Sustained detection of type 2 poliovirus in London sewage between February and July, 2022, by enhanced environmental surveillance

Klapsa, Dimitra; Wilton, Thomas; Zealand, Andrew M.; Bujaki, Erika; Saxentoff, Eugene; Troman, Catherine; Shaw, Alexander; Tedcastle, Alison; Majumdar, Manasi; Mate, Ryan; Akello, Joyce Odeke; Huseynov, Shahin; Zeb, Ali; Zambon, Maria; Bell, Anita; Hagan, José; Wade, Matthew J.; Ramsay, Mary; Grassly, Nicholas C.; Saliba, Vanessa; Martı́n, Javier

doi:10.1016/s0140-6736(22)01804-9

Cited by 72 publications

(42 citation statements)

References 22 publications

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“…Whilst no VDPV outbreaks have been directly linked to iVDPV cases, affected individuals have been reported to experience paralytic illness and also shed highly neurovirulent viral isolates. A recent detection of VDPV type 2 poliovirus in London sewage demonstrates that this is a demonstrable risk to populations (11).…”

Section: Discussionmentioning

confidence: 99%

Case report: Clearance of longstanding, immune-deficiency-associated, vaccine-derived polio virus infection following remdesivir therapy for chronic SARS-CoV-2 infection

et al. 2023

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The global polio eradication campaign has had remarkable success in reducing wild-type poliovirus infection, largely built upon the live attenuated Sabin oral poliovirus vaccine. Whilst rare, vaccine poliovirus strains may cause infection and subsequently revert to a neurovirulent type, termed vaccine-derived poliovirus (VDPV). Persistent, vaccine derived infection may occur in an immunocompromised host (iVDPV), where it is a recognised complication following receipt of the Sabin vaccine. This has significant implications for the global polio eradication campaign and there is currently no agreed global strategy to manage such patients.Here we describe a case of a 50-year-old man with common variable immune deficiency, persistently infected with a neurovirulent vaccine-derived type 2 poliovirus following vaccination in childhood. iVDPV infection had proven resistant to multiple prior attempts at treatment with human breast milk, ribavirin and oral administration of a normal human pooled immunoglobulin product. His iVDPV infection subsequently resolved after 12 days treatment with remdesivir, an adenosine analogue prodrug that is an inhibitor of viral RNA-dependent RNA polymerase, administered as treatment for a prolonged, moderate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. iVDPV from the patient, isolated prior to treatment, was subsequently demonstrated to be sensitive to remdesivir in vitro. Based on the observations made in this case, and the mechanistic rationale for use with iVDPV, there is strong justification for further clinical studies of remdesivir treatment as a potentially curative intervention in patients with iVDPV infection.

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Section: Discussionmentioning

confidence: 99%

Case report: Clearance of longstanding, immune-deficiency-associated, vaccine-derived polio virus infection following remdesivir therapy for chronic SARS-CoV-2 infection

et al. 2023

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“…Our use of environmental surveillance to search for polioviruses, combined with searching in stool samples from healthy children is the most sensitive means to detect poliovirus circulation that is currently feasible. The importance of environmental surveillance in outbreak settings was reinforced in a study of the London VDPV2 investigation and response published recently in The Lancet . In an accompanying Comment, Drs Hill and Pollard state that the use of polio environmental surveillance in London “highlight the crucial role of environmental surveillance in identifying and understanding poliovirus transmission, and guiding appropriate and timely responses” and that “ongoing surveillance will be essential to determine if the intervention in London works or whether further escalation is needed.”…”

Section: Discussionmentioning

confidence: 99%

Analysis of a Sabin-Strain Inactivated Poliovirus Vaccine Response to a Circulating Type 2 Vaccine-Derived Poliovirus Event in Sichuan Province, China 2019-2021

Yang

Zhang

et al. 2023

JAMA Netw Open

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ImportanceThe Sabin-strain inactivated poliovirus vaccine (IPV) may be a tool for polio outbreak response in certain situations.ObjectiveTo investigate the response to a type 2 vaccine-derived poliovirus (VDPV2) outbreak.Design, Setting, and ParticipantsThis case series was conducted in China after a VDPV2 was detected in stool specimens from a child with acute flaccid paralysis (AFP) in Sichuan Province in 2019, 3 years after the global withdrawal of live, attenuated type 2 oral poliovirus vaccine (OPV). Investigation followed National Health Commission and World Health Organization guidance and included searching hospitals for unreported AFP cases; testing stool specimens from the child, his contacts, and local children; enhanced environmental surveillance for VDPV2s in wastewater; and measuring vaccination coverage. Sabin-strain IPV campaigns were conducted in a wide geographic area.Main Outcomes and MeasuresAny VDPV2 detection after completion of the supplementary immunization activities.ResultsA 28-nucleotide-change VDPV2 was isolated from a young boy. Three VDPV2s were detected in healthy children; 2 were contacts of the original child, and none had paralysis. A search of 31 million hospital records found 10 unreported AFP cases; none were polio. No type 2 polioviruses were found in wastewater. Prior to the event, polio vaccine coverage was 65% among children younger than 5 years. Sabin-strain IPV campaigns reached more than 97% of targeted children, administering 1.4 million doses. No transmission source was identified. More than 1 year of enhanced poliovirus environmental and AFP surveillance detected no additional VDPVs.Conclusions and RelevanceThese findings suggest that the circulating VPDV2 outbreak in 2019 was associated with low vaccine coverage. An investigation discovered 3 infected but otherwise healthy children and no evidence of the virus in wastewater. Following Sabin-strain IPV–only campaigns expanding from county to prefecture, the poliovirus was not detected, and the outbreak response was considered by an expert panel and the World Health Organization to have been successful. This success suggests that the Sabin-strain IPV may be a useful tool for responding to circulating VDPV2 outbreaks when high-quality supplementary immunization activities can be conducted and carefully monitored in settings with good sanitation.

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“…spurred many researchers and utilities to volunteer their labor and donate resources in support of the effort, but the vision of a sustained national wastewater surveillance system necessitates a shift from volunteerism to a strategic national plan with well-defined roles supported by federal investments" (33). Given the success of the NWSS in tracking SARS-CoV-2 and citing success in tracking vaccinederived polio outbreaks in London and New York, and success in rapidly tracking monkeypox, the aforementioned committee has recommended expanding the NWSS efforts to monitor other human pathogens (10,(33)(34)(35)(36)(37).…”

Section: Recent Sars-covexperience-rebirthmentioning

confidence: 99%

Wastewater pandemic preparedness: Toward an end-to-end pathogen monitoring program

Clark

Terwilliger

Avadhanula

et al. 2023

Front. Public Health

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Molecular analysis of public wastewater has great potential as a harbinger for community health and health threats. Long-used to monitor the presence of enteric viruses, in particular polio, recent successes of wastewater as a reliable lead indicator for trends in SARS-CoV-2 levels and hospital admissions has generated optimism and emerging evidence that similar science can be applied to other pathogens of pandemic potential (PPPs), especially respiratory viruses and their variants of concern (VOC). However, there are substantial challenges associated with implementation of this ideal, namely that multiple and distinct fields of inquiry must be bridged and coordinated. These include engineering, molecular sciences, temporal-geospatial analytics, epidemiology and medical, and governmental and public health messaging, all of which present their own caveats. Here, we outline a framework for an integrated, state-wide, end-to-end human pathogen monitoring program using wastewater to track viral PPPs.

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Sustained detection of type 2 poliovirus in London sewage between February and July, 2022, by enhanced environmental surveillance

Cited by 72 publications

References 22 publications

Case report: Clearance of longstanding, immune-deficiency-associated, vaccine-derived polio virus infection following remdesivir therapy for chronic SARS-CoV-2 infection

Case report: Clearance of longstanding, immune-deficiency-associated, vaccine-derived polio virus infection following remdesivir therapy for chronic SARS-CoV-2 infection

Analysis of a Sabin-Strain Inactivated Poliovirus Vaccine Response to a Circulating Type 2 Vaccine-Derived Poliovirus Event in Sichuan Province, China 2019-2021

Wastewater pandemic preparedness: Toward an end-to-end pathogen monitoring program

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