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Shabana MR, Zaghloul AY, El Shaarawy TH, Elleboudy NS, Aboshanab KM. Monitoring the VDPV2 outbreak in Egypt during 2020-2021 highlights the crucial role of environmental surveillance and boosting immunization in combating Poliovirus. BMC Infect Dis 2024; 24:866. [PMID: 39187787 PMCID: PMC11348703 DOI: 10.1186/s12879-024-09731-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 08/07/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Poliovirus is a highly infectious enterovirus (EV) that primarily affects children and can lead to lifelong paralysis or even death. Vaccine-derived polioviruses (VDPVs) are a great threat since they are derived from the attenuated virus in the Oral Poliovirus Vaccine (OPV) and can mutate to a more virulent form. The purpose of this study was to identify VDPV serotype 2 through the year 2020-2021 via surveillance of sewage samples collected from different localities and governorates in Egypt and stool specimens from Acute Flaccid Paralysis (AFP) cases. Both were collected through the national poliovirus surveillance system and according to the guidelines recommended by the WHO. METHODS A total of 1266 sewage samples and 3241 stool samples from January 2020 to December 2021 were investigated in the lab according to World Health Organization (WHO) protocol for the presence of Polioviruses by cell culture, molecular identification of positive isolates on L20B cell line was carried out using real-time polymerase chain reactions (RT-PCR). Any positive isolates for Poliovirus type 2 and isolates suspected of Vaccine Derived Poliovirus Type 1 and type 3 screened by (VDPV1) or Vaccine Poliovirus Type 3 (VDPV3) assay in RT-PCR were referred for VP1 genetic sequencing. RESULTS The outbreak was caused by circulating VDPV2 (cVDPV2) strains started in January 2021. By the end of February 2021, a total of 11 cVDPV2s were detected in sewage samples from six governorates confirming the outbreak situation. One additional cVDPV2 was detected later in the sewage sample from Qena (June 2021). The first and only re-emergence of VDPV2 in stool samples during the outbreak was in contact with Luxor in June 2021. By November 2021, a total of 80 VDPVs were detected. The Egyptian Ministry of Health and Population (MOHP), in collaboration with the WHO, responded quickly by launching two massive vaccination campaigns targeting children under the age of five. Additionally, surveillance systems were strengthened to detect new cases and prevent further spread of the virus. CONCLUSION The continued threat of poliovirus and VDPVs requires ongoing efforts to prevent their emergence and spread. Strategies such as improving immunization coverage, using genetically stable vaccines, and establishing surveillance systems are critical to achieving global eradication of poliovirus and efficient monitoring of VDPVs outbreaks.
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Affiliation(s)
- Menna R Shabana
- WHO Regional Reference lab for Diagnosis of Poliovirus and Enteroviruses, VACSERA Dokki, Giza, Cairo, Egypt
| | - Amira Y Zaghloul
- WHO Regional Reference lab for Diagnosis of Poliovirus and Enteroviruses, VACSERA Dokki, Giza, Cairo, Egypt
| | - Tamer H El Shaarawy
- WHO Regional Reference lab for Diagnosis of Poliovirus and Enteroviruses, VACSERA Dokki, Giza, Cairo, Egypt
| | - Nooran S Elleboudy
- Department of Microbiology and Immunology, Faculty of Pharmacy, Organization of African Union, Ain Shams University, St. Abbassia, Cairo, 11566, Egypt
| | - Khaled M Aboshanab
- Department of Microbiology and Immunology, Faculty of Pharmacy, Organization of African Union, Ain Shams University, St. Abbassia, Cairo, 11566, Egypt.
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Bandyopadhyay AS, Burke RM, Hawes KM. Polio Eradication: Status, Struggles and Strategies. Pediatr Infect Dis J 2024; 43:e207-e211. [PMID: 38564755 DOI: 10.1097/inf.0000000000004330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Ananda S Bandyopadhyay
- From the Polio, Global Development, Bill & Melinda Gates Foundation, Seattle, Washington
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Blacksell SD, Dhawan S, Kusumoto M, Le KK, Summermatter K, O'Keefe J, Kozlovac JP, Almuhairi SS, Sendow I, Scheel CM, Ahumibe A, Masuku ZM, Bennett AM, Kojima K, Harper DR, Hamilton K. Laboratory-acquired infections and pathogen escapes worldwide between 2000 and 2021: a scoping review. THE LANCET. MICROBE 2024; 5:e194-e202. [PMID: 38101440 DOI: 10.1016/s2666-5247(23)00319-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 12/17/2023]
Abstract
Laboratory-acquired infections (LAIs) and accidental pathogen escape from laboratory settings (APELS) are major concerns for the community. A risk-based approach for pathogen research management within a standard biosafety management framework is recommended but is challenging due to reasons such as inconsistency in risk tolerance and perception. Here, we performed a scoping review using publicly available, peer-reviewed journal and media reports of LAIs and instances of APELS between 2000 and 2021. We identified LAIs in 309 individuals in 94 reports for 51 pathogens. Eight fatalities (2·6% of all LAIs) were caused by infection with Neisseria meningitidis (n=3, 37·5%), Yersinia pestis (n=2, 25%), Salmonella enterica serotype Typhimurium (S Typhimurium; n=1, 12·5%), or Ebola virus (n=1, 12·5%) or were due to bovine spongiform encephalopathy (n=1, 12·5%). The top five LAI pathogens were S Typhimurium (n=154, 49·8%), Salmonella enteritidis (n=21, 6·8%), vaccinia virus (n=13, 4·2%), Brucella spp (n=12, 3·9%), and Brucella melitensis (n=11, 3·6%). 16 APELS were reported, including those for Bacillus anthracis, SARS-CoV, and poliovirus (n=3 each, 18·8%); Brucella spp and foot and mouth disease virus (n=2 each, 12·5%); and variola virus, Burkholderia pseudomallei, and influenza virus H5N1 (n=1 each, 6·3%). Continual improvement in LAI and APELS management via their root cause analysis and thorough investigation of such incidents is essential to prevent future occurrences. The results are biased due to the reliance on publicly available information, which emphasises the need for formalised global LAIs and APELS reporting to better understand the frequency of and circumstances surrounding these incidents.
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Affiliation(s)
- Stuart D Blacksell
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK.
| | - Sandhya Dhawan
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Marina Kusumoto
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Khanh K Le
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Joseph O'Keefe
- Ministry for Primary Industries, Wellington, New Zealand
| | - Joseph P Kozlovac
- US Department of Agriculture, Agricultural Research Service, Beltsville, MD, USA
| | - Salama S Almuhairi
- National Emergency Crisis and Disaster Management Authority, Abu Dhabi, United Arab Emirates
| | - Indrawati Sendow
- Research Center for Veterinary Science, National Research and Innovation Agency, Jakarta, Indonesia
| | - Christina M Scheel
- WHO Collaborating Center for Biosafety and Biosecurity, Office of the Associate Director for Laboratory Science, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA; Office of Science and Technology Assessment, Office of Occupational Safety and Health Administration, US Department of Labor, Washington, DC, USA
| | - Anthony Ahumibe
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Zibusiso M Masuku
- National Institute for Communicable Diseases a Division of the National Health Laboratory Services, Johannesburg, South Africa
| | | | - Kazunobu Kojima
- Department of Epidemic and Pandemic Preparedness and Prevention, WHO, Geneva, Switzerland
| | - David R Harper
- The Royal Institute of International Affairs, Chatham House, London, UK
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Ottendorfer C, Shelby B, Sanders CA, Llewellyn A, Myrick C, Brown C, Suppiah S, Gustin K, Smith LH. Establishment of a Poliovirus Containment Program and Containment Certification Process for Poliovirus-Essential Facilities, United States 2017-2022. Pathogens 2024; 13:116. [PMID: 38392855 PMCID: PMC10893385 DOI: 10.3390/pathogens13020116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
Upon declaration of poliovirus (PV) type 2 eradication in 2015, the World Health Organization (WHO) published PV containment requirements in the Global Action Plan III (GAPIII) for mitigating the risk of a facility-associated release post eradication. In 2018, the 71st World Health Assembly resolution urged member states retaining PV to appoint a National Authority for Containment (NAC), reduce the number of PV facilities, and submit applications for containment certification. The United States (US) NAC was established in 2018 for containment oversight, and two paths to WHO GAPIII containment certification were developed. Facilities retaining PV were identified through national poliovirus containment surveys. The US NAC conducted 27 site visits at 18 facilities (20 laboratories: A/BSL-2 (65%), A/BSL-3 (20%), and storage-only (15%)) to verify the implementation of US NAC's preliminary containment measures. The NAC identified areas for improvement in seven categories: primary containment, decontamination, hand hygiene, security, emergency response, training, and immunization practices. Sixteen facility applications were endorsed to pursue poliovirus-essential facility (PEF) certification, whereas four facilities opted to withdraw during the containment certification process. The US made noteworthy progress in PV containment to enhance biosafety and biosecurity practices at US PV facilities to safeguard the polio eradication effort.
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Affiliation(s)
- Christy Ottendorfer
- Centers for Disease Control and Prevention, Office of Readiness and Response, U.S. National Authority for Containment of Poliovirus, Atlanta, GA 30329, USA; (C.O.); (C.A.S.)
| | - Bryan Shelby
- Centers for Disease Control and Prevention, Office of Readiness and Response, U.S. National Authority for Containment of Poliovirus, Atlanta, GA 30329, USA; (C.O.); (C.A.S.)
| | - Cecelia A. Sanders
- Centers for Disease Control and Prevention, Office of Readiness and Response, U.S. National Authority for Containment of Poliovirus, Atlanta, GA 30329, USA; (C.O.); (C.A.S.)
| | - Anna Llewellyn
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA 30329, USA;
| | - Christy Myrick
- Centers for Disease Control and Prevention, Office of Laboratory Science and Safety, Atlanta, GA 30329, USA
| | | | - Suganthi Suppiah
- Centers for Disease Control and Prevention, Office of Readiness and Response, U.S. National Authority for Containment of Poliovirus, Atlanta, GA 30329, USA; (C.O.); (C.A.S.)
| | - Kortney Gustin
- Centers for Disease Control and Prevention, Office of Readiness and Response, U.S. National Authority for Containment of Poliovirus, Atlanta, GA 30329, USA; (C.O.); (C.A.S.)
| | - Lia Haynes Smith
- Centers for Disease Control and Prevention, Office of Readiness and Response, U.S. National Authority for Containment of Poliovirus, Atlanta, GA 30329, USA; (C.O.); (C.A.S.)
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Bandyopadhyay AS, O'Ryan M. Safeguarding vaccine production and supply strategies for polio eradication endgame. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 11:100159. [PMID: 34327364 PMCID: PMC8315486 DOI: 10.1016/j.lanwpc.2021.100159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - Miguel O'Ryan
- Microbiology and Mycology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Chile
- Millennium Institute of Immunology and Immunotherapy, Faculty of Medicine, University of Chile, Chile
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Moss WJ, Shendale S, Lindstrand A, O'Brien KL, Turner N, Goodman T, Kretsinger K. Feasibility assessment of measles and rubella eradication. Vaccine 2021; 39:3544-3559. [PMID: 34045102 DOI: 10.1016/j.vaccine.2021.04.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/14/2021] [Indexed: 12/28/2022]
Abstract
This report addresses the epidemiological aspects and feasibility of measles and rubella eradication and the potential resource requirements in response to the request of the Director-General at the Seventieth World Health Assembly held on May 31, 2017. A guiding principle is that the path toward measles and rubella eradication should serve to strengthen primary health care, promote universal health coverage, and be a pathfinder for new vision and strategy for immunization over the next decade as laid out in the Immunization Agenda 2030. Specifically, this report: 1) highlights the importance of measles and rubella as global health priorities; 2) reviews the current global measles and rubella situation; 3) summarizes prior assessments of the feasibility of measles and rubella eradication; 4) assesses the progress and challenges in achieving regional measles and rubella elimination; 5) assesses additional considerations for measles and rubella eradication, including the results of modelling and economic analyses; 6) assesses the implications of establishing a measles and rubella eradication goal and the process for setting an eradication target date; 7) proposes a framework for determining preconditions for setting a target date for measles and rubella eradication and how these preconditions should be understood and used; and 8) concludes with recommendations endorsed by SAGE.
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Affiliation(s)
- William J Moss
- International Vaccine Access Center, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Stephanie Shendale
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Ann Lindstrand
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Katherine L O'Brien
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Nikki Turner
- Division of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Tracey Goodman
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Katrina Kretsinger
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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Risk Assessment and Virological Monitoring Following an Accidental Exposure to Concentrated Sabin Poliovirus Type 3 in France, November 2018. Vaccines (Basel) 2020; 8:vaccines8020331. [PMID: 32580378 PMCID: PMC7350213 DOI: 10.3390/vaccines8020331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/19/2020] [Accepted: 06/19/2020] [Indexed: 11/23/2022] Open
Abstract
The safe and secure containment of infectious poliovirus (PV) in facilities where live PV are handled is the condition to achieve and maintain poliomyelitis eradication. Despite precautions to minimize the risk of release of PV from such facilities to the environment, breaches of containment have already been documented. Here, we report the management of an incident that occurred on 30 November 2018 in a French vaccine manufacturing plant. Five adequately vaccinated operators were exposed to a Sabin poliovirus type 3 (PV3) spill. A microbiological risk assessment was conducted and the operators were monitored for PV shedding. On day 5 after exposure, Sabin PV3 was detected only in the stool sample of the most exposed worker. Shedding of Sabin PV3 (as detected by viral culture) was restricted to a very short period (less than 15 days). Monitoring of this incident was an opportunity to assess the relevance of our national response plan. We concluded that the measures undertaken and reported here were appropriate and proportional.
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