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Shaw AG, Mampuela TK, Lofiko EL, Pratt C, Troman C, Bujaki E, O'Toole Á, Akello JO, Aziza AA, Lusamaki EK, Makangara JC, Akonga M, Lay Y, Nsunda B, White B, Jorgensen D, Pukuta E, Riziki Y, Rankin KE, Rambaut A, Ahuka-Mundeke S, Muyembe JJ, Martin J, Grassly NC, Mbala-Kingebeni P. Sensitive poliovirus detection using nested PCR and nanopore sequencing: a prospective validation study. Nat Microbiol 2023; 8:1634-1640. [PMID: 37591995 PMCID: PMC10465353 DOI: 10.1038/s41564-023-01453-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/19/2023] [Indexed: 08/19/2023]
Abstract
Timely detection of outbreaks is needed for poliovirus eradication, but gold standard detection in the Democratic Republic of the Congo takes 30 days (median). Direct molecular detection and nanopore sequencing (DDNS) of poliovirus in stool samples is a promising fast method. Here we report prospective testing of stool samples from suspected polio cases, and their contacts, in the Democratic Republic of the Congo between 10 August 2021 and 4 February 2022. DDNS detected polioviruses in 62/2,339 (2.7%) of samples, while gold standard combination of cell culture, quantitative PCR and Sanger sequencing detected polioviruses in 51/2,339 (2.2%) of the same samples. DDNS provided case confirmation in 7 days (median) in routine surveillance conditions. DDNS enabled confirmation of three serotype 2 circulating vaccine-derived poliovirus outbreaks 23 days (mean) earlier (range 6-30 days) than the gold standard method. The mean sequence similarity between sequences obtained by the two methods was 99.98%. Our data confirm the feasibility of implementing DDNS in a national poliovirus laboratory.
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Affiliation(s)
- Alexander G Shaw
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK.
| | - Tresor Kabeya Mampuela
- Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | | | - Catherine Pratt
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Catherine Troman
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Erika Bujaki
- Department of Vaccines, National Institute for Biological Standards and Control (NIBSC), Medicines and Healthcare products Regulatory Agency, Potters Bar, UK
| | - Áine O'Toole
- Institute of Ecology and Evolution, University of Edinburgh, Ashworth Laboratories, Edinburgh, UK
| | - Joyce Odeke Akello
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Adrienne Amuri Aziza
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Eddy Kinganda Lusamaki
- Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes), University of Montpellier (UM), French National Research Institute for Sustainable Development (IRD), INSERM, Montpellier, France
| | - Jean Claude Makangara
- Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Marceline Akonga
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Yvonne Lay
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Bibiche Nsunda
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Bailey White
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - David Jorgensen
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Elizabeth Pukuta
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Yogolelo Riziki
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | | | - Andrew Rambaut
- Institute of Ecology and Evolution, University of Edinburgh, Ashworth Laboratories, Edinburgh, UK
| | - Steve Ahuka-Mundeke
- Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe
- Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Javier Martin
- Department of Vaccines, National Institute for Biological Standards and Control (NIBSC), Medicines and Healthcare products Regulatory Agency, Potters Bar, UK
| | - Nicholas C Grassly
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Placide Mbala-Kingebeni
- Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
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Alleman MM, Jorba J, Riziki Y, Henderson E, Mwehu A, Seakamela L, Howard W, Kadiobo Mbule A, Nsamba RN, Djawe K, Yapi MD, Mengouo MN, Gumede N, Ndoutabe M, Kfutwah AKW, Senouci K, Burns CC. Vaccine-derived poliovirus serotype 2 outbreaks and response in the Democratic Republic of the Congo, 2017-2021. Vaccine 2023; 41 Suppl 1:A35-A47. [PMID: 36907733 PMCID: PMC10427717 DOI: 10.1016/j.vaccine.2023.02.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 02/01/2023] [Accepted: 02/13/2023] [Indexed: 03/13/2023]
Abstract
Vaccine-derived polioviruses (VDPVs) can emerge from Sabin strain poliovirus serotypes 1, 2, and 3 contained in oral poliovirus vaccine (OPV) after prolonged person-to-person transmission where population vaccination immunity against polioviruses is suboptimal. VDPVs can cause paralysis indistinguishable from wild polioviruses and outbreaks when community circulation ensues. VDPV serotype 2 outbreaks (cVDPV2) have been documented in The Democratic Republic of the Congo (DRC) since 2005. The nine cVDPV2 outbreaks detected during 2005-2012 were geographically-limited and resulted in 73 paralysis cases. No outbreaks were detected during 2013-2016. During January 1, 2017-December 31, 2021, 19 cVDPV2 outbreaks were detected in DRC. Seventeen of the 19 (including two first detected in Angola) resulted in 235 paralysis cases notified in 84 health zones in 18 of DRC's 26 provinces; no notified paralysis cases were associated with the remaining two outbreaks. The DRC-KAS-3 cVDPV2 outbreak that circulated during 2019-2021, and resulted in 101 paralysis cases in 10 provinces, was the largest recorded in DRC during the reporting period in terms of numbers of paralysis cases and geographic expanse. The 15 outbreaks occurring during 2017-early 2021 were successfully controlled with numerous supplemental immunization activities (SIAs) using monovalent OPV Sabin-strain serotype 2 (mOPV2); however, suboptimal mOPV2 vaccination coverage appears to have seeded the cVDPV2 emergences detected during semester 2, 2018 through 2021. Use of the novel OPV serotype 2 (nOPV2), designed to have greater genetic stability than mOPV2, should help DRC's efforts in controlling the more recent cVDPV2 outbreaks with a much lower risk of further seeding VDPV2 emergence. Improving nOPV2 SIA coverage should decrease the number of SIAs needed to interrupt transmission. DRC needs the support of polio eradication and Essential Immunization (EI) partners to accelerate the country's ongoing initiatives for EI strengthening, introduction of a second dose of inactivated poliovirus vaccine (IPV) to increase protection against paralysis, and improving nOPV2 SIA coverage.
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Affiliation(s)
- Mary M Alleman
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, USA.
| | - Jaume Jorba
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Yogolelo Riziki
- Institut National de Recherche Biomédicale, Ministry of Public Health, Hygiene and Prevention, Democratic Republic of the Congo
| | - Elizabeth Henderson
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Anicet Mwehu
- Emergency Operations Center for Polio, Ministry of Public Health, Hygiene and Prevention, Democratic Republic of the Congo
| | - Lerato Seakamela
- National Institute for Communicable Diseases, National Health Laboratory Services, South Africa
| | - Wayne Howard
- National Institute for Communicable Diseases, National Health Laboratory Services, South Africa
| | - Albert Kadiobo Mbule
- Polio, Office of the Regional Director, World Health Organization, Democratic Republic of the Congo Country Office, Democratic Republic of the Congo
| | - Renee Ntumbannji Nsamba
- Polio, Office of the Regional Director, World Health Organization, Democratic Republic of the Congo Country Office, Democratic Republic of the Congo
| | - Kpandja Djawe
- Polio, Office of the Regional Director, World Health Organization, Democratic Republic of the Congo Country Office, Democratic Republic of the Congo
| | - Moïse Désiré Yapi
- Polio, Office of the Regional Director, World Health Organization, Democratic Republic of the Congo Country Office, Democratic Republic of the Congo
| | - Marcellin Nimpa Mengouo
- Polio, Office of the Regional Director, World Health Organization, Democratic Republic of the Congo Country Office, Democratic Republic of the Congo
| | - Nicksy Gumede
- Polio, Office of the Regional Director, World Health Organization, Regional Office for Africa, Republic of the Congo
| | - Modjirom Ndoutabe
- Polio, Office of the Regional Director, World Health Organization, Regional Office for Africa, Republic of the Congo
| | - Anfumbom K W Kfutwah
- Polio, Office of the Regional Director, World Health Organization, Regional Office for Africa, Republic of the Congo
| | | | - Cara C Burns
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA
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Mbaeyi C, Alleman MM, Ehrhardt D, Wiesen E, Burns CC, Liu H, Ewetola R, Seakamela L, Mdodo R, Ndoutabe M, Wenye PK, Riziki Y, Borus P, Kamugisha C, Wassilak SGF. Update on Vaccine-Derived Poliovirus Outbreaks - Democratic Republic of the Congo and Horn of Africa, 2017-2018. MMWR Morb Mortal Wkly Rep 2019; 68:225-230. [PMID: 30845121 PMCID: PMC6421971 DOI: 10.15585/mmwr.mm6809a2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Widespread use of live attenuated (Sabin) oral poliovirus vaccine (OPV) has resulted in marked progress toward global poliomyelitis eradication (1). However, in underimmunized populations, extensive person-to-person transmission of Sabin poliovirus can result in genetic reversion to neurovirulence and paralytic vaccine-derived poliovirus (VDPV) disease (1). This report updates (as of February 26, 2019) previous reports on circulating VDPV type 2 (cVDPV2) outbreaks during 2017-2018 in the Democratic Republic of the Congo (DRC) and in Somalia, which experienced a concurrent cVDPV type 3 (cVDPV3) outbreak* (2,3). In DRC, 42 cases have been reported in four cVDPV2 outbreaks; paralysis onset in the most recent case was October 7, 2018 (2). Challenges to interrupting transmission have included delays in outbreak-response supplementary immunization activities (SIAs) and difficulty reaching children in all areas. In Somalia, cVDPV2 and cVDPV3 were detected in sewage before the detection of paralytic cases (3). Twelve type 2 and type 3 cVDPV cases have been confirmed; the most recent paralysis onset dates were September 2 (cVDPV2) and September 7, 2018 (cVDPV3). The primary challenge to interrupting transmission is the residence of >300,000 children in areas that are inaccessible for vaccination activities. For both countries, longer periods of surveillance are needed before interruption of cVDPV transmission can be inferred.
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Alleman MM, Chitale R, Burns CC, Iber J, Dybdahl-Sissoko N, Chen Q, Van Koko DR, Ewetola R, Riziki Y, Kavunga-Membo H, Dah C, Andriamihantanirina R. Vaccine-Derived Poliovirus Outbreaks and Events - Three Provinces, Democratic Republic of the Congo, 2017. MMWR Morb Mortal Wkly Rep 2018; 67:300-305. [PMID: 29543791 PMCID: PMC5857197 DOI: 10.15585/mmwr.mm6710a4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The last confirmed wild poliovirus (WPV) case in Democratic Republic of the Congo (DRC) had paralysis onset in December 2011 (1). DRC has had cases of vaccine-derived polioviruses (VDPVs) documented since 2004 (Table 1) (1-6). After an outbreak of 30 circulating VDPV type 2 (cVDPV2) cases during 2011-2012, only five VDPV2 cases were reported during 2013-2016 (Table 1) (1-6). VDPVs can emerge from oral poliovirus vaccine (OPV types 1, 2, or 3; Sabin) polioviruses that have genetically mutated resulting in reversion to neurovirulence. This process occurs during extensive person-to-person transmission in populations with low immunity or after extended replication in the intestines of immune-deficient persons following vaccination (1-6). During 2017 (as of March 8, 2018), 25 VDPV cases were reported in three provinces in DRC: in Tanganyika province, an emergence with one VDPV2 case (pending final classification) in Kabalo health zone and an emergence with one ambiguous VDPV type 1 (aVDPV1) case in Ankoro health zone; in Maniema province, an emergence with two cVDPV2 cases; and in Haut Lomami province, an emergence with 20 cVDPV2 cases that originated in Haut Lomami province and later spread to Tanganyika province (hereafter referred to as the Haut Lomami outbreak area) and an emergence with one aVDPV type 2 (aVDPV2) case in Lwamba health zone (Table 1) (Figure) (6). Outbreak response supplementary immunization activities (SIAs) were conducted during June-December 2017 (Table 2) (6). Because of limitations in surveillance and suboptimal SIA quality and geographic scope, cVDPV2 circulation is likely continuing in 2018, requiring additional SIAs. DRC health officials and Global Polio Eradication Initiative (GPEI) partners are increasing human and financial resources to improve all aspects of outbreak response.
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Alleman MM, Meyer SA, Mulumba A, Nyembwe M, Riziki Y, Mbule A, Mayenga M, Coulibaly T. Improved acute flaccid paralysis surveillance performance in the Democratic Republic of the Congo, 2010-2012. J Infect Dis 2014; 210 Suppl 1:S50-61. [PMID: 25316874 PMCID: PMC10448638 DOI: 10.1093/infdis/jit670] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Democratic Republic of the Congo (DRC) began polio eradication activities in 1996. By 2001, DRC was no longer polio endemic. However, wild poliovirus (WPV) transmission was reestablished in 2006 continuing through 2011 (last WPV case onset 20 December 2011), and vaccine-derived poliovirus type 2 (VDPV2) outbreaks occurred during 2004-2012 (last VDPV2 case onset 4 April 2012). Gaps in acute flaccid paralysis (AFP) surveillance have been consistently documented. METHODS AFP surveillance indicators were assessed at the national, provincial, and zone de santé (ZS) levels for 2010-2012. A spatiotemporal analysis of compatible, WPV type 1 (WPV1), and VDPV2 cases was performed. RESULTS During 2010-2012, AFP cases were reported from all provinces but not every ZS, particularly in Equateur province and Province Orientale. A spatiotemporal relationship between compatible, WPV1, and VDPV2 cases was noted. Nonpolio AFP rates met objectives at national and provincial levels but were sub-optimal in certain ZS. National and provincial trends in timely stool collection, stool condition, adequate stool, and 60-day follow-up exams improved. CONCLUSIONS DRC's AFP surveillance system is functional and improved during 2010-2012. Maintaining improvements and strengthening AFP case detection at the ZS level will provide further support for the apparent interruption of WPV and VDPV2 transmission.
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Affiliation(s)
- Mary M. Alleman
- Global Immunization Division, Centers for Disease Control
and Prevention, Atlanta, Georgia
| | - Sarah A. Meyer
- Epidemic Intelligence Service, and Centers for Disease
Control and Prevention, Atlanta, Georgia
- Division of Bacterial Diseases, Centers for Disease Control
and Prevention, Atlanta, Georgia
| | - Audry Mulumba
- Expanded Programme on Immunization, Kinshasa, Democratic Republic of the Congo
| | - Michel Nyembwe
- Expanded Programme on Immunization, Kinshasa, Democratic Republic of the Congo
| | - Yogolelo Riziki
- Institut National de Recherche Biomédicale, Ministry of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Albert Mbule
- Immunization, Vaccines, and Emergencies Cluster, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - May Mayenga
- Immunization, Vaccines, and Emergencies Cluster, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Tiekoura Coulibaly
- Immunization, Vaccines, and Emergencies Cluster, World Health Organization, Kinshasa, Democratic Republic of the Congo
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