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Hussain I, Umer M, Khan A, Sajid M, Ahmed I, Begum K, Iqbal J, Alam MM, Safdar RM, Baig S, Voorman A, Partridge J, Soofi S. Exploring the path to polio eradication: insights from consecutive seroprevalence surveys among Pakistani children. Front Public Health 2024; 12:1384410. [PMID: 38601488 PMCID: PMC11004230 DOI: 10.3389/fpubh.2024.1384410] [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: 02/09/2024] [Accepted: 03/14/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction After trivalent oral poliovirus vaccine (tOPV) cessation, Pakistan has maintained immunity to type 2 poliovirus by administering inactivated polio vaccine (IPV) in routine immunization, alongside monovalent OPV type 2 (mOPV2) and IPV in supplementary immunization activities (SIAs). This study assesses the change in poliovirus type 2 immunity after tOPV withdrawal and due to SIAs with mOPV2 and IPV among children aged 6-11 months. Methods Three cross-sectional sequential serological surveys were conducted in 12 polio high-risk areas of Pakistan. 25 clusters from each geographical stratum were selected utilizing probability proportional to size. Results Seroprevalence of type 2 poliovirus was 49%, with significant variation observed among surveyed areas; <30% in Pishin, >80% in Killa Abdullah, Mardan & Swabi, and Rawalpindi. SIAs with IPV improved immunity from 38 to 57% in Karachi and 60 to 88% in Khyber. SIAs with IPV following mOPV2 improved immunity from 62 to 65% in Killa Abdullah, and combined mOPV2 and IPV SIAs in Pishin improved immunity from 28 to 89%. Results also reflected that immunity rates for serotypes 1 and 3 were consistently above 90% during all three phases and across all geographical areas. Conclusion The study findings highlight the importance of implementing effective vaccination strategies to prevent the re-emergence of poliovirus. Moreover, the results provide crucial information for policymakers working toward achieving global polio eradication.
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Affiliation(s)
- Imtiaz Hussain
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Muhammad Umer
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Ahmad Khan
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Muhammad Sajid
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Imran Ahmed
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Kehkashan Begum
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Junaid Iqbal
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | | | - Rana M. Safdar
- Polio National Emergency Operations Center, Islamabad, Pakistan
| | - Shahzad Baig
- Polio National Emergency Operations Center, Islamabad, Pakistan
| | - Arie Voorman
- Bill and Melinda Gates Foundation, Seattle, WA, United States
| | | | - Sajid Soofi
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
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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] [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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Performance of Immunoglobulin G Serology on Finger Prick Capillary Dried Blood Spot Samples to Detect a SARS-CoV-2 Antibody Response. Microbiol Spectr 2022; 10:e0140521. [PMID: 35266818 PMCID: PMC9045222 DOI: 10.1128/spectrum.01405-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
We investigate the diagnostic accuracy and predictive value of finger prick capillary dried blood spot (DBS) samples tested by a quantitative multiplex anti-immunoglobulin G (IgG) assay to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies after infection or vaccination. This cross-sectional study involved participants (n = 6,841) from several serological surveys conducted in nonhospitalized children and adults throughout 2020 and 2021 in British Columbia (BC), Canada. Analysis used paired DBS and serum samples from a subset of participants (n = 642) prior to vaccination to establish signal thresholds and calculate diagnostic accuracy by logistic regression. Discrimination of the logistic regression model was assessed by receiver operator curve (ROC) analysis in an n = 2,000 bootstrap of the paired sample (n = 642). The model was cross-validated in a subset of vaccinated persons (n = 90). Unpaired DBS samples (n = 6,723) were used to evaluate anti-IgG signal distributions. In comparison to paired serum, DBS samples from an unvaccinated population possessed a sensitivity of 79% (95% confidence interval [95% CI]: 58 to 91%) and specificity of 97% (95% CI: 95 to 98%). ROC analysis found that DBS samples accurately classify SARS-CoV-2 seroconversion at an 88% percent rate (area under the curve [AUC] = 88% [95% CI: 80 to 95%]). In coronavirus disease 2019 (COVID-19) vaccine dose one or two recipients, the sensitivity of DBS testing increased to 97% (95% CI: 83 to 99%) and 100% (95% CI: 88 to 100%). Modeling found that DBS testing possesses a high positive predictive value (98% [95% CI: 97 to 98%]) in a population with 75% seroprevalence. We demonstrate that DBS testing should be considered to reliably detect SARS-CoV-2 seropositivity from natural infection or vaccination. IMPORTANCE Dried blood spot samples have comparable diagnostic accuracy to serum collected by venipuncture when tested by an electrochemiluminescent assay for antibodies and should be considered to reliably detect seropositivity following SARS-CoV-2 infection and/or vaccination.
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Alfonso VH, Voorman A, Hoff NA, Weldon WC, Gerber S, Gadoth A, Halbrook M, Goldsmith A, Mukadi P, Doshi RH, Ngoie-Mwamba G, Fuller TL, Okitolonda-Wemakoy E, Muyembe-Tamfum JJ, Rimoin AW. Poliovirus immunity among adults in the Democratic Republic of the Congo: a cross-sectional serosurvey. BMC Infect Dis 2022; 22:30. [PMID: 34986786 PMCID: PMC8728990 DOI: 10.1186/s12879-021-06951-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 11/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaccination efforts to eradicate polio currently focus on children under 5 years of age, among whom most cases of poliomyelitis still occur. However, in the Democratic Republic of the Congo (DRC), an outbreak of wild poliovirus type 1 occurred in 2010-2011 in which 16% of cases occurred among adults; in a related outbreak in the neighboring Republic of Congo, 75% of cases occurred among the same adult age-group. Given that infected adults may transmit poliovirus, this study was designed to assess adult immunity against polioviruses. METHODS We assessed poliovirus seroprevalence using dried blood spots from 5,526 adults aged 15-59 years from the 2013-2014 Demographic and Health Survey in the DRC. RESULTS Among adults in the DRC, 74%, 72%, and 57% were seropositive for neutralizing antibodies for poliovirus types 1, 2, and 3, respectively. For all three serotypes, seroprevalence tended to be higher among older age groups, those living in households with more children, and among women. CONCLUSIONS Protection against poliovirus is generally low among adults in the DRC, particularly for type 3 poliovirus. The lack of acquired immunity in adults suggests a potentially limited poliovirus circulation over the lifetime of those surveyed (spanning 1954 through 2014) and transmission of vaccine-derived poliovirus in this age group while underscoring the risk of these outbreaks among adults in the DRC.
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Affiliation(s)
- Vivian H. Alfonso
- Department of Epidemiology, University of California, Los Angeles, USA
- McKing Consulting, Atlanta, GA USA
| | - Arie Voorman
- Bill and Melinda Gates Foundation, Seattle, WA USA
| | - Nicole A. Hoff
- Department of Epidemiology, University of California, Los Angeles, USA
| | - William C. Weldon
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Sue Gerber
- Bill and Melinda Gates Foundation, Seattle, WA USA
| | - Adva Gadoth
- Department of Epidemiology, University of California, Los Angeles, USA
| | - Megan Halbrook
- Department of Epidemiology, University of California, Los Angeles, USA
| | - Amelia Goldsmith
- Department of Epidemiology, University of California, Los Angeles, USA
| | - Patrick Mukadi
- National Institute for Biomedical Research (INRB), Kinshasa, Democratic Republic of the Congo
| | - Reena H. Doshi
- Department of Epidemiology, University of California, Los Angeles, USA
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | | | - Trevon L. Fuller
- Center for Tropical Research, Institute of the Environment and Sustainability, University of California, Los Angeles, USA
| | | | | | - Anne W. Rimoin
- Department of Epidemiology, University of California, Los Angeles, USA
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Holroyd TA, Schiaffino F, Chang RH, Wanyiri JW, Saldanha IJ, Gross M, Moss WJ, Hayford K. Diagnostic accuracy of dried blood spots for serology of vaccine-preventable diseases: a systematic review. Expert Rev Vaccines 2021; 21:185-200. [PMID: 34852211 DOI: 10.1080/14760584.2022.2013821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Venous serum and plasma are optimal specimens for serological testing but may be logistically infeasible. Dried blood spots (DBS) are a feasible alternative, provided results are adequately sensitive and specific. We aimed to assess the diagnostic accuracy of DBS to measure IgG and IgM antibodies for vaccine-preventable diseases and compare test validity of DBS with venous blood. AREAS COVERED In October 2020, we searched seven databases for peer-reviewed studies assessing the diagnostic accuracy of DBS specimens compared with serum in detecting antibodies to VPDs in humans. We extracted data and assessed risk of bias in all included studies. We calculated sensitivity and specificity with 95% confidence intervals for each index-reference test comparison. We narratively synthesized the identified evidence on diagnostic accuracy and blood collection and processing methods for DBS. Studies on measles and rubella IgG and IgM were the most frequently identified and reported generally high sensitivity and specificity. EXPERT OPINION Lack of standardization in collection, storage, and testing methods limited systematic comparison across studies. Our findings indicate a need for additional validation studies on the diagnostic accuracy of DBS to expand their use in serological surveillance. We recommend practical considerations to improve standardized reporting for DBS validation studies.
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Affiliation(s)
- Taylor A Holroyd
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Francesca Schiaffino
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rachel H Chang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jane W Wanyiri
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ian J Saldanha
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Margaret Gross
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - William J Moss
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kyla Hayford
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Solikhah U, Chakim S, Handayani DY. Promotion Media for Children’s Health: Applicable Study of Management Child Illness. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Public understanding of immunization problems, pneumonia cases, and nutrition in children is important to improve children’s health status. Provision of attractive and illustrated media is one option to increase public knowledge in supporting the success of government programs in the health sector.
AIM: The purpose of this study is as a form of promotion effort to support an increase in the immunization movement in infants, a decrease in cases of malnutrition and malnutrition, and a decrease in pneumonia cases in infants.
METHODS: The research method used is qualitative and quantitative study. Researchers analyzed the promoting media and the value of benefits in the community. Qualitative analyze used content analysis to get an assessment of media from cadres and parents of children. Quantitative study used univariable analysis to see understanding of illness prevention effort. Interesting picture books for immunization, pneumonia, and malnutrition are used as the promoting media. The number of samples was 20 cadres and 20 parents of children under five, done by simple random sampling technique.
RESULTS: The results showed that the media used for learning nutrition, immunization, and pneumonia material was effective for cadres and the community about easy to understand, completeness, attractive, assistance, easy to use, and practically. This is evidenced by a positive assessment of the media and increased understanding of the material from 50% to 90%.
CONCLUSION: Thus, it can be said that it is necessary to provide educational media to increase public knowledge and understanding of cases that often arise in the community as a problem.
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Deressa W, Kayembe P, Neel AH, Mafuta E, Seme A, Alonge O. Lessons learned from the polio eradication initiative in the Democratic Republic of Congo and Ethiopia: analysis of implementation barriers and strategies. BMC Public Health 2020; 20:1807. [PMID: 33339529 PMCID: PMC7747367 DOI: 10.1186/s12889-020-09879-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Since its inception in 1988, the Global Polio Eradication Initiative (GPEI) has partnered with 200 countries to vaccinate over 2.5 billion children against poliomyelitis. The polio eradication approach has adapted to emerging challenges and diverse contexts. Knowledge assets gained from these experiences can inform implementation of future health programs, but only if efforts are made to systematically map barriers, identify strategies to overcome them, identify unintended consequences, and compare experiences across country contexts. METHODS A sequential explanatory mixed methods design, including an online survey followed by key informant interviews (KIIs), was utilized to map tacit knowledge derived from the polio eradication experience from 1988 to 2019. The survey and KIIs were conducted between September 2018 and March 2019. A cross-case comparison was conducted of two study countries, the Democratic Republic of Congo (DRC) and Ethiopia, which fit similar epidemiological profiles for polio. The variables of interest (implementation barriers, strategies, unintended consequences) were compared for consistencies and inconsistencies within and across the two country cases. RESULTS Surveys were conducted with 499 and 101 respondents, followed by 23 and 30 KIIs in the DRC and Ethiopia, respectively. Common implementation barriers included accessibility issues caused by political insecurity, population movement, and geography; gaps in human resources, supply chain, finance and governance; and community hesitancy. Strategies for addressing these barriers included adapting service delivery approaches, investing in health systems capacity, establishing mechanisms for planning and accountability, and social mobilization. These investments improved system infrastructure and service delivery; however, resources were often focused on the polio program rather than strengthening routine services, causing community mistrust and limiting sustainability. CONCLUSIONS The polio program investments in the DRC and Ethiopia facilitated program implementation despite environmental, system, and community-level barriers. There were, however, missed opportunities for integration. Remaining pockets of low immunization coverage and gaps in surveillance must be addressed in order to prevent importation of wild poliovirus and minimize circulating vaccine-derived poliovirus. Studying these implementation processes is critical for informing future health programs, including identifying implementation tools, strategies, and principles which can be adopted from polio eradication to ensure health service delivery among hard-to-reach populations. Future disease control or eradication programs should also consider strategies which reduce parallel structures and define a clear transition strategy to limit long-term external dependency.
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Affiliation(s)
- Wakgari Deressa
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Patrick Kayembe
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Abigail H Neel
- International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
| | - Eric Mafuta
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Assefa Seme
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Olakunle Alonge
- International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
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Voorman A, Habib MA, Hussain I, Muhammad Safdar R, Ahmed JA, Weldon WC, Ahmed I, Umer M, Partridge J, Soofi SB. Immunity and field efficacy of type 2-containing polio vaccines after cessation of trivalent oral polio vaccine: A population-based serological study in Pakistan. Vaccine X 2020; 5:100067. [PMID: 32462141 PMCID: PMC7240192 DOI: 10.1016/j.jvacx.2020.100067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 04/11/2020] [Accepted: 04/29/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In Pakistan and other countries using oral polio vaccine (OPV), immunity to type 2 poliovirus is now maintained by a single dose of inactivated polio vaccine (IPV) in routine immunization, supplemented in outbreak settings by monovalent OPV type 2 (mOPV2) and IPV. While well-studied in clinical trials, population protection against poliovirus type 2 achieved in routine and outbreak settings is generally unknown. METHODS We conducted two phases of a population-based serological survey of 7940 children aged 6-11 months old, between November 2016 and October 2017 from 13 polio high-risk locations in Pakistan. RESULTS Type 2 seroprevalence was 50% among children born after trivalent OPV (tOPV) withdrawal (April 2016), with heterogeneity across survey areas. Supplementary immunization activities (SIAs) with mOPV2 followed by IPV improved population immunity, varying from 89% in Pishin to 64% in Killa Abdullah, with little observed marginal benefit of subsequent campaigns. In the other high-risk districts surveyed, a single SIA with IPV was conducted and appeared to improve immunity to 57% in Karachi to 84% in Khyber. CONCLUSIONS Our study documents declining population immunity following trivalent OPV withdrawal in Pakistan, and wide heterogeneity in the population impact of supplementary immunization campaigns. Differences between areas, attributable to vaccination campaign coverage, were far more important for type 2 humoral immunity than the number of vaccination campaigns or vaccines used. This emphasizes the importance of immunization campaign coverage for type 2 outbreak response in the final stages of polio eradication. Given the declining type 2 immunity in new birth cohorts it is also recommended that 2 or more doses of IPV should be introduced in the routine immunization program of Pakistan.
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Affiliation(s)
- Arie Voorman
- Polio Program, Global Development, Bill & Melinda Gates Foundation, USA
| | | | - Imtiaz Hussain
- Department of Pediatrics & Child Health, The Aga Khan University, Pakistan
| | | | - Jamal A. Ahmed
- Polio Eradication Program, World Health Organization, Pakistan
| | - William C. Weldon
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Imran Ahmed
- Department of Pediatrics & Child Health, The Aga Khan University, Pakistan
| | - Muhammad Umer
- Department of Pediatrics & Child Health, The Aga Khan University, Pakistan
| | - Jeffrey Partridge
- Polio Program, Global Development, Bill & Melinda Gates Foundation, USA
| | - Sajid Bashir Soofi
- Department of Pediatrics & Child Health, The Aga Khan University, Pakistan
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Thompson KM, Kalkowska DA. Review of poliovirus modeling performed from 2000 to 2019 to support global polio eradication. Expert Rev Vaccines 2020; 19:661-686. [PMID: 32741232 PMCID: PMC7497282 DOI: 10.1080/14760584.2020.1791093] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/22/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Over the last 20 years (2000-2019) the partners of the Global Polio Eradication Initiative (GPEI) invested in the development and application of mathematical models of poliovirus transmission as well as economics, policy, and risk analyses of polio endgame risk management options, including policies related to poliovirus vaccine use during the polio endgame. AREAS COVERED This review provides a historical record of the polio studies published by the three modeling groups that primarily performed the bulk of this work. This review also systematically evaluates the polio transmission and health economic modeling papers published in English in peer-reviewed journals from 2000 to 2019, highlights differences in approaches and methods, shows the geographic coverage of the transmission modeling performed, identified common themes, and discusses instances of similar or conflicting insights or recommendations. EXPERT OPINION Polio modeling performed during the last 20 years substantially impacted polio vaccine choices, immunization policies, and the polio eradication pathway. As the polio endgame continues, national preferences for polio vaccine formulations and immunization strategies will likely continue to change. Future modeling will likely provide important insights about their cost-effectiveness and their relative benefits with respect to controlling polio and potentially achieving and maintaining eradication.
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Estivariz CF, Bennett SD, Lickness JS, Feldstein LR, Weldon WC, Leidman E, Ehlman DC, Khan MFH, Adhikari JM, Hasan M, Billah MM, Oberste MS, Alamgir ASM, Flora MD. Assessment of immunity to polio among Rohingya children in Cox's Bazar, Bangladesh, 2018: A cross-sectional survey. PLoS Med 2020; 17:e1003070. [PMID: 32231366 PMCID: PMC7108688 DOI: 10.1371/journal.pmed.1003070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 02/27/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We performed a cross-sectional survey in April-May 2018 among Rohingya in Cox's Bazar, Bangladesh, to assess polio immunity and inform vaccination strategies. METHODS AND FINDINGS Rohingya children aged 1-6 years (younger group) and 7-14 years (older group) were selected using multi-stage cluster sampling in makeshift settlements and simple random sampling in Nayapara registered camp. Surveyors asked parents/caregivers if the child received any oral poliovirus vaccine (OPV) in Myanmar and, for younger children, if the child received vaccine in any of the 5 campaigns delivering bivalent OPV (serotypes 1 and 3) conducted during September 2017-April 2018 in Cox's Bazar. Dried blood spot (DBS) specimens were tested for neutralizing antibodies to poliovirus types 1, 2, and 3 in 580 younger and 297 older children. Titers ≥ 1:8 were considered protective. Among 632 children (335 aged 1-6 years, 297 aged 7-14 years) enrolled in the study in makeshift settlements, 51% were male and 89% had arrived after August 9, 2017. Among 245 children (all aged 1-6 years) enrolled in the study in Nayapara, 54% were male and 10% had arrived after August 9, 2017. Among younger children, 74% in makeshift settlements and 92% in Nayapara received >3 bivalent OPV doses in campaigns. Type 1 seroprevalence was 85% (95% CI 80%-89%) among younger children and 91% (95% CI 86%-95%) among older children in makeshift settlements, and 92% (88%-95%) among younger children in Nayapara. Type 2 seroprevalence was lower among younger children than older children in makeshift settlements (74% [95% CI 68%-79%] versus 97% [95% CI 94%-99%], p < 0.001), and was 69% (95% CI 63%-74%) among younger children in Nayapara. Type 3 seroprevalence was below 75% for both age groups and areas. The limitations of this study are unknown routine immunization history and poor retention of vaccination cards. CONCLUSIONS Younger Rohingya children had immunity gaps to all 3 polio serotypes and should be targeted by future campaigns and catch-up routine immunization. DBS collection can enhance the reliability of assessments of outbreak risk and vaccination strategy impact in emergency settings.
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Affiliation(s)
- Concepcion F. Estivariz
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sarah D. Bennett
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jacquelyn S. Lickness
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Leora R. Feldstein
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - William C. Weldon
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eva Leidman
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Daniel C. Ehlman
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Mainul Hasan
- United Nations Children’s Fund, Dhaka, Bangladesh
| | - Mallick M. Billah
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - M. Steven Oberste
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - A. S. M. Alamgir
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Meerjady D. Flora
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
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11
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Balbir Singh HK, Badgujar VB, Yahaya RS, Abd Rahman S, Sami FM, Badgujar S, Govindan SN, Ansari MT. Assessment of knowledge and attitude among postnatal mothers towards childhood vaccination in Malaysia. Hum Vaccin Immunother 2019. [DOI: 10.1080/21645515.2019.1612666
https:/www.ncbi.nlm.nih.gov/pmc/articles/pmc6930045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Affiliation(s)
- Helvinder Kaur Balbir Singh
- General Studies Unit, Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia
| | - Vishal Bhagwan Badgujar
- Department of Pharmacy, Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia
| | - Rose Suzila Yahaya
- General Studies Unit, Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia
| | - Santibuana Abd Rahman
- Department of Pharmacy, Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia
| | - Farheen Mohd Sami
- Department of Pharmacy, Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia
| | - Sangeeta Badgujar
- School of Pharmacy, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, India
| | - Subhashini Nair Govindan
- Department of Nursing, Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia
| | - Mohammed Tahir Ansari
- Department of Pharmacy, Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia
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12
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Balbir Singh HK, Badgujar VB, Yahaya RS, Abd Rahman S, Sami FM, Badgujar S, Govindan SN, Ansari MT. Assessment of knowledge and attitude among postnatal mothers towards childhood vaccination in Malaysia. Hum Vaccin Immunother 2019; 15:2544-2551. [PMID: 31070987 DOI: 10.1080/21645515.2019.1612666] [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: 10/26/2022] Open
Abstract
Aim: Mothers knowledge and attitude toward childhood vaccination influence uptake is the most adequate tool and preventive aspects to infectious disease epidemics. The present study assesses and measures knowledge and attitude of postnatal mothers toward vaccination.Methods and results: The present study adopted a cross-sectional study design, whereby 200 postnatal mothers were identified during their postnatal visit to clinics. The subjects were accessed using questionnaire to assess the level of knowledge and attitude of mothers regarding vaccination. The objectives were to study the level of knowledge, the attitude, and to find the association between knowledge and attitude of the study subjects. The data were analyzed using SPSS version 16. The results was analyzed through chi-square test. The association between age (p = .031), education (p = .021), occupation (p = .013), and knowledge score toward vaccination was found to be statistically significant. However, ethnicity (p = .127), employment (p = .197), and mode of delivery (p = .750) toward mothers vaccination knowledge were not significant for the study. Mothers education, age, and occupation were found to be associated with attitude toward childhood vaccination. No association was found between ethnicity, employment, and mode of delivery with attitude of childhood vaccination.Conclusion: More than half of the studied mothers had good knowledge scores on vaccination, more than two-thirds of the studied mothers had good attitude scores on vaccination. However, the religious misconception and fear of autism was the main cause of vaccine resistance in Malaysia.
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Affiliation(s)
- Helvinder Kaur Balbir Singh
- General Studies Unit, Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia
| | - Vishal Bhagwan Badgujar
- Department of Pharmacy, Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia
| | - Rose Suzila Yahaya
- General Studies Unit, Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia
| | - Santibuana Abd Rahman
- Department of Pharmacy, Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia
| | - Farheen Mohd Sami
- Department of Pharmacy, Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia
| | - Sangeeta Badgujar
- School of Pharmacy, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, India
| | - Subhashini Nair Govindan
- Department of Nursing, Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia
| | - Mohammed Tahir Ansari
- Department of Pharmacy, Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia
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13
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Alfonso VH, Bratcher A, Ashbaugh H, Doshi R, Gadoth A, Hoff N, Mukadi P, Ghanem A, Cheng A, Gerber S, Mwamba GN, Muyembe Tamfum JJ, Okitolonda Wemakoy E, Rimoin AW. Changes in childhood vaccination coverage over time in the Democratic Republic of the Congo. PLoS One 2019; 14:e0217426. [PMID: 31125375 PMCID: PMC6534301 DOI: 10.1371/journal.pone.0217426] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/11/2019] [Indexed: 11/19/2022] Open
Abstract
Despite increased vaccination rates, the burden, morbidity and mortality associated with vaccine preventable diseases remains high. In the Democratic Republic of the Congo (DRC), potentially unreliable data and geographically varied program provision call for a better understanding of vaccination coverage and its changes over time at the country and province level. To assess changes in the proportion of children who were fully vaccinated over time in the DRC, vaccination histories for children 12-59 months of age were obtained from both the 2007 and 2013-2014 Demographic and Health Surveys (DHS). Changes were assessed, both at the country- and province-levels, to identify potential geographic variations. Vaccination coverage improved 70% between the DHS waves: 26% compared to 44% of 12-59 month-old children met full vaccination criteria in 2007 and 2013-2014, respectively (n2007 = 3032 and n2013-14 = 6619). Similarly, there was an overall trend across both DHS waves where as year of birth increased, so did vaccination coverage. There was geographic variation in immunization changes with most central and eastern provinces increasing in coverage and most northern, western and southern provinces having decreased vaccination coverage at the second time point. Using nationally representative data, we identified significant changes over time in vaccination coverage which may help to inform future policy, interventions and research to improve vaccination rates among children in the DRC. This study is the first of its kind for the population of DRC and provides an important initial step towards better understanding trends in vaccination coverage over time.
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Affiliation(s)
- Vivian H. Alfonso
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
- McKing Consulting, Atlanta, Georgia, United States of America
| | - Anna Bratcher
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Hayley Ashbaugh
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Reena Doshi
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Adva Gadoth
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Nicole Hoff
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Patrick Mukadi
- National Institute for Biomedical Research (INRB), Kinshasa, Democratic Republic of the Congo
| | - Angie Ghanem
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Alvan Cheng
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Sue Gerber
- Bill and Melinda Gates Foundation, Seattle, Washington, United States of America
| | | | | | | | - Anne W. Rimoin
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
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14
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Sadeuh-Mba SA, Kavunga-Membo H, Joffret ML, Yogolelo R, Endegue-Zanga MC, Bessaud M, Njouom R, Muyembe-Tamfu JJ, Delpeyroux F. Genetic landscape and macro-evolution of co-circulating Coxsackieviruses A and Vaccine-derived Polioviruses in the Democratic Republic of Congo, 2008-2013. PLoS Negl Trop Dis 2019; 13:e0007335. [PMID: 31002713 PMCID: PMC6505894 DOI: 10.1371/journal.pntd.0007335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/06/2019] [Accepted: 03/27/2019] [Indexed: 02/06/2023] Open
Abstract
Enteroviruses (EVs) are among the most common viruses infecting humans worldwide
but only a few Non-Polio Enterovirus (NPEV) isolates have been characterized in
the Democratic Republic of Congo (DR Congo). Moreover, circulating
vaccine-derived polioviruses (PVs) [cVDPVs] isolated during multiple outbreaks
in DR Congo from 2004 to 2018 have been characterized so far only by the
sequences of their VP1 capsid coding gene. This study was carried to i)
investigate the circulation and genetic diversity of NPEV and polio vaccine
isolates recovered from healthy children and Acute Flaccid Paralysis (AFP)
patients, ii) evaluate the occurrence of genetic recombination among EVs
belonging to the Enterovirus C species (including PVs) and iii)
identify the virological factors favoring multiple emergences of cVDPVs in DR
Congo. The biological material considered in this study included i) a collection
of 91 Sabin-like PVs, 54 cVDPVs and 150 NPEVs isolated from AFP patients between
2008 and 2012 in DR Congo and iii) a collection of 330 stool specimens collected
from healthy children in 2013 in the Kasai Oriental and Maniema provinces of DR
Congo. Studied virus isolates were sequenced in four distinct sub-genomic
regions 5’-UTR, VP1, 2CATPase and 3Dpol. Resulting
sequences were compared through comparative phylogenetic analyses. Virus
isolation showed that 19.1% (63/330) healthy children were infected by EVs
including 17.9% (59/330) of NPEVs and 1.2% (4/330) of type 3 Sabin-like PVs.
Only one EV-C type, EV-C99 was identified among the NPEV collection from AFP
patients whereas 27.5% of the 69 NPEV isolates typed in healthy children
belonged to the EV-C species: CV-A13 (13/69), A20 (5/69) and A17 (1/69).
Interestingly, 50 of the 54 cVDPVs featured recombinant genomes containing
exogenous sequences in at least one of the targeted non-structural regions of
their genomes: 5’UTR, 2CATPase and 3Dpol. Some of these
non-vaccine sequences of the recombinant cVDPVs were strikingly related to
homologous sequences from co-circulating CV-A17 and A20 in the
2CATPase region as well as to those from co-circulating CV-A13,
A17 and A20 in the 3Dpol region. This study provided the first
evidence uncovering CV-A20 strains as major recombination partners of PVs. High
quality AFP surveillance, sensitive environmental surveillance and efficient
vaccination activities remain essential to ensure timely detection and efficient
response to recombinant cVDPVs outbreaks in DR Congo. Such needs are valid for
any epidemiological setting where high frequency and genetic diversity of
Coxsackieviruses A13, A17 and A20 provide a conducive viral ecosystem for the
emergence of virulent recombinant cVDPVs. The strategy of the Global Polio Eradication Initiative is based on the
surveillance of patients suffering from Acute Flaccid Paralysis (AFP) and mass
vaccination with live-attenuated vaccine strains of polioviruses (PVs) in
endemic areas. However, vaccine strains of PVs can circulate and replicate for a
long time when the vaccine coverage of the population is low. Such prolonged
circulation and replication of vaccine strains of PVs can result to the
emergence of circulating vaccine-derived polioviruses [cVDPVs] that are as
virulent as wild PVs. In this study, we performed the molecular characterization
of a large collection of 377 virus isolates recovered from paralyzed patients
between 2008 and 2012 in DR Congo and healthy children in 2013 in the Kasai
Oriental and Maniema provinces of DR Congo. We found that the genetic diversity
of enteroviruses of the species Enterovirus C is more important
than previously reported. Interestingly, 50 of the 54 cVDPVs featured
recombinant genomes containing exogenous sequences of the 2C ATPase and/or 3D
polymerase coding genes acquired from co-circulating Coxsackieviruses A13, A17
and A20. Coxsackieviruses A20 strains were identified for the first time as
major partners of genetic recombination with co-circulating live-attenuated
polio vaccine strains. Our findings highlight the need to reinforce and maintain high quality
surveillance of PVs and efficient immunization activities in order to ensure
early detection and control of emerging cVDPVs in all settings where high
frequency and diversity of Coxsackieviruses A13, A17 and A20 have been
documented.
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Affiliation(s)
- Serge Alain Sadeuh-Mba
- Virology Service, Centre Pasteur of Cameroon, Yaounde, Centre region,
Cameroon
- * E-mail: ,
| | - Hugo Kavunga-Membo
- Virology Department, Institut National de Recherche Biomédicale,
Kinshasa, Democratic Republic of Congo
| | - Marie-Line Joffret
- Biology of Enteric Viruses Unit, Institut Pasteur, Paris,
France
- INSERM U994 Unit, INSERM, Paris, France
| | - Riziki Yogolelo
- Virology Department, Institut National de Recherche Biomédicale,
Kinshasa, Democratic Republic of Congo
| | | | - Maël Bessaud
- Biology of Enteric Viruses Unit, Institut Pasteur, Paris,
France
- INSERM U994 Unit, INSERM, Paris, France
| | - Richard Njouom
- Virology Service, Centre Pasteur of Cameroon, Yaounde, Centre region,
Cameroon
| | | | - Francis Delpeyroux
- Biology of Enteric Viruses Unit, Institut Pasteur, Paris,
France
- INSERM U994 Unit, INSERM, Paris, France
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