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Sun Y, Keskinocak P, Steimle LN, Kovacs SD, Wassilak SG. Modeling the spread of circulating vaccine-derived poliovirus type 2 outbreaks and interventions: A case study of Nigeria. Vaccine X 2024; 18:100476. [PMID: 38617838 PMCID: PMC11011220 DOI: 10.1016/j.jvacx.2024.100476] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 04/16/2024] Open
Abstract
Background Despite the successes of the Global Polio Eradication Initiative, substantial challenges remain in eradicating the poliovirus. The Sabin-strain (live-attenuated) virus in oral poliovirus vaccine (OPV) can revert to circulating vaccine-derived poliovirus (cVDPV) in under-vaccinated communities, regain neurovirulence and transmissibility, and cause paralysis outbreaks. Since the cessation of type 2-containing OPV (OPV2) in 2016, there have been cVDPV type 2 (cVDPV2) outbreaks in four out of six geographical World Health Organization regions, making these outbreaks a significant public health threat. Preparing for and responding to cVDPV2 outbreaks requires an updated understanding of how different factors, such as outbreak responses with the novel type of OPV2 (nOPV2) and the existence of under-vaccinated areas, affect the disease spread. Methods We built a differential-equation-based model to simulate the transmission of cVDPV2 following reversion of the Sabin-strain virus in prolonged circulation. The model incorporates vaccinations by essential (routine) immunization and supplementary immunization activities (SIAs), the immunity induced by different poliovirus vaccines, and the reversion process from Sabin-strain virus to cVDPV. The model's outcomes include weekly cVDPV2 paralytic case counts and the die-out date when cVDPV2 transmission stops. In a case study of Northwest and Northeast Nigeria, we fit the model to data on the weekly cVDPV2 case counts with onset in 2018-2021. We then used the model to test the impact of different outbreak response scenarios during a prediction period of 2022-2023. The response scenarios included no response, the planned response (based on Nigeria's SIA calendar), and a set of hypothetical responses that vary in the dates at which SIAs started. The planned response scenario included two rounds of SIAs that covered almost all areas of Northwest and Northeast Nigeria except some under-vaccinated areas (e.g., Sokoto). The hypothetical response scenarios involved two, three, and four rounds of SIAs that covered the whole Northwest and Northeast Nigeria. All SIAs in tested outbreak response scenarios used nOPV2. We compared the outcomes of tested outbreak response scenarios in the prediction period. Results Modeled cVDPV2 weekly case counts aligned spatiotemporally with the data. The prediction results indicated that implementing the planned response reduced total case counts by 79% compared to no response, but did not stop the transmission, especially in under-vaccinated areas. Implementing the hypothetical response scenarios involving two rounds of nOPV2 SIAs that covered all areas further reduced cVDPV2 case counts in under-vaccinated areas by 91-95% compared to the planned response, with greater impact from completing the two rounds at an earlier time, but it did not stop the transmission. When the first two rounds were completed in early April 2022, implementing two additional rounds stopped the transmission in late January 2023. When the first two rounds were completed six weeks earlier (i.e., in late February 2022), implementing one (two) additional round stopped the transmission in early February 2023 (late November 2022). The die out was always achieved last in the under-vaccinated areas of Northwest and Northeast Nigeria. Conclusions A differential-equation-based model of poliovirus transmission was developed and validated in a case study of Northwest and Northeast Nigeria. The results highlighted (i) the effectiveness of nOPV2 in reducing outbreak case counts; (ii) the need for more rounds of outbreak response SIAs that covered all of Northwest and Northeast Nigeria in 2022 to stop the cVDPV2 outbreaks; (iii) that persistent transmission in under-vaccinated areas delayed the progress towards stopping outbreaks; and (iv) that a quicker outbreak response would avert more paralytic cases and require fewer SIA rounds to stop the outbreaks.
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Affiliation(s)
- Yuming Sun
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Pinar Keskinocak
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Lauren N. Steimle
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA
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Bislava SB, Daja A, Oderinde BS, Uzairu SM. Prevalence of vaccine-derived poliovirus in sewage waters in Maiduguri, Borno State, Nigeria. Infez Med 2024; 32:90-98. [PMID: 38456020 PMCID: PMC10917565 DOI: 10.53854/liim-3201-12] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 02/13/2024] [Indexed: 03/09/2024]
Abstract
After a long global battle with wild poliovirus, the virus has been defeated through researches and vaccination using the oral polio vaccine and inactivated polio vaccine as well as sensitization. The issue that is now of global concern is that of vaccine-derived poliovirus which emerged from the unstable oral polio vaccine. Ninety sewage water samples were collected from slums in Maiduguri using grab method, concentrated using two phase separation method and subjected to intratypic differentiation and vaccine-derived poliovirus screening. The result revealed the presence of Sabin 1in 17 samples (61.0%) and Sabin 3 in 22 samples (79.0%), all of which were positive after vaccine-derived poliovirus screening. The presence of strains of Sabin 1 and Sabin 3 in the sewage water samples collected is an indication of virus shedding in individuals which could be as a result of vaccination or contact with the faeces infected or vaccinated individuals.
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Affiliation(s)
| | - Aliyu Daja
- Department of Biochemistry, University of Maiduguri, Borno State, Nigeria
| | - Bamidele Soji Oderinde
- Department of Medical Laboratory Sciences, University of Maiduguri, Borno State, Nigeria
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Tegegne AA, Anyuon AN, Legge GA, Ferede MA, Isaac Z, Laku KA, Biadgilign S, Kilo OTD, Ndenzako F, Modjirom N, Olu OO, Maleghemi S. A circulating vaccine-derived poliovirus type 2 outbreak in a chronic conflict setting: a descriptive epidemiological study in South Sudan - 2020 to 2021. BMC Infect Dis 2023; 23:816. [PMID: 37990165 PMCID: PMC10664300 DOI: 10.1186/s12879-023-08758-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/26/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND In this study, we describe the epidemiological profile of an outbreak of the circulating Vaccine Derived Polio Virus type 2 in South Sudan from 2020 to 2021. METHOD We conducted a retrospective descriptive epidemiological study using data from the national polio/AFP surveillance database, the outbreak investigation reports, and the vaccination coverage survey databases stored at the national level. RESULTS Between September 2020 and April 2021, 59 cases of the circulating virus were confirmed in the country, with 50 cases in 2020 and 9 cases in 2021. More cases were males (56%) under five (93%). The median age of the cases was 23.4 ± 11.9 months, ranging from 1 to 84 months. All states, with 28 out of the 80 counties, reported at least one case. Most of the cases (44, 75%) were reported from five states, namely Warrap (31%), Western Bahr el Ghazal (12%), Unity (12%), Central Equatoria (10%), and Jonglei (10%). Four counties accounted for 45.8% of the cases; these are Gogrial West with 12 (20%), Jur River with 5 (8.5%), Tonj North with 5 (8.5%), and Juba with 5 (8.5%) cases. The immunization history of the confirmed cases indicated that 14 (24%) of the affected children had never received any doses of oral polio or injectable vaccines either from routine or during supplemental immunization before the onset of paralysis, 17 (28.8%) had received 1 to 2 doses, while 28 (47.5%) had received 3 or more doses (Fig. 4). Two immunization campaigns and a mop-up were conducted with monovalent Oral Polio Vaccine type 2 in response to the outbreak, with administrative coverage of 91.1%, 99.1%, and 97% for the first, second, and mop-up rounds, respectively. CONCLUSION The emergence of the circulating vaccine-derived poliovirus outbreak in South Sudan was due to low population immunity, highlighting the need to improve the country's routine and polio immunization campaign coverage.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Fabian Ndenzako
- World Health Organization Country Office, Juba, Republic of South Sudan
| | - Ndoutabe Modjirom
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Olushayo Oluseun Olu
- World Health Organization Country Office, Juba, Republic of South Sudan
- World Health Organization Regional Office for Africa, Brazzaville, Congo
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Bammeke P, Adamu US, Bolu O, Waziri N, Erberto T, Aregay A, Nsubuga P, Wiesen E, Shuaib F. Descriptive epidemiology of poliomyelitis cases due to wild poliovirus type 1 and wild poliovirus type 3 in Nigeria, 2000-2020. Pan Afr Med J 2023; 45:4. [PMID: 38370099 PMCID: PMC10874097 DOI: 10.11604/pamj.supp.2023.45.2.38079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/18/2022] [Indexed: 02/20/2024] Open
Abstract
Introduction in August 2020, the World Health Organization African Region was certified free of wild poliovirus (WPV) when Nigeria became the last African country to interrupt wild poliovirus transmission. The National Polio Emergency Operations Center instituted in 2012 to coordinate and manage Nigerian polio eradication efforts reviewed the epidemiology of WPV cases during 2000-2020 to document lessons learned. Methods we analyzed reported WPV cases by serotype based on age, oral poliovirus vaccine immunization history, month and year of reported cases, and annual geographic distribution based on incidence rates at the Local Government Area level. The observed trends of cases were related to major events and the poliovirus vaccines used during mass vaccination campaigns within the analysis period. Results a total of 3,579 WPV type 1 and 1,548 WPV type 3 laboratory-confirmed cases were reported with onset during 2000-2020. The highest WPV incidence rates per 100,000 population in Local Government Areas were 19.4, 12.0, and 11.3, all in 2006. Wild poliovirus cases were reported each year during 2000-2014; the endemic transmission went undetected throughout 2015 until the last cases in 2016. Ten events/milestones were highlighted, including insurgency in the northeast which led to a setback in 2016 with four cases from children previously trapped in security-compromised areas. Conclusion Nigeria interrupted WPV transmission despite the challenges faced because of the emergency management approach, implementation of mass vaccination campaigns, the commitment of the government agencies, support from global polio partners, and special strategies deployed to conduct vaccination and surveillance in the security-compromised areas.
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Affiliation(s)
- Philip Bammeke
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | | | - Omotayo Bolu
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | | | | | | | - Peter Nsubuga
- Global Public Health Solutions, Atlanta, Georgia, United States
| | - Eric Wiesen
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Faisal Shuaib
- National Primary Healthcare Development Agency, Abuja, Nigeria
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Asekun A, Nkwogu L, Bawa S, Usman S, Edukugho A, Ocheh J, Banda R, Nganda GW, Nsubuga P, Archer R, Nebechukwu T, Mohammed A, Shuaib F, Bolu O, Adamu U. Deployment of novel oral polio vaccine type 2 under emergency use listing in Nigeria: the rollout experience. Pan Afr Med J 2023; 45:3. [PMID: 38370105 PMCID: PMC10874098 DOI: 10.11604/pamj.supp.2023.45.2.38033] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/27/2022] [Indexed: 02/20/2024] Open
Abstract
In 2011, a dedicated consortium of experts commenced work on the development of the novel oral poliovirus vaccine type 2 (nOPV2). After careful and rigorous analysis of data to enable early, targeted use of the vaccine, World Health Organization´s (WHO´s) Strategic Advisory Group of Experts on Immunization (SAGE) reviewed data from accelerated clinical development of nOPV2 and endorsed entering assessment under WHO´s Emergency Use Listing (EUL) procedure. In November 2020, nOPV2 received an interim recommendation for use under EUL to enable rapid field availability and potential wider rollout of the vaccine. In December 2020, Nigeria initiated preparation to meet all criteria for initial use of nOPV2 in the country and the documentation process to verify meeting them. The process entailed addressing the status of meeting 25 readiness criteria in nine categories for nOPV2 use in Nigeria for response efforts to ongoing cVDPV2 outbreaks. During January-February 2021, Nigeria submitted the required documentation for all required indicators for nOPV2 initial use. In February 2021, the country obtained approval from the GPEI nOPV2 Readiness Verification Team to introduce nOPV2 and in March 2021, rolled out the novel vaccine in mass vaccination campaigns for outbreak response in Bayelsa, Delta, Niger, Sokoto and Zamfara states, and one area council in the Federal Capital Territory (FCT). The lessons learned from this rollout experience in Nigeria are being applied as the country streamlines and strengthens the nOPV2 rollout process across the remaining states.
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Affiliation(s)
- Adeyelu Asekun
- US Centers for Disease Control and Prevention, Georgia, United States of America
| | | | | | | | | | | | | | - Gatei wa Nganda
- US Centers for Disease Control and Prevention, Georgia, United States of America
| | - Peter Nsubuga
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Roodly Archer
- US Centers for Disease Control and Prevention, Georgia, United States of America
| | | | - Aminu Mohammed
- Global Public Health Solutions, Georgia, United States of America
| | | | - Omotayo Bolu
- US Centers for Disease Control and Prevention, Georgia, United States of America
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Wong W, Gauld J, Famulare M. From vaccine to pathogen: Modeling Sabin 2 vaccine virus reversion and evolutionary epidemiology in Matlab, Bangladesh. Virus Evol 2023; 9:vead044. [PMID: 37692896 PMCID: PMC10491863 DOI: 10.1093/ve/vead044] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 06/26/2023] [Accepted: 07/07/2023] [Indexed: 09/12/2023] Open
Abstract
The oral poliovirus vaccines (OPVs) are one of the most effective disease eradication tools in public health. However, the OPV strains are genetically unstable and can cause outbreaks of circulating, vaccine-derived Type 2 poliovirus (cVDPV2) that are clinically indistinguishable from wild poliovirus (WPV) outbreaks. Here, we developed a Sabin 2 reversion model that simulates the reversion of Sabin 2 to reacquire a WPV-like phenotype based on the clinical differences in shedding duration and infectiousness between individuals vaccinated with Sabin 2 and those infected with WPV. Genetic reversion is informed by a canonical reversion pathway defined by three gatekeeper mutations (A481G, U2909C, and U398C) and the accumulation of deleterious nonsynonymous mutations. Our model captures essential aspects of both phenotypic and molecular evolution and simulates transmission using a multiscale transmission model that consolidates the relationships among immunity, susceptibility, and transmission risk. Despite rapid Sabin 2 attenuation reversal, we show that the emergence of a revertant virus does not guarantee a cVDPV2 outbreak. When simulating outbreaks in Matlab, Bangladesh, we found that cVDPV2 outbreaks are most likely in areas with low population-level immunity and poor sanitation. In Matlab, our model predicted that declining immunity against Type 2 poliovirus following the cessation of routine OPV vaccination was not enough to promote cVDPV2 emergence. However, cVDPV2 emergencedepended on the average viral exposure dose per contact, which was modeled as a combination of the viral concentration per fecal gram and the average fecal-oral dose per contact. These results suggest that cVDPV2 emergence risk can be mitigated by reducing the amount of infectious fecal material individuals are exposed to. Thus, a combined strategy of assessing and improving sanitation levels in conjunction with high-coverage vaccination campaigns could limit the future cVDPV2 emergence.
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Affiliation(s)
- Wesley Wong
- Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, SPH 1, Boston, MA 02115, USA
| | - Jillian Gauld
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, 500 5th Ave N, Seattle, WA 98109, USA
| | - Michael Famulare
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, 500 5th Ave N, Seattle, WA 98109, USA
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Mbani CJ, Nekoua MP, Moukassa D, Hober D. The Fight against Poliovirus Is Not Over. Microorganisms 2023; 11:1323. [PMID: 37317297 DOI: 10.3390/microorganisms11051323] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/13/2023] [Accepted: 05/14/2023] [Indexed: 06/16/2023] Open
Abstract
Poliovirus (PV), the virus that causes both acute poliomyelitis and post-polio syndrome, is classified within the Enterovirus C species, and there are three wild PV serotypes: WPV1, WPV2 and WPV3. The launch of the Global Polio Eradication Initiative (GPEI) in 1988 eradicated two of the three serotypes of WPV (WPV2 and WPV3). However, the endemic transmission of WPV1 persists in Afghanistan and Pakistan in 2022. There are cases of paralytic polio due to the loss of viral attenuation in the oral poliovirus vaccine (OPV), known as vaccine-derived poliovirus (VDPV). Between January 2021 and May 2023, a total of 2141 circulating VDPV (cVDPV) cases were reported in 36 countries worldwide. Because of this risk, inactivated poliovirus (IPV) is being used more widely, and attenuated PV2 has been removed from OPV formulations to obtain bivalent OPV (containing only types 1 and 3). In order to avoid the reversion of attenuated OPV strains, the new OPV, which is more stable due to genome-wide modifications, as well as sabin IPV and virus-like particle (VLP) vaccines, is being developed and offers promising solutions for eradicating WP1 and VDPV.
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Affiliation(s)
- Chaldam Jespère Mbani
- Laboratoire de Virologie URL3610, Université de Lille, CHU Lille, 59000 Lille, France
- Laboratoire de Biologie Cellulaire et Moléculaire, Faculté des Sciences et Technique, Université Marien Ngouabi, Brazzaville BP 69, Congo
| | | | - Donatien Moukassa
- Laboratoire de Biologie Cellulaire et Moléculaire, Faculté des Sciences et Technique, Université Marien Ngouabi, Brazzaville BP 69, Congo
| | - Didier Hober
- Laboratoire de Virologie URL3610, Université de Lille, CHU Lille, 59000 Lille, France
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Lohiniva AL, Nurzhynska A, Mueed A, Ali A, Ahmed K, Ayiku P, Amo-Adjei J, Kawakatsu Y, Shetye M, Greiner K, McIntosh R. Strengthening polio vaccine demand in Ghana: Understanding the factors influencing uptake of the vaccine and the effectiveness of different message frames. PLoS One 2023; 18:e0279809. [PMID: 36763581 PMCID: PMC9916648 DOI: 10.1371/journal.pone.0279809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 12/15/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Ghana has experienced recent polio outbreaks. Behavioral insights can be used to understand behavior and create demand for the polio vaccine. METHODS This cross-sectional study is based on an interactive mobile phone survey that explored factors influencing the uptake of the polio vaccine among Ghanaian mothers with children younger than five years old. The survey also explores the mothers' intention to vaccinate their children in the future as well as an experiment with short polio vaccine voice message nudges to identify the most effective message frames in encouraging vaccination. The study sample was drawn from volunteers from a mobile service platform. Linear probability model regressions with Ordinary Least Squares (OLS) estimates were used to analyze the data. RESULTS In total, data from 708 caregivers was assessed. Out of the sample, 35% (n = 250) had not vaccinated their children against polio, around 8% (n = 53) of respondents stated they did not plan to do so, while 28% expressed intent to do so during the next polio vaccination campaign. Higher vaccination of children against polio, i.e. better uptake of the polio vaccine, appeared to be associated with children's caregivers knowing that polio causes paralysis (with a coefficient of 0.13 (95% CI: 0.02, 0.24), i.e. 13% more likely than not to have their child vaccinated). Higher vaccine uptake also appeared to be associated with the perception that the polio vaccine is safe (with a coefficient of 0.11 (95% CI: 0.01, 0.22), i.e. 11% more likely than not to have their child vaccinated). Another factor in increasing vaccine uptake is whether caregivers receive support from healthcare workers with a coefficient of 0.11 (95% CI: 0.02, 0.20), i.e. 11% more likely than not to have their child vaccinated. Crucially, difficulty accessing the polio vaccine appeared to be associate with a negative change in vaccine uptake (with a coefficient of -0.16 (95% CI: -0.23, -0.08), i.e. 16% less likely to have their child vaccinated). Satisfaction with the information provided by vaccinators was also associated with better vaccine uptake (with a coefficient of 0.12 (95% CI: 0.05, 0.20) i.e. 12% more likely than not to have their child vaccinated); and having seen or heard something negative about the polio vaccine with a coefficient of 0.10 (95% CI: 0.03, 0.17), i.e. 10% more likely than not to have their child vaccinated. The social norms message frame was statistically significant with a coefficient of 0.06 (95% CI: -0.004, 012). CONCLUSION The findings from this study suggest that most women with children under the age of 5 appear to have vaccinated their children against polio. Many more caregivers express an intention to vaccinate their children, never having done so before. The behavior and the intention to vaccinate are both driven by a number of factors that must be addressed to create demand for the polio vaccine. Targeted message frames appeared to be statistically significant drivers of vaccine uptake. However, more research is required to understand how they impact vaccine behavior and future intention for vaccination.
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Affiliation(s)
- Anna-Leena Lohiniva
- Social and Behaviour Change Section, UNICEF Ghana Country Office, Accra, Ghana,* E-mail:
| | | | | | | | | | | | - Joshua Amo-Adjei
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Yoshito Kawakatsu
- Department of Data and Analytics, UNICEF HQ, New York, New York, United States of America
| | - Mrunal Shetye
- Health Section, UNICEF Ghana Country Office, Accra, Ghana
| | - Karen Greiner
- Social and Behaviour Change Section, UNICEF West and Central Africa, Dagar, Senegal
| | - Ross McIntosh
- UNICEF Polio, UNICEF HQ, New York, New York, United States of America
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Gray EJ, Cooper LV, Bandyopadhyay AS, Blake IM, Grassly NC. The origins and risk factors for serotype-2 vaccine-derived poliovirus (VDPV2) emergences in Africa during 2016-2019. J Infect Dis 2023:6984902. [PMID: 36630295 DOI: 10.1093/infdis/jiad004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/23/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023] Open
Abstract
Serotype 2 oral poliovirus vaccine (OPV2) can revert to regain wild-type neurovirulence and spread to cause emergences of vaccine-derived poliovirus (VDPV2). After its global withdrawal from routine immunisation in 2016, outbreak response use has created a cycle of VDPV2 emergences that threaten eradication. We implemented a hierarchical model based on VP1 region genetic divergence, time, and location to attribute emergences to campaigns and identify risk factors. We found that a 10 percentage point increase in population immunity in children under 5 years at the campaign time and location corresponds to a 18.0% decrease (95% CrI:6.3%-28%) in per-campaign relative risk, and that campaign size is associated with emergence risk (relative risk scaling with population size to a power of 0.80, (95% CrI:0.50-1.10). Our results imply how Sabin OPV2 can be used alongside the genetically stable but supply-limited novel OPV2 (listed for emergency use in November 2020) to minimise emergence risk.
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Affiliation(s)
- Elizabeth J Gray
- Department of Infectious Disease Epidemiology, Imperial College London, 86 Wood Lane, London, UK
| | - Laura V Cooper
- Department of Infectious Disease Epidemiology, Imperial College London, 86 Wood Lane, London, UK
| | | | - Isobel M Blake
- Department of Infectious Disease Epidemiology, Imperial College London, 86 Wood Lane, London, UK
| | - Nicholas C Grassly
- Department of Infectious Disease Epidemiology, Imperial College London, 86 Wood Lane, London, UK
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John TJ, Dharmapalan D. Lessons from Vaccine-Related Poliovirus in Israel, UK and USA. Vaccines (Basel) 2022; 10:1969. [PMID: 36423064 PMCID: PMC9695509 DOI: 10.3390/vaccines10111969] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 12/07/2023] Open
Abstract
Genetic variants of vaccine poliovirus type 2, imported from an unknown source, were detected in waste waters in Jerusalem, London and New York in early 2022. Wild poliovirus type 2 was globally eradicated in 1999, but vaccine virus type 2 continued for 16 more years; routine use of the vaccine was discontinued in 2016 and reintroduced occasionally on purpose. As an unintended consequence, type 2 vaccine virus variants (circulating vaccine-derived polioviruses, cVDPVs) that mimic wild viruses' contagiousness and neurovirulence, have been emerging and spreading. To illustrate, in just the past four years (2018-2021), 2296 children developed cVDPV polio in 35 low-income countries. Many assume that virus transmission is via the faecal-oral route. Sustained virus transmission was documented in London and New York, in spite of high standards of sanitation and hygiene. Here, virus transmission cannot be attributed to faecal contamination of food or drinking water (for faecal-oral transmission). Hence, contagious transmission can only be explained by inhalation of droplets/aerosol containing virus shed in pharyngeal fluids (respiratory transmission), as was the classical teaching of polio epidemiology. If transmission efficiency of VDPV is via the respiratory route where hygiene is good, it stands to reason that it is the same case in countries with poor hygiene, since poor hygiene cannot be a barrier against respiratory transmission. By extrapolation, the extreme transmission efficiency of wild polioviruses must also have been due to their ability to exploit respiratory route transmission. These lessons have implications for global polio eradication. It was as a result of assuming faecal-oral transmission that eradication was attempted with live attenuated oral polio vaccine (OPV), ignoring its safety problems and very low efficacy in low-income countries. Inactivated poliovirus vaccine (IPV) is completely safe and highly efficacious in protecting children against polio, with just three routine doses. Protecting all children from polio must be the interim goal of eradication, until poliovirus circulation dies out under sustained immunisation pressure. OPV should be discontinued under cover of immunity induced by IPV to stop the emergence of new lineages of VDPVs, not only type 2, but also types 1 and 3, to expedite the completion of polio eradication.
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Affiliation(s)
- T. Jacob John
- Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Dhanya Dharmapalan
- Department of Pediatrics, Apollo Hospitals, CBD Belapur, Navi, Mumbai 400614, Maharashtra, India
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Harrington C, Sun H, Jeffries-Miles S, Gerloff N, Mandelbaum M, Pang H, Collins N, Burns CC, Vega E. Culture-Independent Detection of Poliovirus in Stool Samples by Direct RNA Extraction. Microbiol Spectr 2021;:e0066821. [PMID: 34756088 DOI: 10.1128/Spectrum.00668-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Laboratory surveillance for poliovirus (PV) relies on virus isolation by cell culture to identify PV in stool specimens from acute flaccid paralysis (AFP) cases. Although this method successfully identifies PV, it is time-consuming and necessitates the additional biorisk of growing live virus in an increasingly polio-free world. To reduce the risk of culturing PV, the Global Polio Laboratory Network (GPLN) must switch to culture-independent diagnostic methods with sensitivity at least equivalent to that of cell culture procedures. Five commercial nucleic acid extraction kits and one enrichment method were tested for PV extraction efficiency. RNA yield was measured using real-time reverse transcription (RT)-PCR. Based on greater RNA yield, compared with the other kits, the Quick-RNA viral kit was selected for further testing and was optimized using an RNA extraction procedure for stool suspensions. RNA extraction was retrospectively tested with 182 stool samples that had previously tested positive for PVs, in parallel with the standard GPLN virus isolation algorithm. After virus isolation or RNA extraction, real-time RT-PCR assays were performed. RNA extraction was significantly more sensitive than virus isolation (McNemar’s test, P < 0.001). Thereafter, the RNA extraction method was tested in parallel for 202 prospective samples; RNA extraction and virus isolation were not significantly different from each other (McNemar’s test, P = 0.13). Direct RNA extraction was noninferior to current cell culture methods for detecting PV in stool samples. Our results show that direct RNA extraction can make downstream manipulation safer and can reduce the risk of accidental posteradication viral release. The method is amenable to implementation in a wide variety of polio laboratories. IMPORTANCE Successfully identifying poliovirus from acute flaccid paralysis (AFP) cases is a vital role of the Global Polio Laboratory Network to achieve the goals of the Global Polio Eradication Initiative. Currently, laboratory surveillance relies on virus isolation by cell culture to test for PV present in stool samples. Although this method can identify polioviruses, laboratories must switch to culture-independent methods to reduce the risk associated with growing live viruses in a soon-to-be polio-free world. By implementing this streamlined method, in combination with real-time RT-PCR, laboratories can quickly screen for and type polioviruses of programmatic importance to support the final stages of global polio eradication.
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13
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Kalthan E, Gouandjika-Vasilache I, Mbailao R, Doté J, Kossone M, Gbangai M. [Discovery of Foci of Type-2 Poliovirus Derived from Oral Polio Vaccine in Central African Republic in 2019]. Med Trop Sante Int 2021; 1:mtsibulletin.2021.114. [PMID: 35586583 PMCID: PMC9022749 DOI: 10.48327/mtsibulletin.2021.114] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/04/2021] [Indexed: 11/05/2022]
Abstract
Objective In 2019, the Central African Republic identified foci of circulating vaccine-derived poliovirus 2 (PVDV2c). The objective of this work is to describe the vaccination status of children paralyzed by PVDV2c and their contacts and to assess the circulation of this strain in these contacts. Patients and method The study population of this retrospective survey consists of children with acute flaccid paralysis (AFP) and their contacts. We included paralyzed children whose sequencing results showed the presence of PVDV2c. Results A total of 21 children paralyzed by PVDVc and 64 contacts were enrolled in the survey. Fourteen out of 21 children who are paralyzed (66%) received at least one dose of bivalent oral polio vaccine (OPV) compared to 36 out of 64 contacts (57%, non-significant difference). Of the vaccinated patients, 7 had received less than three doses. For the injectable polio vaccine (IPV), vaccination coverage for both patients and contacts was 33%.The proportion of children who received both doses of OPV and IPV was 33% among patients and 25% in contacts. Contacts with VDPV2 were vaccinated with OPV and IPV, respectively 55 and 27%. VDPV2 and Sabin 2 were also found in contact stools, 34% and 9% respectively. Conclusion The absence or inadequacy of IPV vaccination has a serious impact on children by the occurrence of virus derived from the vaccine responsible for life-old paralysis. Protecting children from poliomyelitis requires a combination of a good cold chain, multiple doses and adherence to the vaccine schedule.
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Affiliation(s)
- E. Kalthan
- Ministère de la santé et de la population, direction de la surveillance épidémiologique et de gestion d'urgence en santé publique, République centrafricaine,*
| | - I. Gouandjika-Vasilache
- Institut Pasteur de Bangui, laboratoire régional de référence OMS pour la poliomyélite en Afrique, République centrafricaine
| | - R. Mbailao
- Ministère de la santé et de la population, direction générale de l'épidémiologie et de lutte contre les maladies, République centrafricaine
| | - J.W. Doté
- Institut Pasteur de Bangui, laboratoire régional de référence OMS pour la poliomyélite en Afrique, République centrafricaine
| | - M.N. Kossone
- Ministère de la santé et de la population, district sanitaire de Bambari, République centrafricaine
| | - M. Gbangai
- Ministère de la santé et de la population, service de la vaccination, République centrafricaine
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14
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Kalkowska DA, Franka R, Higgins J, Kovacs SD, Forbi JC, Wassilak SG, Pallansch MA, Thompson KM. Modeling Poliovirus Transmission in Borno and Yobe, Northeast Nigeria. Risk Anal 2021; 41:289-302. [PMID: 32348621 PMCID: PMC7814397 DOI: 10.1111/risa.13485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/18/2020] [Accepted: 03/27/2020] [Indexed: 05/05/2023]
Abstract
Beginning in 2013, multiple local government areas (LGAs) in Borno and Yobe in northeast Nigeria and other parts of the Lake Chad basin experienced a violent insurgency that resulted in substantial numbers of isolated and displaced people. Northeast Nigeria represents the last known reservoir country of wild poliovirus (WPV) transmission in Africa, with detection of paralytic cases caused by serotype 1 WPV in 2016 in Borno and serotype 3 WPV in late 2012. Parts of Borno and Yobe are also problematic areas for transmission of serotype 2 circulating vaccine-derived polioviruses, and they continue to face challenges associated with conflict and inadequate health services in security-compromised areas that limit both immunization and surveillance activities. We model poliovirus transmission of all three serotypes for Borno and Yobe using a deterministic differential equation-based model that includes four subpopulations to account for limitations in access to immunization services and dynamic restrictions in population mixing. We find that accessibility issues and insufficient immunization allow for prolonged poliovirus transmission and potential undetected paralytic cases, although as of the end of 2019, including responsive program activities in the modeling suggest die out of indigenous serotypes 1 and 3 WPVs prior to 2020. Specifically, recent and current efforts to access isolated populations and provide oral poliovirus vaccine continue to reduce the risks of sustained and undetected transmission, although some uncertainty remains. Continued improvement in immunization and surveillance in the isolated subpopulations should minimize these risks. Stochastic modeling can build on this analysis to characterize the implications for undetected transmission and confidence about no circulation.
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Affiliation(s)
| | - Richard Franka
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jeff Higgins
- Geospatial Research, Analysis and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, GA, USA
| | - Stephanie D. Kovacs
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joseph C. Forbi
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Steven G.F Wassilak
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark A. Pallansch
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kimberly M. Thompson
- Kid Risk, Inc., 7512 Dr. Phillips Blvd. #50-523 Orlando, FL 32819
- Corresponding author:
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15
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Valesano AL, Taniuchi M, Fitzsimmons WJ, Islam MO, Ahmed T, Zaman K, Haque R, Wong W, Famulare M, Lauring AS. The Early Evolution of Oral Poliovirus Vaccine Is Shaped by Strong Positive Selection and Tight Transmission Bottlenecks. Cell Host Microbe 2021; 29:32-43.e4. [PMID: 33212020 DOI: 10.1016/j.chom.2020.10.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/12/2020] [Accepted: 10/26/2020] [Indexed: 01/06/2023]
Abstract
The emergence of circulating vaccine-derived polioviruses through evolution of the oral polio vaccine (OPV) poses a significant obstacle to polio eradication. Understanding the early genetic changes that occur as OPV evolves and transmits is important for preventing future outbreaks. Here, we use deep sequencing to define the evolutionary trajectories of type 2 OPV in a vaccine trial. By sequencing 497 longitudinal stool samples from 271 OPV2 recipients and household contacts, we were able to examine the extent of convergent evolution in vaccinated individuals and the amount of viral diversity that is transmitted. In addition to rapid reversion of key attenuating mutations, we identify strong selection at 19 sites across the genome. We find that a tight transmission bottleneck limits the onward transmission of these early adaptive mutations. Our results highlight the distinct evolutionary dynamics of live attenuated virus vaccines and have important implications for the success of next-generation OPV.
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16
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Fatiregun A, Famiyesin E, Bawa S, Ogunbodede N. Field investigation and response to a vaccine-derived poliovirus pre-tOPV switch in Southwest Nigeria, October 2015. Pan Afr Med J 2020; 37:6. [PMID: 32983324 PMCID: PMC7501745 DOI: 10.11604/pamj.2020.37.6.17344] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 08/14/2020] [Indexed: 11/11/2022] Open
Abstract
A vaccine-derived poliovirus (VDPV) was isolated in an acute flaccid paralysis (AFP) case reported from Ile-Ife, in Osun state, Southwest Nigeria. We investigated the epidemiological characteristics of the polio event and described the immediate public health response that followed. We interviewed the primary caregiver of the case and conducted active case searches for additional AFP cases in the communities in Ife East Local Government Area (LGA) of Osun state. Stool samples of contacts and non-contacts were collected and sent for laboratory investigation. A public health response with mass supplementary immunization in the affected areas followed immediately in the ward the case was located in October 2015. Also, we reviewed the administrative record of the oral polio vaccine (OPV) coverage in the LGA in the previous four years. The VDPV case was a female, one-month-old child with adequate vaccination history for her age. However, the environment of the child was relatively filthy with inappropriate facilities. Laboratory reports from contact samples were negative for VDPV or any polio isolates. A missed AFP case was found from active case searches and a high proportion of under-five children was immunized with tOPV. The OPV3 administrative coverage in the LGA peaked in 2014 (103%) and dropped in 2015 (67%). Efforts directed toward improving environmental hygiene in households and improving OPV coverage in subsequent routine and supplementary immunization are suggested.
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17
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Jeannoël M, Antona D, Lazarus C, Lina B, Schuffenecker I. Risk Assessment and Virological Monitoring Following an Accidental Exposure to Concentrated Sabin Poliovirus Type 3 in France, November 2018. Vaccines (Basel) 2020; 8:E331. [PMID: 32580378 DOI: 10.3390/vaccines8020331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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18
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Halpern MS, Altamirano J, Maldonado Y. Pediatric HIV Infection and Decreased Prevalence of OPV Point Mutations Linked to Vaccine-associated Paralytic Poliomyelitis. Clin Infect Dis 2019; 67:S78-S84. [PMID: 30376083 PMCID: PMC6206102 DOI: 10.1093/cid/ciy635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Mutations associated with prolonged replication of the attenuated polioviruses found in oral poliovirus vaccine (OPV) can lead to vaccine-derived poliovirus (VDPV) and cause paralysis indistinguishable from that caused by wild poliovirus. In response, the World Health Organization has initiated the transition to exclusive use of inactivated poliovirus vaccine (IPV), with OPV administration in cases of outbreak. However, it is currently unclear how IPV-only vaccination, well known to provide humoral but not mucosal immunity, will impact the development of paralysis causing OPV variants. Children infected with human immunodeficiency virus (HIV) have been documented to show decreased mucosal immunity following OPV vaccination. Thus, HIV-infected children vaccinated with OPV may serve as proxy for children with IPV-only vaccination. Methods We conducted a prospective study of Zimbabwean infants receiving OPV as part of their routine vaccination schedule. Stool samples collected from OPV-vaccinated children serially until age 24 months were tested for OPV serotypes using a real-time polymerase chain reaction protocol that quantifies the amount of mutant OPV variants found in each sample. Results Out of 2130 stool samples collected from 402 infants 365 stool samples were OPV positive: 313 from 212 HIV-noninfected (HIV−) infants and 52 from 34 HIV-infected (HIV+) infants. HIV− infants showed significantly higher proportions of OPV mutants when compared to HIV+ infants. Conclusions HIV infection is associated with a reduced proportion of OPV vaccine associated paralytic polio mutants. These results suggest that OPV administered to individuals previously vaccinated only with IPV will show decreased propensity for OPV mutations.
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Affiliation(s)
- Meira S Halpern
- Stanford School of Medicine, Stanford University, California
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19
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Adamu US, Archer WR, Braka F, Damisa E, Siddique A, Baig S, Higgins J, Sume GE, Banda R, Korir CK, Waziri N, Gidado S, Bammeke P, Edukugo A, Nganda GW, Forbi JC, Burns CC, Liu H, Jorba J, Asekun A, Franka R, Wassilak SG, Bolu O. Progress Toward Poliomyelitis Eradication - Nigeria, January 2018-May 2019. MMWR Morb Mortal Wkly Rep 2019; 68:642-646. [PMID: 31344023 PMCID: PMC6660103 DOI: 10.15585/mmwr.mm6829a3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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 number of wild poliovirus (WPV) cases in Nigeria decreased from 1,122 in 2006 to six WPV type 1 (WPV1) in 2014 (1). During August 2014-July 2016, no WPV cases were detected; during August-September 2016, four cases were reported in Borno State. An insurgency in northeastern Nigeria had resulted in 468,800 children aged <5 years deprived of health services in Borno by 2016. Military activities in mid-2016 freed isolated families to travel to camps, where the four WPV1 cases were detected. Oral poliovirus vaccine (OPV) campaigns were intensified during August 2016-December 2017; since October 2016, no WPV has been detected (2). Vaccination activities in insurgent-held areas are conducted by security forces; however, 60,000 unvaccinated children remain in unreached settlements. Since 2018, circulating vaccine-derived poliovirus type 2 (cVDPV2) has emerged and spread from Nigeria to Niger and Cameroon; outbreak responses to date have not interrupted transmission. This report describes progress in Nigeria polio eradication activities during January 2018-May 2019 and updates the previous report (2). Interruption of cVDPV2 transmission in Nigeria will need increased efforts to improve campaign quality and include insurgent-held areas. Progress in surveillance and immunization activities will continue to be reviewed, potentially allowing certification of interruption of WPV transmission in Africa in 2020.
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Clarke A, Blidi N, Dahn B, Agbo C, Tuopileyi R, Rude MJ, Williams GS, Seid M, Gasasira A, Wambai Z, Skrip L, Nagbe T, Nyenswah T, Chukwudi JO, Johnson T, Talisuna A, Yahaya AA, Rajatonirina S, Fall IS. Strengthening acute flaccid paralysis surveillance post Ebola virus disease outbreak 2015 - 2017: the Liberia experience. Pan Afr Med J 2019; 33:2. [PMID: 31402963 PMCID: PMC6675926 DOI: 10.11604/pamj.supp.2019.33.2.16848] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 04/15/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction Liberia remains at high risk of poliovirus outbreaks due to importation. The country maintained certification level acute flaccid paralysis (AFP) surveillance indicators each year until 2014 due to Ebola outbreak. During this time, there was a significant drop in non-polio AFP rate to (1.2/100,000 population under 15 years) in 2015 from 2.9/100, 000 population in 2013, due to a variety of reasons including suspension on shipment of acute flaccid paralysis stool specimen to the polio regional lab in Abidjan, refocusing of surveillance officers attention solely on Ebola virus disease (EVD) surveillance, inactivation of national polio expert committee (NPEC) and National Certification Committee (NCC). The Ministry of Health (MOH) supported by partners worked to restore AFP surveillance post EVD outbreak and ensure that Liberia maintains its polio free certification. Methods We conducted a desk review to summarize key activities conducted to restore acute flaccid paralysis (AFP) surveillance based on World Health Organization (WHO) AFP surveillance guidelines for Africa region. We also reviewed AFP surveillance indicators and introduction of new technologies. Data sources were from program reports, scientific and gray literature, AFP database, auto visual AFP detection and reporting (AVADAR) and ONA Servers. Data analysis was done using Microsoft excel and access spread sheets, ONA software and Geographic Information System (Arc GIS). Results AFP surveillance indicators improved with a rebound of non-polio AFP rate (NPAFP) rate from 1.2/100, 000 population under 15 years in 2015 to 4.3 in 2017. The stool adequacy rate at the national level also improved from 79% in 2016 to 82% in 2017, meeting the global target. The percentage of counties meeting the two critical AFP surveillance indicators NPAFP rate and stool adequacy improved from 47% in 2016 to 67% in 2017.The Last polio case reported in Liberia was in late 2010. Conclusion There was significant improvement in the key AFP surveillance indicators such as NPAFP rate and stool adequacy with a 3.5 fold increase in NPAFP from 2014 to 2017. By 2017, the stool adequacy rate was up to target levels compared to 2016, which was below target level of 80%. The number of counties meeting target for the two critical AFP surveillance indicators also increased by 20% points between 2016 and 2017. Similarly there was approximately two-fold increase in the oral polio vaccines (OPV) coverage for the reported AFP cases between 2015 and 2017. Strategies employed to address gaps in AFP surveillance included enhanced active case search for AFP, re-instatement of laboratory testing, supportive supervision in addition to facilitating enhanced community engagement in surveillance activities. New technologies such as AVADAR Pilot, electronic integrated supportive supervision (ISS) and electronic surveillance (eSurv) tools were introduced to improve real time AFP case reporting. However, there remain residual gaps in AFP surveillance in the country especially at the sub-national level. Similarly, the newly introduced technologies will require continued funding and capacity building for MOH staff to ensure sustainability of the initiatives.
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Affiliation(s)
| | | | | | | | | | | | | | - Mohammed Seid
- World Health Organization, Country Office, Monrovia, Liberia
| | - Alex Gasasira
- World Health Organization, Country Office, Monrovia, Liberia
| | - Zakari Wambai
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Laura Skrip
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Thomas Nagbe
- National Public Health Institute of Liberia, Monrovia, Liberia
| | | | | | - Ticha Johnson
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ambrose Talisuna
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ali Ahmed Yahaya
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | - Ibrahima Socé Fall
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Hsu CH, Wannemuehler KA, Soofi S, Mashal M, Hussain I, Bhutta ZA, McDuffie L, Weldon W, Farag NH. Poliovirus immunity among children under five years-old in accessible areas of Afghanistan, 2013. Vaccine 2019; 37:1577-1583. [PMID: 30782488 PMCID: PMC6466626 DOI: 10.1016/j.vaccine.2019.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/14/2018] [Revised: 01/30/2019] [Accepted: 02/03/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Afghanistan remains among the three countries with endemic wild poliovirus transmission, and high population immunity levels are required to interrupt transmission and prevent outbreaks. Surveillance and vaccination of children in Afghanistan have been challenging due to security issues limiting accessibility in certain areas. METHODS A serosurvey was conducted in 2013 within accessible enumeration areas (EAs) among children aged <5 years using samples collected for a national micronutrient assessment survey to assess poliovirus immunity in Afghanistan. Of 21194 total EAs in Afghanistan, 107 were inaccessible and therefore were excluded from the sampling frame. RESULTS Population immunity was high overall but varied for the poliovirus serotypes, and was lowest for type 3 (95% [95% CI: 93%, 96%]) compared to type 1 (99% [95% CI:97%, 99%]) and type 2 (98% [95% CI:96%, 99%]). The proportion of the population immune to all three types was 93% (95% CI: 91%, 95%), and the proportion seronegative for all three types was 0.5% (95% CI: 0.2%, 1.7%). CONCLUSION Except for regional differences in immunity to type 3 virus, there were no other apparent differences in seroprevalence by region or by any of the demographic or nutritional characteristics assessed in this study. The study was not powered to provide provincial level seroprevalence estimates, but Paktika Province, in the South region, had the largest proportion of seronegative specimens for type 1 (4 seronegative of 17 serum specimens compared to 14 seronegative of 673 for the remainder of the areas). Among accessible children in Afghanistan, seroprevalence of antibodies to poliovirus was high, with most seroprevalence reported at 95% or greater. Despite high seroprevalence in areas assessed in this study, the continued detection of poliovirus cases in the South and East regions indicate that overall regional vaccination coverage and performance is not sufficient to stop polio transmission.
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Affiliation(s)
- Christopher H Hsu
- Polio Eradication Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | - Sajid Soofi
- Woman and Child Health Division, Aga Khan University, Karachi, Pakistan
| | | | - Imtiaz Hussain
- Woman and Child Health Division, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Woman and Child Health Division, Aga Khan University, Karachi, Pakistan
| | | | - William Weldon
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Noha H Farag
- Polio Eradication Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Bassey BE, Braka F, Vaz RG, Komakech W, Maleghemi ST, Koko R, Igbu T, Ireye F, Agwai S, Akpan GU, Tegegne SG, Mohammed AAG, Okocha-Ejeko A. The global switch from trivalent oral polio vaccine (tOPV) to bivalent oral polio vaccine (bOPV): facts, experiences and lessons learned from the south-south zone; Nigeria, April 2016. BMC Infect Dis 2018; 18:57. [PMID: 29374467 PMCID: PMC5787308 DOI: 10.1186/s12879-018-2963-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/16/2018] [Indexed: 11/13/2022] Open
Abstract
Background The globally synchronized switch from trivalent Oral Polio Vaccine (tOPV) to bivalent Oral Polio Vaccine (bOPV) took place in Nigeria on April 18th 2016. The country is divided into six geopolitical zones. This study reports the experiences and lessons learned from the switch process in the six states that make up Nigeria’s south-south geopolitical zone. Methods This was a descriptive retrospective review of Nigeria’s switch plan and structures used for implementing the tOPV-bOPV switch in the south-south zone. Nigeria’s National Polio Emergency Operation Centre (NPEOC) protocols, global guidelines and reports from switch supervisors during the switch were used to provide background information for this study. Quantitative data were derived from reviewing switch monitoring and validation documents as submitted to the NPEOC Results The switch process took place in all 3078 Health Facilities (HFs) and 123 Local Government Areas (LGAs) that make up the six states in the zone. A total of $139,430 was used for this process. The ‘healthcare personnel’ component received the highest budgetary allocation (59%) followed by the ‘logistics’ component (18%). Akwa Ibom state was allocated the highest number of healthcare personnel and hence received the most budgetary allocation compared to the six states (total healthcare personnel = 458, total budgetary allocation = $17,428). Validation of the switch process revealed that eight HFs in Bayelsa, Cross-River, Edo and Rivers states still possessed tOPV in cold-chain while six HFs in Cross-River and Rivers states had tOPV out of cold-chain but without the ‘do not use’ sticker. Akwa-Ibom was the only state in the zone to have bOPV and Inactivated Polio Vaccine (IPV) available in all its HFs monitored. Conclusion The Nigerian tOPV-bOPV switch was successful. For future Oral Polio Vaccine (OPV) withdrawals, implementation of the switch plan would be more feasible with an earlier dissemination of funds from global donor organizations, which would greatly aid timely planning and preparations. Increased budgetary allocation to the ‘logistics’ component to accommodate unexpected hikes in transportation prices and the general inefficiencies with power supply in the country is also advised.
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Duintjer Tebbens RJ, Thompson KM. Polio endgame risks and the possibility of restarting the use of oral poliovirus vaccine. Expert Rev Vaccines 2018; 17:739-751. [PMID: 30056767 PMCID: PMC6168953 DOI: 10.1080/14760584.2018.1506333] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/26/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Ending all cases of poliomyelitis requires successful cessation of all oral poliovirus vaccine (OPV), but the Global Polio Eradication Initiative (GPEI) partners should consider the possibility of an OPV restart. AREAS COVERED We review the risks of continued live poliovirus transmission after OPV cessation and characterize events that led to OPV restart in a global model that focused on identifying optimal strategies for OPV cessation and the polio endgame. Numerous different types of events that occurred since the globally coordinated cessation of serotype 2-containing OPV in 2016 highlight the possibility of continued outbreaks after homotypic OPV cessation. Modeling suggests a high risk of uncontrolled outbreaks once more than around 5,000 homotypic polio cases occur after cessation of an OPV serotype, at which point restarting OPV would become necessary to protect most populations. Current efforts to sunset the GPEI and transition its responsibilities to national governments poses risks that may limit the ability to implement management strategies needed to minimize the probability of an OPV restart. EXPERT COMMENTARY OPV restart remains a real possibility, but risk management choices made by the GPEI partners and national governments can reduce the risks of this low-probability but high-consequence event.
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Zaman K, Estívariz CF, Morales M, Yunus M, Snider CJ, Gary HE, Weldon WC, Oberste MS, Wassilak SG, Pallansch MA, Anand A. Immunogenicity of type 2 monovalent oral and inactivated poliovirus vaccines for type 2 poliovirus outbreak response: an open-label, randomised controlled trial. Lancet Infect Dis 2018; 18:657-665. [PMID: 29571817 PMCID: PMC10495755 DOI: 10.1016/s1473-3099(18)30113-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 01/22/2018] [Accepted: 02/05/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Monovalent type 2 oral poliovirus vaccine (mOPV2) and inactivated poliovirus vaccine (IPV) are used to respond to type 2 poliovirus outbreaks. We aimed to assess the effect of two mOPV2 doses on the type 2 immune response by varying the time interval between mOPV2 doses and IPV co-administration with mOPV2. METHODS We did a randomised, controlled, parallel, open-label, non-inferiority, inequality trial at two study clinics in Dhaka, Bangladesh. Healthy infants aged 6 weeks (42-48 days) at enrolment were randomly assigned (1:1:1:1) to receive two mOPV2 doses (each dose consisting of two drops [0·1 mL in total] of about 105 50% cell culture infectious dose of type 2 Sabin strain) at intervals of 1 week, 2 weeks, 4 weeks (standard or control group), or 4 weeks with IPV (0·5 mL of type 1 [Mahoney, 40 D-antigen units], type 2 [MEF-1, 8 D-antigen units], and type 3 [Saukett, 32 D-antigen units]) administered intramuscularly with the first mOPV2 dose. We used block randomisation, randomly selecting blocks of sizes four, eight, 12, or 16 stratified by study sites. We concealed randomisation assignment from staff managing participants in opaque, sequentially numbered, sealed envelopes. Parents and clinic staff were unmasked to assignment after the randomisation envelope was opened. Laboratory staff analysing sera were masked to assignment, but investigators analysing data and assessing outcomes were not. The primary outcome was type 2 immune response measured 4 weeks after mOPV2 administration. The primary modified intention-to-treat analysis included participants with testable serum samples before and after vaccination. A non-inferiority margin of 10% and p=0·05 (one-tailed) was used. This trial is registered at ClinicalTrials.gov, number NCT02643368, and is closed to accrual. FINDINGS Between Dec 7, 2015, and Jan 5, 2016, we randomly assigned 760 infants to receive two mOPV2 doses at intervals of 1 week (n=191), 2 weeks (n=191), 4 weeks (n=188), or 4 weeks plus IPV (n=190). Immune responses after two mOPV2 doses were observed in 161 (93%) of 173 infants with testable serum samples in the 1 week group, 169 (96%) of 177 in the 2 week group, and 176 (97%) of 181 in the 4 week group. 1 week and 2 week intervals between two mOPV2 doses were non-inferior to 4 week intervals because the lower bound of the absolute differences in the percentage of immune responses were greater than -10% (-4·2% [90% CI -7·9 to -0·4] in the 1 week group and -1·8% [-5·0 to 1·5] in the 2 week group vs the 4 week group). The immune response elicited by two mOPV2 doses 4 weeks apart was not different when IPV was added to the first dose (176 [97%] of 182 infants with IPV vs 176 [97%] of 181 without IPV; p=1·0). During the trial, two serious adverse events (pneumonia; one [1%] of 186 patients in the 1 week group and one [1%] of 182 in the 4 week group) and no deaths were reported; the adverse events were not attributed to the vaccines. INTERPRETATION Administration of mOPV2 at short intervals does not interfere with its immunogenicity. The addition of IPV to the first mOPV2 dose did not improve poliovirus type 2 immune response. FUNDING US Centers for Disease Control and Prevention.
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Affiliation(s)
- Khalequ Zaman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | | | - Mohammad Yunus
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Howard E Gary
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | - Abhijeet Anand
- Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Donbraye E, Olasunkanmi OI, Opabode BA, Ishola TR, Faleye TOC, Adewumi OM, Adeniji JA. Abundance of enterovirus C in RD-L20B cell culture-negative stool samples from acute flaccid paralysis cases in Nigeria is geographically defined. J Med Microbiol 2018; 67:854-865. [PMID: 29708482 DOI: 10.1099/jmm.0.000737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE We recently showed that enteroviruses (EVs) andenterovirus species C (EV-C) in particular were abundant in faecal samples from children who had been diagnosed with acute flaccid paralysis (AFP) in Nigeria but declared to be EV-free by the RD-L20B cell culture-based algorithm. In this study, we investigated whether this observed preponderance of EVs (and EV-Cs) in such samples varies by geographical region. METHODOLOGY One hundred and eight samples (i.e. 54 paired stool suspensions from 54 AFP cases) that had previously been confirmed to be negative for EVs by the WHO-recommended RD-L20B cell culture-based algorithm were analysed. The 108 samples were made into 54 pools (27 each from North-West and South-South Nigeria). All were subjected to RNA extraction, cDNA synthesis and the WHO-recommended semi-nested PCR assay and its modifications. All of the amplicons were sequenced, and the enteroviruses identified, using the enterovirus genotyping tool and phylogenetic analysis. RESULTS EVs were detected in 16 (29.63 %) of the 54 samples that were screened and successfully identified in 14 (25.93 %). Of these, 10 were from North-West and 4 were from South-South Nigeria. One (7.14 %), 2 (14.29 %) and 11 (78.57 %) of the strains detected were EV-A, EV-B and EV-C, respectively. The 10 strains from North-West Nigeria included 7 EV types, namely CV-A10, E29, CV-A13, CV-A17, CV-A19, CV-A24 and EV-C99. The four EV types recovered from South-South Nigeria were E31, CV-A1, EV-C99 and EV-C116. CONCLUSION The results of this study showed that the presence of EVs and consequently EV-Cs in AFP samples declared to be EV-free by the RD-L20B cell culture-based algorithm varies by geographical region in Nigeria.
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Affiliation(s)
- Emmanuel Donbraye
- Department of Medical Microbiology and Parasitology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | | | - Babatunde Ayoola Opabode
- Department of Medical Microbiology and Parasitology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Temitayo Rachael Ishola
- Department of Medical Microbiology and Parasitology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Temitope Oluwasegun Cephas Faleye
- Department of Virology, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
- Department of Microbiology, Faculty of Science, Ekiti State University, Ado-Ekiti, Ekiti, State, Nigeria
| | - Olubusuyi Moses Adewumi
- Department of Virology, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Johnson Adekunle Adeniji
- Department of Virology, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
- WHO National Polio Laboratory, University of Ibadan, Ibadan, Oyo State, Nigeria
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Nanteza MB, Bakamutumaho B, Kisakye A, Namuwulya P, Bukenya H, Katushabe E, Bwogi J, Byabamazima CR, Williams R, Gumede N. The detection of 3 ambiguous type 2 vaccine-derived polioviruses (VDPV2s) in Uganda. Virol J 2018; 15:77. [PMID: 29699577 PMCID: PMC5922010 DOI: 10.1186/s12985-018-0990-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Oral Polio Vaccine (OPV or Sabin) is genetically unstable and may mutate to form vaccine-derived polioviruses (VDPVs). METHODS In 2014, two VDPVs type 2 were identified during routine surveillance of acute flaccid paralysis (AFP) cases. Consequently, a retrospective VDPV survey was conducted to ensure that there was no circulating VDPV in the country. All Sabin poliovirus isolates identified in Uganda 6 months before and 6 months after were re-screened; Sabin 1 and 3 polioviruses were re-screened for Sabin 2 and Sabin 2 polioviruses were re-screened for VDPVs type 2. The Poliovirus rRT-PCR ITD/VDPV 4.0 assay and sequencing were used respectively. RESULTS The first two VDPVs type2 were identified in Eastern Uganda and the third was identified during the survey from South-western Uganda. These regions had low OPV coverage and poor AFP surveillance indicators. CONCLUSION The retrospective VDPV survey was a useful strategy to screen for VDPVs more exhaustively. Supplementary surveillance methods need to be encouraged.
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Affiliation(s)
- Mary Bridget Nanteza
- Uganda Virus Research Institute (UVRI), Plot 51 - 59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda.
| | - Barnabas Bakamutumaho
- Uganda Virus Research Institute (UVRI), Plot 51 - 59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Annet Kisakye
- World Health Organization (WHO), Plot 60 Prince Charles Avenue, Kololo, P.O. Box 24578, Kampala, Uganda
| | - Prossy Namuwulya
- Uganda Virus Research Institute (UVRI), Plot 51 - 59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Henry Bukenya
- Uganda Virus Research Institute (UVRI), Plot 51 - 59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Edson Katushabe
- World Health Organization (WHO), Plot 60 Prince Charles Avenue, Kololo, P.O. Box 24578, Kampala, Uganda
| | - Josephine Bwogi
- Uganda Virus Research Institute (UVRI), Plot 51 - 59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | | | - Raffaella Williams
- National Institute for Communicable Diseases (NICD), 1 Modderfontein Road Sandringham Johannesburg. Private Bag x4, Sandringham, 2131, South Africa.,NSW HIV State Reference Laboratory, St Vicent's Hospital, Darlinghurst, NSW, 2010, Australia
| | - Nicksy Gumede
- World Health Organization, Regional Office for Africa, P.O. Box 06, Brazzaville, Republic of Congo
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Shaw J, Jorba J, Zhao K, Iber J, Chen Q, Adu F, Adeniji A, Bukbuk D, Baba M, Henderson E, Dybdahl-Sissoko N, McDonald S, Weldon WC, Gumede N, Oberste MS, Kew OM, Burns CC. Dynamics of Evolution of Poliovirus Neutralizing Antigenic Sites and Other Capsid Functional Domains during a Large and Prolonged Outbreak. J Virol 2018; 92:e01949-17. [PMID: 29444940 DOI: 10.1128/JVI.01949-17] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/06/2018] [Indexed: 12/19/2022] Open
Abstract
We followed the dynamics of capsid amino acid replacement among 403 Nigerian outbreak isolates of type 2 circulating vaccine-derived poliovirus (cVDPV2) from 2005 through 2011. Four different functional domains were analyzed: (i) neutralizing antigenic (NAg) sites, (ii) residues binding the poliovirus receptor (PVR), (iii) VP1 residues 1 to 32, and (iv) the capsid structural core. Amino acid replacements mapped to 37 of 43 positions across all 4 NAg sites; the most variable and polymorphic residues were in NAg sites 2 and 3b. The most divergent of the 120 NAg variants had no more than 5 replacements in all NAg sites and were still neutralized at titers similar to those of Sabin 2. PVR-binding residues were less variable (25 different variants; 0 to 2 replacements per isolate; 30/44 invariant positions), with the most variable residues also forming parts of NAg sites 2 and 3a. Residues 1 to 32 of VP1 were highly variable (133 different variants; 0 to 6 replacements per isolate; 5/32 invariant positions), with residues 1 to 18 predicted to form a well-conserved amphipathic helix. Replacement events were dated by mapping them onto the branches of time-scaled phylogenies. Rates of amino acid replacement varied widely across positions and followed no simple substitution model. Replacements in the structural core were the most conservative and were fixed at an overall rate ∼20-fold lower than the rates for the NAg sites and VP1 1 to 32 and ∼5-fold lower than the rate for the PVR-binding sites. Only VP1 143-Ile, a non-NAg site surface residue and known attenuation site, appeared to be under strong negative selection.IMPORTANCE The high rate of poliovirus evolution is offset by strong selection against amino acid replacement at most positions of the capsid. Consequently, poliovirus vaccines developed from strains isolated decades ago have been used worldwide to bring wild polioviruses almost to extinction. The apparent antigenic stability of poliovirus obscures a dynamic of continuous change within the neutralizing antigenic (NAg) sites. During 7 years of a large outbreak in Nigeria, the circulating type 2 vaccine-derived polioviruses generated 120 different NAg site variants via multiple independent pathways. Nonetheless, overall antigenic evolution was constrained, as no isolate had fixed more than 5 amino acid differences from the Sabin 2 NAg sites, and the most divergent isolates were efficiently neutralized by human immune sera. Evolution elsewhere in the capsid was also constrained. Amino acids binding the poliovirus receptor were strongly conserved, and extensive variation in the VP1 amino terminus still conserved a predicted amphipathic helix.
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Wang HB, Luo HM, Li L, Fan CX, Hao LX, Ma C, Su QR, Yang H, Reilly KH, Wang HQ, Wen N. Vaccine-derived poliovirus surveillance in China during 2001-2013: the potential challenge for maintaining polio free status. BMC Infect Dis 2017; 17:742. [PMID: 29197328 PMCID: PMC5712118 DOI: 10.1186/s12879-017-2849-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 11/22/2017] [Indexed: 11/19/2022] Open
Abstract
Background The goal of polio eradication is to complete elimination and containment of all wild, vaccine-related and Sabin polioviruses. Vaccine-derived poliovirus (VDPV) surveillance in China from 2001–2013 is summarized in this report, which has important implications for the global polio eradication initiative. Methods Acute flaccid paralysis (AFP) cases and their contacts with VDPVs isolated from fecal specimens were identified in our AFP surveillance system or by field investigation. Epidemiological and laboratory information for these children were analyzed and the reasons for the VDPV outbreak was explored. Results VDPVs were isolated from a total of 49 children in more than two-thirds of Chinese provinces from 2001–2013, including 15 VDPV cases, 15 non-polio AFP cases and 19 contacts of AFP cases or healthy subjects. A total of 3 circulating VDPVs (cVDPVs) outbreaks were reported in China, resulting in 6 cVDPVs cases who had not been vaccinated with oral attenuated poliomyelitis vaccine. Among the 4 immunodeficiency-associated VDPVs (iVDPVs) cases, the longest duration of virus excretion was about 20 months. In addition, one imported VDPV case from Myanmar was detected in Yunnan Province. Conclusions Until all wild, vaccine-related and Sabin polioviruses are eradicated in the world, high quality routine immunization and sensitive AFP surveillance should be maintained, focusing efforts on underserved populations in high risk areas.
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Affiliation(s)
- Hai-Bo Wang
- Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, People's Republic of China.,Peking University Clinical Research Institute, Xueyuan Rd 38#, Haidian District, Beijing, 100191, People's Republic of China
| | - Hui-Ming Luo
- Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, People's Republic of China
| | - Li Li
- Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, People's Republic of China
| | - Chun-Xiang Fan
- Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, People's Republic of China
| | - Li-Xin Hao
- Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, People's Republic of China
| | - Chao Ma
- Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, People's Republic of China
| | - Qi-Ru Su
- Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, People's Republic of China
| | - Hong Yang
- Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, People's Republic of China
| | | | - Hua-Qing Wang
- Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, People's Republic of China
| | - Ning Wen
- Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, People's Republic of China.
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McCarthy KA, Chabot-Couture G, Famulare M, Lyons HM, Mercer LD. The risk of type 2 oral polio vaccine use in post-cessation outbreak response. BMC Med 2017; 15:175. [PMID: 28974220 DOI: 10.1186/s12916-017-0937-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 08/25/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Wild type 2 poliovirus was last observed in 1999. The Sabin-strain oral polio vaccine type 2 (OPV2) was critical to eradication, but it is known to revert to a neurovirulent phenotype, causing vaccine-associated paralytic poliomyelitis. OPV2 is also transmissible and can establish circulating lineages, called circulating vaccine-derived polioviruses (cVDPVs), which can also cause paralytic outbreaks. Thus, in April 2016, OPV2 was removed from immunization activities worldwide. Interrupting transmission of cVDPV2 lineages that survive cessation will require OPV2 in outbreak response, which risks seeding new cVDPVs. This potential cascade of outbreak responses seeding VDPVs, necessitating further outbreak responses, presents a critical risk to the OPV2 cessation effort. METHODS The EMOD individual-based disease transmission model was used to investigate OPV2 use in outbreak response post-cessation in West African populations. A hypothetical outbreak response in northwest Nigeria is modeled, and a cVDPV2 lineage is considered established if the Sabin strain escapes the response region and continues circulating 9 months post-response. The probability of this event was investigated in a variety of possible scenarios. RESULTS Under a broad range of scenarios, the probability that widespread OPV2 use in outbreak response (~2 million doses) establishes new cVDPV2 lineages in this model may exceed 50% as soon as 18 months or as late as 4 years post-cessation. CONCLUSIONS The risk of a cycle in which outbreak responses seed new cVDPV2 lineages suggests that OPV2 use should be managed carefully as time from cessation increases. It is unclear whether this risk can be mitigated in the long term, as mucosal immunity against type 2 poliovirus declines globally. Therefore, current programmatic strategies should aim to minimize the possibility that continued OPV2 use will be necessary in future years: conducting rapid and aggressive outbreak responses where cVDPV2 lineages are discovered, maintaining high-quality surveillance in all high-risk settings, strengthening the use of the inactivated polio vaccine as a booster in the OPV2-exposed and in routine immunization, and gaining access to currently inaccessible areas of the world to conduct surveillance.
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Sahoo MK, Holubar M, Huang C, Mohamed-Hadley A, Liu Y, Waggoner JJ, Troy SB, Garcia-Garcia L, Ferreyra-Reyes L, Maldonado Y, Pinsky BA. Detection of Emerging Vaccine-Related Polioviruses by Deep Sequencing. J Clin Microbiol 2017; 55:2162-71. [PMID: 28468861 DOI: 10.1128/JCM.00144-17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/19/2017] [Indexed: 12/13/2022] Open
Abstract
Oral poliovirus vaccine can mutate to regain neurovirulence. To date, evaluation of these mutations has been performed primarily on culture-enriched isolates by using conventional Sanger sequencing. We therefore developed a culture-independent, deep-sequencing method targeting the 5′ untranslated region (UTR) and P1 genomic region to characterize vaccine-related poliovirus variants. Error analysis of the deep-sequencing method demonstrated reliable detection of poliovirus mutations at levels of <1%, depending on read depth. Sequencing of viral nucleic acids from the stool of vaccinated, asymptomatic children and their close contacts collected during a prospective cohort study in Veracruz, Mexico, revealed no vaccine-derived polioviruses. This was expected given that the longest duration between sequenced sample collection and the end of the most recent national immunization week was 66 days. However, we identified many low-level variants (<5%) distributed across the 5′ UTR and P1 genomic region in all three Sabin serotypes, as well as vaccine-related viruses with multiple canonical mutations associated with phenotypic reversion present at high levels (>90%). These results suggest that monitoring emerging vaccine-related poliovirus variants by deep sequencing may aid in the poliovirus endgame and efforts to ensure global polio eradication.
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Abstract
Polio cases due to wild virus are reported by only three countries in the world. Poliovirus type 2 has been globally eradicated and the last detection of poliovirus type 3 dates to November 2012. Poliovirus type 1 remains the only circulating wild strain; between January and September 2016 it caused 26 cases (nine in Afghanistan, 14 in Pakistan, three in Nigeria). The use of oral polio vaccine (OPV) has been the key to success in the eradication effort. However, paradoxically, moving towards global polio eradication, the burden caused by vaccine-derived polioviruses (VDPVs) becomes increasingly important. In this paper circulation of both wild virus and VDPVs is reviewed and implications for the polio eradication endgame are discussed. Between April and May 2016 OPV2 cessation has been implemented globally, in a coordinated switch from trivalent OPV to bivalent OPV. In order to decrease the risk for cVDPV2 re-emergence inactivated polio vaccine (IPV) has been introduced in the routine vaccine schedule of all countries. The likelihood of re-emergence of cVDPVs should markedly decrease with time after OPV cessation, but silent circulation of polioviruses cannot be ruled out even a long time after cessation. For this reason, immunity levels against polioviruses should be kept as high as possible in the population by the use of IPV, and both clinical and environmental surveillance should be maintained at a high level.
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Iliyasu Z, Verma H, Craig KT, Nwaze E, Ahmad-Shehu A, Jibir BW, Gwarzo GD, Gajida AU, Weldon WC, Steven Oberste M, Takane M, Mkanda P, Muhammad AJG, Sutter RW. Poliovirus seroprevalence before and after interruption of poliovirus transmission in Kano State, Nigeria. Vaccine 2016; 34:5125-5131. [PMID: 27591950 PMCID: PMC5036508 DOI: 10.1016/j.vaccine.2016.08.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/14/2016] [Accepted: 08/17/2016] [Indexed: 11/18/2022]
Abstract
Polio seroprevalence surveys help measure progress towards polio eradication. Nigeria program conducted multiple seroprevalence surveys in northern states. This article covers seroprevalence survey in Kano Nigeria in 2013 and 2014. Data represents levels before and after the interruption of poliovirus transmission. Significant improvement in seroprevalence in 2014 over 2013, but gaps continue. Good participation even by vaccine refusers in this health facility based project.
Introduction In September 2015, Nigeria was removed from the list of polio-endemic countries after more than 12 months had passed since the detection of last wild poliovirus case in the country on 24 July 2014. We are presenting here a report of two polio seroprevalence surveys conducted in September 2013 and October 2014, respectively, in the Kano state of northern Nigeria. Methods Health facility based seroprevalence surveys were undertaken at Murtala Mohammad Specialist Hospital, Kano. Parents or guardians of children aged 6–9 months, 36–47 months, 5–9 years and 10–14 years in 2013 and 6–9 months and 19–22 months (corresponding to 6–9 months range at the time of 2013 survey) in 2014 presenting to the outpatient department, were approached for participation, screened for eligibility and asked to provide informed consent. A questionnaire was administered and a blood sample collected for polio neutralization assay. Results Among subjects aged 6–9 months in the 2013 survey, seroprevalence was 58% (95% confidence interval [CI] 51–66%) to poliovirus type 1, 42% (95% CI 34–50%) to poliovirus type 2, and 52% (95% CI 44–60%) to poliovirus type 3. Among children 36–47 months and older, seroprevalence was 85% or higher for all three serotypes. In 2014, seroprevalence in 6–9 month infants was 72% (95% CI 65–79%) for type 1, 59% (95% CI 52–66%) for type 2, and 65% (95% CI 57–72%) for type 3 and in 19–22 months, 80% (95% CI 74–85%), 57% (49–63%) and 78% (71–83%) respectively. Seroprevalence was positively associated with history of increasing oral poliovirus vaccine doses. Conclusions There was significant improvement in seroprevalence in 2014 over the 2013 levels indicating a positive impact of recent programmatic interventions. However the continued low seroprevalence in 6–9 month age is a concern and calls for improved immunization efforts to sustain the polio-free Nigeria.
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Affiliation(s)
- Zubairu Iliyasu
- Department of Community Medicine, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | | | | | - Eric Nwaze
- National Primary Health Care Development Agency, Abuja, Nigeria
| | | | - Binta Wudil Jibir
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Garba Dayyabu Gwarzo
- Department of Pediatrics, Aminu Kano Teaching Hospital & Bayero University, Kano, Nigeria
| | - Auwalu U Gajida
- Department of Community Medicine, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - William C Weldon
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - M Steven Oberste
- Centers for Disease Control and Prevention, Atlanta, GA, United States
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Pons-Salort M, Burns CC, Lyons H, Blake IM, Jafari H, Oberste MS, Kew OM, Grassly NC. Preventing Vaccine-Derived Poliovirus Emergence during the Polio Endgame. PLoS Pathog 2016; 12:e1005728. [PMID: 27384947 PMCID: PMC4934862 DOI: 10.1371/journal.ppat.1005728] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 06/06/2016] [Indexed: 12/28/2022] Open
Abstract
Reversion and spread of vaccine-derived poliovirus (VDPV) to cause outbreaks of poliomyelitis is a rare outcome resulting from immunisation with the live-attenuated oral poliovirus vaccines (OPVs). Global withdrawal of all three OPV serotypes is therefore a key objective of the polio endgame strategic plan, starting with serotype 2 (OPV2) in April 2016. Supplementary immunisation activities (SIAs) with trivalent OPV (tOPV) in advance of this date could mitigate the risks of OPV2 withdrawal by increasing serotype-2 immunity, but may also create new serotype-2 VDPV (VDPV2). Here, we examine the risk factors for VDPV2 emergence and implications for the strategy of tOPV SIAs prior to OPV2 withdrawal. We first developed mathematical models of VDPV2 emergence and spread. We found that in settings with low routine immunisation coverage, the implementation of a single SIA increases the risk of VDPV2 emergence. If routine coverage is 20%, at least 3 SIAs are needed to bring that risk close to zero, and if SIA coverage is low or there are persistently "missed" groups, the risk remains high despite the implementation of multiple SIAs. We then analysed data from Nigeria on the 29 VDPV2 emergences that occurred during 2004-2014. Districts reporting the first case of poliomyelitis associated with a VDPV2 emergence were compared to districts with no VDPV2 emergence in the same 6-month period using conditional logistic regression. In agreement with the model results, the odds of VDPV2 emergence decreased with higher routine immunisation coverage (odds ratio 0.67 for a 10% absolute increase in coverage [95% confidence interval 0.55-0.82]). We also found that the probability of a VDPV2 emergence resulting in poliomyelitis in >1 child was significantly higher in districts with low serotype-2 population immunity. Our results support a strategy of focused tOPV SIAs before OPV2 withdrawal in areas at risk of VDPV2 emergence and in sufficient number to raise population immunity above the threshold permitting VDPV2 circulation. A failure to implement this risk-based approach could mean these SIAs actually increase the risk of VDPV2 emergence and spread.
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Affiliation(s)
- Margarita Pons-Salort
- Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, United Kingdom
| | - Cara C. Burns
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hil Lyons
- Institute for Disease Modeling, Seattle, Washington, United States of America
| | - Isobel M. Blake
- Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, United Kingdom
| | - Hamid Jafari
- World Health Organization (WHO), Geneva, Switzerland
| | - M. Steven Oberste
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Olen M. Kew
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Nicholas C. Grassly
- Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, United Kingdom
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Craig KT, Verma H, Iliyasu Z, Mkanda P, Touray K, Johnson T, Walla A, Banda R, Tegegne SG, Yehualashet YG, Abba B, Ahmad-Shehu A, Takane M, Sutter RW, Nsubuga P, Muhammad AJG, Vaz RG. Role of Serial Polio Seroprevalence Studies in Guiding Implementation of the Polio Eradication Initiative in Kano, Nigeria: 2011-2014. J Infect Dis 2016; 213 Suppl 3:S124-30. [PMID: 26908720 PMCID: PMC4818560 DOI: 10.1093/infdis/jiv774] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nigeria was one of 3 polio-endemic countries before it was de-listed in September 2015 by the World Health Organization, following interruption of transmission of the poliovirus. During 2011-2014, Nigeria conducted serial polio seroprevalence surveys (SPS) in Kano Metropolitan Area, comprising 8 local government areas (LGAs) in Kano that is considered very high risk (VHR) for polio, to monitor performance of the polio eradication program and guide the program in the adoption of innovative strategies. METHODS Study subjects who resided in any of the 8 local government areas of Kano Metropolitan Area and satisfied age criteria were recruited from patients at Murtala Mohammed Specialist Hospital (Kano) for 3 seroprevalence surveys. The same methods were used to conduct each survey. RESULTS The 2011 study showed seroprevalence values of 81%, 75%, and 73% for poliovirus types 1, 2, and 3, respectively, among infants aged 6-9 months age. Among children aged 36-47 months, seroprevalence values were greater (91%, 87%, and 85% for poliovirus types 1, 2, and 3, respectively).In 2013, the results showed that the seroprevalence was unexpectedly low among infants aged 6-9 months, remained high among children aged 36-47 months, and increased minimally among children aged 5-9 years and those aged 10-14 years. The baseline seroprevalence among infants aged 6-9 months in 2014 was better than that in 2013. CONCLUSIONS The results from the polio seroprevalence surveys conducted in Kano Metropolitan Area in 2011, 2013, and 2014 served to assess the trends in immunity and program performance, as well as to guide the program, leading to various interventions being implemented with good effect, as evidenced by the reduction of poliovirus circulation in Kano.
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Affiliation(s)
| | | | - Zubairu Iliyasu
- Aminu Kano Teaching Hospital Bayero University, Kano, Nigeria
| | - Pascal Mkanda
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Kebba Touray
- World Health Organization, Country Representative Office
| | - Ticha Johnson
- World Health Organization, Country Representative Office
| | | | - Richard Banda
- World Health Organization, Country Representative Office
| | | | | | - Bashir Abba
- World Health Organization, Country Representative Office
| | | | | | | | | | | | - Rui G Vaz
- World Health Organization, Country Representative Office
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Xu W, Zhang Y. Isolation and Characterization of Vaccine-Derived Polioviruses, Relevance for the Global Polio Eradication Initiative. Methods Mol Biol 2016; 1387:213-26. [PMID: 26983736 DOI: 10.1007/978-1-4939-3292-4_10] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Stool specimens were collected from children with acute flaccid paralysis (AFP) and their contacts, and viral isolation was performed according to standard procedures. If the specimens tested positive for poliovirus, then intratypic differentiation (ITD) methods were performed on the viral isolates to determine whether the poliovirus isolates were wild or of vaccine origin, these include a poliovirus diagnostic ITD real-time PCR method and a vaccine-derived poliovirus (VDPV) screening real-time PCR method.Viral RNA was extracted from the poliovirus isolates by using the QIAamp Mini Viral RNA Extraction Kit (Qiagen) and was used for RT-PCR amplification by the standard method. The entire VP1 region of the poliovirus isolates was amplified by RT-PCR with primers that flanked the VP1-coding region. After purification of the PCR products by the QIAquick Gel Extraction Kit (Qiagen), the amplicons were bidirectionally sequenced with the ABI PRISM 3130 Genetic Analyzer (Applied Biosystems). A neurovirulence test of polioviruses isolates was carried out using PVR-Tg21 mice that expressed the human poliovirus receptor (CD155). And the temperature sensitivities of polioviruses isolates were assayed on monolayer RD cells in 24-well plates as described.
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Zhang Y, Yan D, Zhu S, Nishimura Y, Ye X, Wang D, Jorba J, Zhu H, An H, Shimizu H, Kew O, Xu W. An Insight into Recombination with Enterovirus Species C and Nucleotide G-480 Reversion from the Viewpoint of Neurovirulence of Vaccine-Derived Polioviruses. Sci Rep 2015; 5:17291. [PMID: 26603565 DOI: 10.1038/srep17291] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 10/28/2015] [Indexed: 12/03/2022] Open
Abstract
A poliomyelitis outbreak caused by type 1 circulating vaccine-derived polioviruses
(cVDPVs) was identified in China in 2004. Six independent cVDPVs (eight isolates)
could be grouped into a single cluster with pathways of divergence different from a
single cVDPV progenitor, which circulated and evolved into both a highly
neurovirulent lineage and a less neurovirulent lineage. They were as neurovirulent
as the wild type 1 Mahoney strain, recombination was absent, and their nucleotide
480-G was identical to that of the Sabin strain. The Guizhou/China cVDPV strains
shared 4 amino acid replacements in the NAg sites: 3 located at the BC loop, which
may underlie the aberrant results of the ELISA intratypic differentiation (ITD)
test. The complete ORF tree diverged into two main branches from a common ancestral
infection estimated to have occurred in about mid-September 2003, nine months before
the appearance of the VDPV case, which indicated recently evolved VDPV. Further,
recombination with species C enteroviruses may indicate the presence and density of
these enteroviruses in the population and prolonged virus circulation in the
community. The aforementioned cVDPVs has important implications in the global
initiative to eradicate polio: high quality surveillance permitted earliest
detection and response.
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Famulare M, Chang S, Iber J, Zhao K, Adeniji JA, Bukbuk D, Baba M, Behrend M, Burns CC, Oberste MS. Sabin Vaccine Reversion in the Field: a Comprehensive Analysis of Sabin-Like Poliovirus Isolates in Nigeria. J Virol 2016; 90:317-31. [PMID: 26468545 DOI: 10.1128/JVI.01532-15] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/07/2015] [Indexed: 02/05/2023] Open
Abstract
UNLABELLED To assess the dynamics of genetic reversion of live poliovirus vaccine in humans, we studied molecular evolution in Sabin-like poliovirus isolates from Nigerian acute flaccid paralysis cases obtained from routine surveillance. We employed a novel modeling approach to infer substitution and recombination rates from whole-genome sequences and information about poliovirus infection dynamics and the individual vaccination history. We confirmed observations from a recent vaccine trial that VP1 substitution rates are increased for Sabin-like isolates relative to the rate for the wild type due to increased nonsynonymous substitution rates. We also inferred substitution rates for attenuating nucleotides and confirmed that reversion can occur in days to weeks after vaccination. We combine our observations for Sabin-like virus evolution with the molecular clock for VP1 of circulating wild-type strains to infer that the mean time from the initiating vaccine dose to the earliest detection of circulating vaccine-derived poliovirus (cVDPV) is 300 days for Sabin-like virus type 1, 210 days for Sabin-like virus type 2, and 390 days for Sabin-like virus type 3. Phylogenetic relationships indicated transient local transmission of Sabin-like virus type 3 and, possibly, Sabin-like virus type 1 during periods of low wild polio incidence. Comparison of Sabin-like virus recombinants with known Nigerian vaccine-derived poliovirus recombinants shows that while recombination with non-Sabin enteroviruses is associated with cVDPV, the recombination rates are similar for Sabin isolate-Sabin isolate and Sabin isolate-non-Sabin enterovirus recombination after accounting for the time from dosing to the time of detection. Our study provides a comprehensive picture of the evolutionary dynamics of the oral polio vaccine in the field. IMPORTANCE The global polio eradication effort has completed its 26th year. Despite success in eliminating wild poliovirus from most of the world, polio persists in populations where logistical, social, and political factors have not allowed vaccination programs of sustained high quality. One issue of critical importance is eliminating circulating vaccine-derived polioviruses (cVDPVs) that have properties indistinguishable from those of wild poliovirus and can cause paralytic disease. cVDPV emerges due to the genetic instability of the Sabin viruses used in the oral polio vaccine (OPV) in populations that have low levels of immunity to poliovirus. However, the dynamics responsible are incompletely understood because it has historically been difficult to gather and interpret data about evolution of the Sabin viruses used in OPV in regions where cVDPV has occurred. This study is the first to combine whole-genome sequencing of poliovirus isolates collected during routine surveillance with knowledge about the intrahost dynamics of poliovirus to provide quantitative insight into polio vaccine evolution in the field.
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Duintjer Tebbens RJ, Pallansch MA, Cochi SL, Wassilak SGF, Thompson KM. An economic analysis of poliovirus risk management policy options for 2013-2052. BMC Infect Dis 2015; 15:389. [PMID: 26404632 PMCID: PMC4582932 DOI: 10.1186/s12879-015-1112-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 09/07/2015] [Indexed: 01/05/2023] Open
Abstract
Background The Global Polio Eradication Initiative plans for coordinated cessation of oral poliovirus vaccine (OPV) after interrupting all wild poliovirus (WPV) transmission, but many questions remain related to long-term poliovirus risk management policies. Methods We used an integrated dynamic poliovirus transmission and stochastic risk model to simulate possible futures and estimate the health and economic outcomes of maintaining the 2013 status quo of continued OPV use in most developing countries compared with OPV cessation policies with various assumptions about global inactivated poliovirus vaccine (IPV) adoption. Results Continued OPV use after global WPV eradication leads to continued high costs and/or high cases. Global OPV cessation comes with a high probability of at least one outbreak, which aggressive outbreak response can successfully control in most instances. A low but non-zero probability exists of uncontrolled outbreaks following a poliovirus reintroduction long after OPV cessation in a population in which IPV-alone cannot prevent poliovirus transmission. We estimate global incremental net benefits during 2013–2052 of approximately $16 billion (US$2013) for OPV cessation with at least one IPV routine immunization dose in all countries until 2024 compared to continued OPV use, although significant uncertainty remains associated with the frequency of exportations between populations and the implementation of long term risk management policies. Conclusions Global OPV cessation offers the possibility of large future health and economic benefits compared to continued OPV use. Long-term poliovirus risk management interventions matter (e.g., IPV use duration, outbreak response, containment, continued surveillance, stockpile size and contents, vaccine production site requirements, potential antiviral drugs, and potential safer vaccines) and require careful consideration. Risk management activities can help to ensure a low risk of uncontrolled outbreaks and preserve or further increase the positive net benefits of OPV cessation. Important uncertainties will require more research, including characterizing immunodeficient long-term poliovirus excretor risks, containment risks, and the kinetics of outbreaks and response in an unprecedented world without widespread live poliovirus exposure. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1112-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Mark A Pallansch
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Stephen L Cochi
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Steven G F Wassilak
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Duintjer Tebbens RJ, Pallansch MA, Cochi SL, Wassilak SGF, Thompson KM. An economic analysis of poliovirus risk management policy options for 2013-2052. BMC Infect Dis 2015. [PMID: 26404632 DOI: 10.1186/s12879-12015-11112-12878] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND The Global Polio Eradication Initiative plans for coordinated cessation of oral poliovirus vaccine (OPV) after interrupting all wild poliovirus (WPV) transmission, but many questions remain related to long-term poliovirus risk management policies. METHODS We used an integrated dynamic poliovirus transmission and stochastic risk model to simulate possible futures and estimate the health and economic outcomes of maintaining the 2013 status quo of continued OPV use in most developing countries compared with OPV cessation policies with various assumptions about global inactivated poliovirus vaccine (IPV) adoption. RESULTS Continued OPV use after global WPV eradication leads to continued high costs and/or high cases. Global OPV cessation comes with a high probability of at least one outbreak, which aggressive outbreak response can successfully control in most instances. A low but non-zero probability exists of uncontrolled outbreaks following a poliovirus reintroduction long after OPV cessation in a population in which IPV-alone cannot prevent poliovirus transmission. We estimate global incremental net benefits during 2013-2052 of approximately $16 billion (US$2013) for OPV cessation with at least one IPV routine immunization dose in all countries until 2024 compared to continued OPV use, although significant uncertainty remains associated with the frequency of exportations between populations and the implementation of long term risk management policies. CONCLUSIONS Global OPV cessation offers the possibility of large future health and economic benefits compared to continued OPV use. Long-term poliovirus risk management interventions matter (e.g., IPV use duration, outbreak response, containment, continued surveillance, stockpile size and contents, vaccine production site requirements, potential antiviral drugs, and potential safer vaccines) and require careful consideration. Risk management activities can help to ensure a low risk of uncontrolled outbreaks and preserve or further increase the positive net benefits of OPV cessation. Important uncertainties will require more research, including characterizing immunodeficient long-term poliovirus excretor risks, containment risks, and the kinetics of outbreaks and response in an unprecedented world without widespread live poliovirus exposure.
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Affiliation(s)
| | - Mark A Pallansch
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Stephen L Cochi
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Steven G F Wassilak
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Thompson KM, Duintjer Tebbens RJ. Health and economic consequences of different options for timing the coordinated global cessation of the three oral poliovirus vaccine serotypes. BMC Infect Dis 2015; 15:374. [PMID: 26381878 PMCID: PMC4574397 DOI: 10.1186/s12879-015-1113-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 09/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND World leaders remain committed to globally-coordinated oral poliovirus vaccine (OPV) cessation following successful eradication of wild polioviruses, but the best timing and strategy for implementation depend on existing and emerging conditions. METHODS Using an existing integrated global poliovirus risk management model, we explore alternatives to the current timing plan of coordinated cessation of each OPV serotype (i.e., OPV1, OPV2, and OPV3 cessation for serotypes 1, 2, and 3, respectively). We assume the current timing plan involves OPV2 cessation in 2016 followed by OPV1 and OPV3 cessation in 2019 and we compare this to alternative timing options, including cessation of all three serotypes in 2018 or 2019, and cessation of both OPV2 and OPV3 in 2017 followed by OPV1 in 2019. RESULTS If Supplemtal Immunization Activity frequency remains sufficiently high through cessation of the last OPV serotype, then all OPV cessation timing options prevent circulating vaccine-derived poliovirus (cVDPV) outbreaks after OPV cessation of any serotype. The various OPV cessation timing options result in relatively modest differences in expected vaccine-associated paralytic poliomyelitis cases and expected total of approximately 10-13 billion polio vaccine doses used. However, the expected amounts of vaccine of different OPV formulations needed changes dramatically with each OPV cessation timing option. Overall health economic impacts remain limited for timing options that only change the OPV formulation but preserve the currently planned year for cessation of the last OPV serotype and the global introduction of inactivated poliovirus vaccine (IPV) introduction. Earlier cessation of the last OPV serotype or later global IPV introduction yield approximately $1 billion in incremental net benefits due to saved vaccination costs, although the logistics of implementation of OPV cessation remain uncertain and challenging. CONCLUSIONS All countries should maintain the highest possible levels of population immunity to transmission for each poliovirus serotype prior to the coordinated cessation of the OPV serotype to manage cVDPV risks. If OPV2 cessation gets delayed, then global health leaders should consider other OPV cessation timing options.
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Thompson KM, Duintjer Tebbens RJ. Health and economic consequences of different options for timing the coordinated global cessation of the three oral poliovirus vaccine serotypes. BMC Infect Dis 2015. [PMID: 26381878 DOI: 10.1186/s12879-12015-11113-12877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND World leaders remain committed to globally-coordinated oral poliovirus vaccine (OPV) cessation following successful eradication of wild polioviruses, but the best timing and strategy for implementation depend on existing and emerging conditions. METHODS Using an existing integrated global poliovirus risk management model, we explore alternatives to the current timing plan of coordinated cessation of each OPV serotype (i.e., OPV1, OPV2, and OPV3 cessation for serotypes 1, 2, and 3, respectively). We assume the current timing plan involves OPV2 cessation in 2016 followed by OPV1 and OPV3 cessation in 2019 and we compare this to alternative timing options, including cessation of all three serotypes in 2018 or 2019, and cessation of both OPV2 and OPV3 in 2017 followed by OPV1 in 2019. RESULTS If Supplemtal Immunization Activity frequency remains sufficiently high through cessation of the last OPV serotype, then all OPV cessation timing options prevent circulating vaccine-derived poliovirus (cVDPV) outbreaks after OPV cessation of any serotype. The various OPV cessation timing options result in relatively modest differences in expected vaccine-associated paralytic poliomyelitis cases and expected total of approximately 10-13 billion polio vaccine doses used. However, the expected amounts of vaccine of different OPV formulations needed changes dramatically with each OPV cessation timing option. Overall health economic impacts remain limited for timing options that only change the OPV formulation but preserve the currently planned year for cessation of the last OPV serotype and the global introduction of inactivated poliovirus vaccine (IPV) introduction. Earlier cessation of the last OPV serotype or later global IPV introduction yield approximately $1 billion in incremental net benefits due to saved vaccination costs, although the logistics of implementation of OPV cessation remain uncertain and challenging. CONCLUSIONS All countries should maintain the highest possible levels of population immunity to transmission for each poliovirus serotype prior to the coordinated cessation of the OPV serotype to manage cVDPV risks. If OPV2 cessation gets delayed, then global health leaders should consider other OPV cessation timing options.
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Parker EPK, Molodecky NA, Pons-Salort M, O’Reilly KM, Grassly NC. Impact of inactivated poliovirus vaccine on mucosal immunity: implications for the polio eradication endgame. Expert Rev Vaccines 2015; 14:1113-23. [PMID: 26159938 PMCID: PMC4673562 DOI: 10.1586/14760584.2015.1052800] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The polio eradication endgame aims to bring transmission of all polioviruses to a halt. To achieve this aim, it is essential to block viral replication in individuals via induction of a robust mucosal immune response. Although it has long been recognized that inactivated poliovirus vaccine (IPV) is incapable of inducing a strong mucosal response on its own, it has recently become clear that IPV may boost immunity in the intestinal mucosa among individuals previously immunized with oral poliovirus vaccine. Indeed, mucosal protection appears to be stronger following a booster dose of IPV than oral poliovirus vaccine, especially in older children. Here, we review the available evidence regarding the impact of IPV on mucosal immunity, and consider the implications of this evidence for the polio eradication endgame. We conclude that the implementation of IPV in both routine and supplementary immunization activities has the potential to play a key role in halting poliovirus transmission, and thereby hasten the eradication of polio.
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Affiliation(s)
- Edward PK Parker
- Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, UK
| | - Natalie A Molodecky
- Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, UK
| | - Margarita Pons-Salort
- Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, UK
| | - Kathleen M O’Reilly
- Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, UK
| | - Nicholas C Grassly
- Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, UK
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Duintjer Tebbens RJ, Pallansch MA, Wassilak SGF, Cochi SL, Thompson KM. Combinations of Quality and Frequency of Immunization Activities to Stop and Prevent Poliovirus Transmission in the High-Risk Area of Northwest Nigeria. PLoS One 2015; 10:e0130123. [PMID: 26068928 PMCID: PMC4465973 DOI: 10.1371/journal.pone.0130123] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 05/18/2015] [Indexed: 11/19/2022] Open
Abstract
Background Frequent supplemental immunization activities (SIAs) with the oral poliovirus vaccine (OPV) represent the primary strategy to interrupt poliovirus transmission in the last endemic areas. Materials and Methods Using a differential-equation based poliovirus transmission model tailored to high-risk areas in Nigeria, we perform one-way and multi-way sensitivity analyses to demonstrate the impact of different assumptions about routine immunization (RI) and the frequency and quality of SIAs on population immunity to transmission and persistence or emergence of circulating vaccine-derived polioviruses (cVDPVs) after OPV cessation. Results More trivalent OPV use remains critical to avoid serotype 2 cVDPVs. RI schedules with or without inactivated polio vaccine (IPV) could significantly improve population immunity if coverage increases well above current levels in under-vaccinated subpopulations. Similarly, the impact of SIAs on overall population immunity and cVDPV risks depends on their ability to reach under-vaccinated groups (i.e., SIA quality). Lower SIA coverage in the under-vaccinated subpopulation results in a higher frequency of SIAs needed to maintain high enough population immunity to avoid cVDPVs after OPV cessation. Conclusions National immunization program managers in northwest Nigeria should recognize the benefits of increasing RI and SIA quality. Sufficiently improving RI coverage and improving SIA quality will reduce the frequency of SIAs required to stop and prevent future poliovirus transmission. Better information about the incremental costs to identify and reach under-vaccinated children would help determine the optimal balance between spending to increase SIA and RI quality and spending to increase SIA frequency.
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Affiliation(s)
| | - Mark A. Pallansch
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Steven G. F. Wassilak
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Stephen L. Cochi
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Adeniji JA, Osundare FA, Adewumi OM, Onoja AB, Fagbami AH. Immunity to poliovirus serotypes in children population of selected communities in South-west, Nigeria. Afr J Infect Dis 2015; 9:1-5. [PMID: 25722843 PMCID: PMC4325351 DOI: 10.4314/ajid.v9i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Poliovirus outbreaks are still reported in Nigeria despite renewed efforts to improve vaccine coverage, thus suggesting the existence of susceptible hosts. Also, there is anecdotal evidence of variation in vaccine coverage by region and specifically between urban and rural communities. Consequently, this study assessed neutralizing antibodies to poliovirus serotypes among children in selected urban and rural communities in south western Nigeria. METHODOLOGY Two hundred and forty-four {(M=119, F=125); Urban: 142 (M=63, F=79); Rural: 102 (M=56, F=46)} children of consenting parent/guardian aged one week to 15 years were enrolled for the study. About 2-3ml of blood was collected from each child by venepuncture into a labelled sterile container free of anticoagulants. Subsequently, questionnaire was administered to the parent/guardian of each child to retrieve relevant information. Recovered sera were analysed for detectable neutralizing antibodies to poliovirus serotypes by the standard method of constant virus, varying serum dilutions. RESULTS Overall, 64.3% (n=157) of the children had detectable neutralizing antibodies to the three poliovirus serotypes. Also, 84.8% (n=207), 91.0% (n=222) and 75.0% (n=183) of the children had detectable antibodies to poliovirus serotypes 1, 2 and 3 respectively. Eighty seven (35.7%) of the children had no detectable neutralizing antibody to at least one of the three poliovirus serotypes, while 9 (3.7%) children had no detectable neutralizing antibody to the three poliovirus serotypes. Geometric mean titre (GMT) of neutralizing antibodies to the three poliovirus serotypes varied significantly (p=0.0005). CONCLUSION Disparity in immunity to poliovirus infection and existence of children with low or zero neutralizing antibody levels were confirmed.
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Affiliation(s)
- Johnson Adekunle Adeniji
- Department of Virology, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Folakemi Abiodun Osundare
- Department of Science Laboratory Technology, School of Applied Science, The Federal Polytechnic, Ede, Nigeria
| | - Olubusuyi Moses Adewumi
- Department of Virology, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Anyebe Bernard Onoja
- Department of Virology, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Ademola Hezekiah Fagbami
- Department of Biological Sciences, Faculty of Science, Ondo State University of Science and Technology, Okitipupa, Nigeria
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Endegue-Zanga MC, Sadeuh-Mba SA, Iber J, Burns C, Nimpa-Mengouo M, Demanou M, Vernet G, Etoa FX, Njouom R. Circulating vaccine-derived polioviruses in the Extreme North region of Cameroon. J Clin Virol 2015; 62:80-3. [DOI: 10.1016/j.jcv.2014.11.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 11/21/2014] [Accepted: 11/23/2014] [Indexed: 12/23/2022]
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Abstract
The attenuated oral poliovirus vaccine (OPV) has many properties favoring its use in polio eradication: ease of administration, efficient induction of intestinal immunity, induction of durable humoral immunity, and low cost. Despite these advantages, OPV has the disadvantage of genetic instability, resulting in rare and sporadic cases of vaccine-associated paralytic poliomyelitis (VAPP) and the emergence of genetically divergent vaccine-derived polioviruses (VDPVs). Whereas VAPP is an adverse event following exposure to OPV, VDPVs are polioviruses whose genetic properties indicate prolonged replication or transmission. Three categories of VDPVs are recognized: (1) circulating VDPVs (cVDPVs) from outbreaks in settings of low OPV coverage, (2) immunodeficiency-associated VDPVs (iVDPVs) from individuals with primary immunodeficiencies, and (3) ambiguous VDPVs (aVDPVs), which cannot be definitively assigned to either of the first 2 categories. Because most VDPVs are type 2, the World Health Organization's plans call for coordinated worldwide replacement of trivalent OPV with bivalent OPV containing poliovirus types 1 and 3.
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Affiliation(s)
- Cara C Burns
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Olen M Kew
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
Polio eradication requires the removal of all polioviruses from human populations, whether wild poliovirus or those emanating from the oral poliovirus vaccine (OPV). The Polio Eradication & Endgame Strategic Plan 2013-2018 provides a framework for interruption of wild poliovirus transmission in remaining endemic foci and lays out a plan for the new polio end game, which includes the withdrawal of Sabin strains, starting with type 2, and the introduction of inactivated poliovirus vaccine, for risk mitigation purposes. This report summarizes the rationale and evidence that supports the policy decision to switch from trivalent OPV to bivalent OPV and to introduce 1 dose of inactivated poliovirus vaccine into routine immunization schedules, and it describes the proposed implementation of this policy in countries using trivalent OPV.
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Affiliation(s)
- Roland W Sutter
- Polio Eradication & Emergency Cluster (PEC), World Health Organization, Geneva, Switzerland
| | - Lauren Platt
- Polio Eradication & Emergency Cluster (PEC), World Health Organization, Geneva, Switzerland
| | - Ondrej Mach
- Polio Eradication & Emergency Cluster (PEC), World Health Organization, Geneva, Switzerland
| | - Hamid Jafari
- Polio Eradication & Emergency Cluster (PEC), World Health Organization, Geneva, Switzerland
| | - R Bruce Aylward
- Polio Eradication & Emergency Cluster (PEC), World Health Organization, Geneva, Switzerland
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Kalkowska DA, Duintjer Tebbens RJ, Thompson KM. Modeling strategies to increase population immunity and prevent poliovirus transmission in the high-risk area of northwest Nigeria. J Infect Dis 2014; 210 Suppl 1:S412-23. [PMID: 25316863 DOI: 10.1093/infdis/jit834] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Nigeria continues to struggle in its efforts to eliminate circulating live polioviruses using oral poliovirus vaccine (OPV). METHODS We modeled population immunity, and we estimated cases and the timing of transmission die-out for numerous policies that could accelerate the elimination of wild poliovirus type 1 (WPV1) and help Nigeria manage the risks of circulating vaccine-derived polioviruses (cVDPVs). We used a differential-equation based poliovirus transmission and OPV evolution model focused on northwest Nigeria to characterize the impact and trade-offs of potential vaccination strategies, including the introduction of inactivated poliovirus vaccine (IPV). RESULTS Northwest Nigeria appears close to reaching the threshold of population immunity it must exceed to stop WPV1 transmission if it continues immunizing previously under-vaccinated children. Avoiding type 2 cVDPVs (cVDPV2s) will depend on using sufficient amounts of trivalent OPV, which will also reduce the risks of cVDPV2s after coordinated cessation of type 2-containing OPV (OPV2). Using IPV during the OPV cessation period may increase population immunity, but it leads to a much lower impact on cVDPV risks than ensuring sufficient trivalent OPV use prior to OPV2 cessation. CONCLUSIONS Northwest Nigeria needs to intensify and sustain its immunization efforts to achieve and maintain higher levels of population immunity.
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Affiliation(s)
- Dominika A Kalkowska
- Kid Risk, Inc, Orlando, Florida Delft University of Technology, Delft, The Netherlands
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