performed a descriptive analysis of cVDPV2 cases and key indicators of poliovirus surveillance and vaccination activities during 2016-2018. In the absence of reliable subnational coverage data, we used the caregiver-reported vaccination status of children with non-polio acute flaccid paralysis (AFP) as a proxy for vaccination coverage. We then estimated the relative odds of being unvaccinated against polio, comparing children in areas affected by the outbreak to children in other parts of Syria in order to establish the presence of poliovirus immunity gaps in outbreak affected areas. FINDINGS A total of 74 cVDPV2 cases were reported, with paralysis onset ranging from 3 March to 21 September 2017. All but three cases were reported from Deir-ez-Zor governorate and 84% had received < 3 doses of oral poliovirus vaccine (OPV). After adjusting for age and sex, non-polio AFP case-patients aged 6-59 months in outbreak-affected areas had 2.5 (95% CI: 1.1-5.7) increased odds of being unvaccinated with OPV compared with non-polio AFP case-patients in the same age group in other parts of Syria. Three outbreak response rounds of monovalent OPV type 2 (mOPV2) vaccination were conducted, with governorate-level coverage mostly exceeding 80%. INTERPRETATION Significant declines in both national and subnational polio vaccination coverage, precipitated by war and a humanitarian crisis, led to a cVDPV2 outbreak in Syria that was successfully contained following three rounds of mOPV2 vaccination.
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Affiliation(s)
- Chukwuma Mbaeyi
- United States Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA 30329, USA.
| | - Thomas Moran
- World Health Organization Headquarters, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Zubair Wadood
- World Health Organization Headquarters, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Fazal Ather
- Middle East and North Africa Office, United Nations Children's Fund, Abdulqader Al-Abed Street, Building No. 15, Tla'a Al-Ali, Amman, Jordan
| | - Emma Sykes
- World Health Organization, Regional Office for the Eastern Mediterranean, Mohammad Jamjoum Street, Ministry of Interior Circle Building No. 5, P.O. Box 811547, Amman 11181, Jordan
| | - Joanna Nikulin
- World Health Organization, Regional Office for the Eastern Mediterranean, Mohammad Jamjoum Street, Ministry of Interior Circle Building No. 5, P.O. Box 811547, Amman 11181, Jordan
| | - Mohammad Al Safadi
- World Health Organization Headquarters, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Tasha Stehling-Ariza
- United States Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA 30329, USA
| | - Laurel Zomahoun
- World Health Organization Headquarters, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Abdelkarim Ismaili
- World Health Organization, Regional Office for the Eastern Mediterranean, Mohammad Jamjoum Street, Ministry of Interior Circle Building No. 5, P.O. Box 811547, Amman 11181, Jordan
| | - Nidal Abourshaid
- Syria Country Office, United Nations Children's Fund, East Mazzeh, Al Shafiee St., Damascus, Syria
| | - Humayun Asghar
- World Health Organization, Regional Office for the Eastern Mediterranean, Mohammad Jamjoum Street, Ministry of Interior Circle Building No. 5, P.O. Box 811547, Amman 11181, Jordan
| | - Gulay Korukluoglu
- Public Health Institutions of Turkey, Adnan Saygun Cad. No. 55, F Blok 06100 Sihhiye, Ankara, Turkey
| | - Erwin Duizer
- National Polio Laboratory, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA, Bilthoven, the Netherlands
| | - Derek Ehrhardt
- United States Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA 30329, USA
| | - Cara C Burns
- United States Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA 30329, USA
| | - Magdi Sharaf
- World Health Organization, Regional Office for the Eastern Mediterranean, Mohammad Jamjoum Street, Ministry of Interior Circle Building No. 5, P.O. Box 811547, Amman 11181, Jordan
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Kadoya SS, Nishimura O, Kato H, Sano D. Predictive water virology using regularized regression analyses for projecting virus inactivation efficiency in ozone disinfection. WATER RESEARCH X 2021; 11:100093. [PMID: 33665597 PMCID: PMC7903012 DOI: 10.1016/j.wroa.2021.100093] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 05/26/2023]
Abstract
Wastewater reclamation and reuse have been practically applied to water-stressed regions, but waterborne pathogens remaining in insufficiently treated wastewater are of concern. Sanitation Safety Planning adopts the hazard analysis and critical control point (HACCP) approach to manage human health risks upon exposure to reclaimed wastewater. HACCP requires a predetermined reference value (critical limit: CL) at critical control points (CCPs), in which specific parameters are monitored and recorded in real time. A disinfection reactor of a wastewater treatment plant (WWTP) is regarded as a CCP, and one of the CCP parameters is the disinfection intensity (e.g., initial disinfectant concentration and contact time), which is proportional to the log reduction value (LRV) of waterborne pathogens. However, the achievable LRVs are not always stable because the disinfection intensity is affected by water quality parameters, which vary among WWTPs. In this study, we established models for projecting virus LRVs using ozone, in which water quality and operational parameters were used as explanatory variables. For the model construction, we used five machine learning algorithms and found that automatic relevance determination with interaction terms resulted in better prediction performances for norovirus and rotavirus LRVs. Poliovirus and coxsackievirus LRVs were predicted well by a Bayesian ridge with interaction terms and lasso with quadratic terms, respectively. The established models were relatively robust to predict LRV using new datasets that were out of the range of the training data used here, but it is important to collect LRV datasets further to make the models more predictable and flexible for newly obtained datasets. The modeling framework proposed here can help WWTP operators and risk assessors determine the appropriate CL to protect human health in wastewater reclamation and reuse.
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Affiliation(s)
- Syun-suke Kadoya
- Department of Civil and Environmental Engineering, Graduate School of Engineering, Tohoku University, Aoba 6-6-06, Aramaki, Aoba-ku, Sendai, Miyagi, 980-8579, Japan
| | - Osamu Nishimura
- Department of Civil and Environmental Engineering, Graduate School of Engineering, Tohoku University, Aoba 6-6-06, Aramaki, Aoba-ku, Sendai, Miyagi, 980-8579, Japan
| | - Hiroyuki Kato
- New Industry Creation Hatchery Center, Tohoku University, Sendai, Miyagi, Japan
| | - Daisuke Sano
- Department of Civil and Environmental Engineering, Graduate School of Engineering, Tohoku University, Aoba 6-6-06, Aramaki, Aoba-ku, Sendai, Miyagi, 980-8579, Japan
- Department of Frontier Sciences for Advanced Environment, Graduate School of Environmental Studies, Tohoku University, Aoba 6-6-06, Aramaki, Aoba-ku, Sendai, Miyagi, 980-8579, Japan
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10
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Craig AT, Kaldor J, Schierhout G, Rosewell AE. Surveillance strategies for the detection of disease outbreaks in the Pacific islands: meta-analysis of published literature, 2010-2019. Trop Med Int Health 2020; 25:906-918. [PMID: 32446271 DOI: 10.1111/tmi.13448] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Due to their tropical location, development status and the limited capacity of health systems, Pacific island counties and territories are particularly susceptible to infectious disease outbreaks; but evidence as to the optimal way in which outbreaks are detected is scarce. In this review, we synthesise evidence from literature about how outbreaks are detected in Pacific island countries and territories and critique factors identified as inhibiting surveillance practice. METHOD For this systematic review, we searched electronic databases Embase, Global Health, MEDLINE and MEDLINE Epub from 1 January 2010 and 31 March 2019 for reports describing infectious disease outbreaks occurring in the Pacific islands. Reports were included if they reported the method by which an outbreak was detected or the time between an outbreak's onset and its detection. We extracted information about the report type and authors, the outbreak and its method/s of detection, and pertinent issues inhibiting surveillance practice. RESULTS Of 860 articles identified, 37 reports describing 39 outbreaks met the inclusion criteria. Most outbreaks (n = 30) were identified through formal event-based surveillance; six through syndromic surveillance; and two by ad hoc notification from the community. Barriers to early outbreak detection included population isolation; lack of resources and infrastructure to support surveillance implementation and signal investigation; and broader health system factors such as preparedness planning and availability of laboratory services. CONCLUSION Most surveillance-related gain in the Pacific islands may be made through building formal event-based surveillance systems and streamlining reporting processes to facilitate outbreak notification. This observation is pertinent given the focus on establishing and expanding syndromic surveillance approaches for outbreak detection in the islands over the last decade.
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Affiliation(s)
- Adam T Craig
- University of New South Wales, Sydney, NSW, Australia
| | - John Kaldor
- University of New South Wales, Sydney, NSW, Australia
| | - Gill Schierhout
- The George Institute for Global Health, Newtown, NSW, Australia
| | - Alexander E Rosewell
- University of New South Wales, Sydney, NSW, Australia.,World Health Organization, Geneva, Switzerland
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11
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Roberts JA, Hobday LK, Ibrahim A, Thorley BR. Australian National Enterovirus Reference Laboratory annual report, 2018. ACTA ACUST UNITED AC 2020; 44. [PMID: 32299336 DOI: 10.33321/cdi.2020.44.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Australia monitors its polio-free status by conducting surveillance for cases of AFP in children less than 15 years of age, as recommended by the WHO. Cases of AFP in children are notified to the Australian Paediatric Surveillance Unit or the Paediatric Active Enhanced Disease Surveillance System and faecal specimens are referred for virological investigation to the National Enterovirus Reference Laboratory. In 2018, no cases of poliomyelitis were reported from clinical surveillance and Australia reported 1.24 non-polio AFP cases per 100,000 children, meeting the WHO performance criterion for a sensitive surveillance system. Several non-polio enteroviruses, coxsackievirus A4, coxsackievirus B1, echovirus 9, echovirus 30, enterovirus D68 and enterovirus A71, were identified from clinical specimens collected from AFP cases. Australia also performs enterovirus and environmental surveillance to complement the clinical system focussed on children. In 2018, 33 cases of wild polio were reported with three countries remaining endemic: Afghanistan, Nigeria and Pakistan.
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Affiliation(s)
- Jason A Roberts
- National Enterovirus Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, 792 Elizabeth St, Melbourne 3000, Victoria, Australia
| | - Linda K Hobday
- National Enterovirus Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, 792 Elizabeth St, Melbourne 3000, Victoria, Australia
| | - Aishah Ibrahim
- National Enterovirus Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, 792 Elizabeth St, Melbourne 3000, Victoria, Australia
| | - Bruce R Thorley
- National Enterovirus Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, 792 Elizabeth St, Melbourne 3000, Victoria, Australia
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12
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Jorba J, Diop OM, Iber J, Henderson E, Zhao K, Quddus A, Sutter R, Vertefeuille JF, Wenger J, Wassilak SG, Pallansch MA, Burns CC. Update on Vaccine-Derived Poliovirus Outbreaks - Worldwide, January 2018-June 2019. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:1024-1028. [PMID: 31725706 PMCID: PMC6855511 DOI: 10.15585/mmwr.mm6845a4] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Van Damme P, Coster ID, Bandyopadhyay AS, Suykens L, Rudelsheim P, Neels P, Oberste MS, Weldon WC, Clemens R, Revets H. Poliopolis: pushing boundaries of scientific innovations for disease eradication. Future Microbiol 2019; 14:1321-1330. [PMID: 31482728 DOI: 10.2217/fmb-2019-0196] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Although global polio eradication is within reach, sustained eradication of all polioviruses requires cessation of oral poliovirus vaccine use to mitigate against vaccine-derived poliovirus circulation and vaccine-associated paralytic poliomyelitis. The first step in this direction was the WHO-recommended global withdrawal of live attenuated type 2 Sabin poliovirus from routine immunisation in May 2016, with future use restricted to outbreak response, and handling controlled by strict containment provisions (GAPIII). This creates unique challenges for development and testing of novel type 2 poliovirus vaccines. We describe the creation of a novel purpose-built containment facility, Poliopolis, to study new monovalent OPV2 vaccine candidates in healthy adult volunteers, which may be a model for future endeavors in vaccine development for emergency use.
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Affiliation(s)
- Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Belgium
| | - Ilse De Coster
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Belgium
| | | | - Leen Suykens
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Belgium
| | | | | | | | | | - Ralf Clemens
- Global Research in Infectious Diseases (GRID), Rio de Janeiro, Brazil
| | - Hilde Revets
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Belgium
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14
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Greene SA, Ahmed J, Datta SD, Burns CC, Quddus A, Vertefeuille JF, Wassilak SG. Progress Toward Polio Eradication - Worldwide, January 2017-March 2019. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:458-462. [PMID: 31120868 PMCID: PMC6532951 DOI: 10.15585/mmwr.mm6820a3] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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