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Hamisu AW, Etapelong SG, Ayodeji I, Richard B, Fiona B, Gidado S, Abbott SL, Edukugho AA, Bolu O, Adeyelu A, Mawashi KY, Adamu US, Nsubuga P, Shuaib F. Experience and findings from surveillance peer review in Nigeria, August 2017-May 2019. Pan Afr Med J 2023; 45:9. [PMID: 38370096 PMCID: PMC10874099 DOI: 10.11604/pamj.supp.2023.45.2.39450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 08/23/2023] [Indexed: 02/20/2024] Open
Abstract
Introduction acute flaccid paralysis (AFP) surveillance is the gold standard of the Global Polio Eradication Initiative (GPEI) for detecting cases of poliomyelitis and tracking poliovirus transmission. Nigeria's AFP surveillance performance indicators are among the highest in countries of the World Health Organization (WHO) African Region. The primary AFP surveillance performance indicators are the rate of non-polio AFP among children and the proportion of timely, adequate specimen collection. The surveillance working group of the National Emergency Operations Centre assessed the quality of AFP surveillance data in some reportedly high-performing states. Methods we conducted a retrospective review of AFP surveillance performance indicators in Nigeria for 2010-2019. We also reviewed data in reports from four groups of surveillance peer reviews and validation visits (conducted by in-country GPEI partners) during August 2017-May 2019 in 16 states with high primary AFP surveillance indicators; the validation visits reviewed clinical information and the dates of specimen collection and onset of paralysis with caretakers. Results there were consistently increasing AFP surveillance primary performance indicators during 2010-2016, followed by declines during 2017-2019. From the data for 16 states with peer reviews conducted from August 2017-May 2019, overall concordance of reported and "true" (validated) AFP indicator data in peer review investigations was highly variable. True AFP concordance ranged from 58%-100%, and stool timeliness concordance ranged from 56%-95%. The most common clinical causes of reported AFP cases that were not true AFP were spastic paralysis, malaria, sickle cell disease, and malnutrition. All the states that participated in peer reviews developed surveillance improvement plans based on the gaps identified. Conclusion Nigeria has highly sensitive AFP surveillance according to reported primary AFP performance indicators. The findings of peer reviews indicate that the AFP surveillance system needs to be strengthened and well-supervised to enhance data quality.
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Affiliation(s)
| | | | - Isiaka Ayodeji
- World Health Organization, Nigeria Country Office, Abuja, Nigeria
| | - Banda Richard
- World Health Organization, Nigeria Country Office, Abuja, Nigeria
| | - Braka Fiona
- World Health Organization, Nigeria Country Office, Abuja, Nigeria
| | - Saheed Gidado
- National Stop Transmission of Polio (NSTOP)/African Field Epidemiology Network (AFENET), Aso, Federal Capital Territory, Abuja, Nigeria
| | - Samuel Luka Abbott
- National Stop Transmission of Polio (NSTOP)/African Field Epidemiology Network (AFENET), Aso, Federal Capital Territory, Abuja, Nigeria
| | - Aboyowa Arayuwa Edukugho
- National Stop Transmission of Polio (NSTOP)/African Field Epidemiology Network (AFENET), Aso, Federal Capital Territory, Abuja, Nigeria
| | - Omotayo Bolu
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Asekun Adeyelu
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | | | - Usman Said Adamu
- National Primary Healthcare Development Authority, Abuja, Nigeria
| | - Peter Nsubuga
- Global Public Health Solutions, Atlanta, Georgia, United States
| | - Faisal Shuaib
- National Primary Healthcare Development Authority, Abuja, Nigeria
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Fan Q, Ma J, Li X, Jorba J, Yuan F, Zhu H, Hu L, Song Y, Wang D, Zhu S, Yan D, Chen H, Xu W, Zhang Y. Molecular evolution and antigenic drift of type 3 iVDPVs excreted from a patient with immunodeficiency in Ningxia, China. J Med Virol 2023; 95:e28215. [PMID: 36224711 DOI: 10.1002/jmv.28215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/28/2022] [Accepted: 10/11/2022] [Indexed: 01/11/2023]
Abstract
A 2.5-year-old pediatric patient with acute flaccid paralysis was diagnosed with primary immunodeficiency (PID) in Ningxia Province, China, in 2011. Twelve consecutive stool specimens were collected from the patient over a period of 10 months (18 February 2011 to 20 November 2011), and 12 immunodeficiency vaccine-derived poliovirus (iVDPV) strains (CHN15017-1 to CHN15017-12) were subsequently isolated. Nucleotide sequencing analysis of the plaque-purified iVDPVs revealed 2%-3.5% VP1-region differences from their parental Sabin 3 strain. Full-length genome sequencing showed they were all Sabin 3/Sabin 1 recombinants, sharing a common 2C-region crossover site, and the two key determinants of attenuation (U472C in the 5' untranslated region and T2493C in the VP1 region) had reverted. Temperature-sensitive experiments demonstrated that the first two iVDPV strains partially retained the temperature-sensitive phenotype's nature, while the subsequent ten iVDPV strains distinctly lost it, possibly associated with increased neurovirulence. Nineteen amino-acid substitutions were detected between 12 iVDPVs and the parental Sabin strain, of which only one (K1419R) was found on the subsequent 10 iVDPV isolates, suggesting this site's potential as a temperature-sensitive determination site. A Bayesian Monte Carlo Markov Chain phylogenetic analysis based on the P1 coding region yielded a mean iVDPV evolutionary rate of 1.02 × 10-2 total substitutions/site/year, and the initial oral-polio-vaccine dose was presumably administered around June 2009. Our findings provide valuable information regarding the genetic structure, high-temperature growth sensitivity, and antigenic properties of iVDPVs following long-term evolution in a single PID patient, thus augmenting the currently limited knowledge regarding the dynamic changes and evolutionary pathway of iVDPV populations with PID during long-term global replication.
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Affiliation(s)
- Qin Fan
- National Laboratory for poliomyelitis, WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety and National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China.,Department of HIV/AIDS Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People's Republic of China
| | - Jiangtao Ma
- Ningxia Hui Autonomous Region Center for Disease Control and Prevention, Yinchuan City, Ningxia Hui Autonomous Region, Yinchuan, People's Republic of China
| | - Xiaolei Li
- National Laboratory for poliomyelitis, WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety and National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Jaume Jorba
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fang Yuan
- Ningxia Hui Autonomous Region Center for Disease Control and Prevention, Yinchuan City, Ningxia Hui Autonomous Region, Yinchuan, People's Republic of China
| | - Hui Zhu
- National Laboratory for poliomyelitis, WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety and National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Lan Hu
- National Laboratory for poliomyelitis, WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety and National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Yang Song
- National Laboratory for poliomyelitis, WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety and National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Dongyan Wang
- National Laboratory for poliomyelitis, WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety and National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Shuangli Zhu
- National Laboratory for poliomyelitis, WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety and National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Dongmei Yan
- National Laboratory for poliomyelitis, WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety and National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Hui Chen
- Ningxia Hui Autonomous Region Center for Disease Control and Prevention, Yinchuan City, Ningxia Hui Autonomous Region, Yinchuan, People's Republic of China
| | - Wenbo Xu
- National Laboratory for poliomyelitis, WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety and National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China.,Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, People's Republic of China
| | - Yong Zhang
- National Laboratory for poliomyelitis, WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety and National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China.,Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, People's Republic of China
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3
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Sellers SC, Gosnell E, Bryant D, Belmonte S, Self S, McCarter MSJ, Kennedy K, Norman RS. Building-level wastewater surveillance of SARS-CoV-2 is associated with transmission and variant trends in a university setting. ENVIRONMENTAL RESEARCH 2022; 215:114277. [PMID: 36084672 PMCID: PMC9448636 DOI: 10.1016/j.envres.2022.114277] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 05/31/2023]
Abstract
The University of South Carolina (UofSC) was among the first universities to include building-level wastewater surveillance of SARS-CoV-2 to complement clinical testing during its reopening in the Fall 2020 semester. In the Spring 2021 semester, 24h composite wastewater samples were collected twice per week from 10 residence halls and the on-campus student isolation and quarantine building. The isolation and quarantine building served as a positive control site. The wastewater was analyzed using RT-ddPCR for the quantification of nucleocapsid genes (N1 and N2) to identify viral transmission trends within residence halls. Log10 SARS-CoV-2 RNA concentrations were compared to both new clinical cases identified in the days following wastewater collection and recovered cases returning to sites during the days preceding sample collection to test temporal and spatial associations. There was a statistically significant positive relationship between the number of cases reported from the sites during the seven-day period following wastewater sampling and the log10 viral RNA copies/L (overall IRR 1.08 (1.02, 1.16) p-value 0.0126). Additionally, a statistically significant positive relationship was identified between the number of cases returning to the residence halls after completing isolation during the seven-day period preceding wastewater sampling and the log10 viral RNA copies/L (overall 1.09 (1.01, 1.17) p-value 0.0222). The statistical significance of both identified cases and recovered return cases on log10 viral RNA copies/L in wastewater indicates the importance of including both types of clinical data in wastewater-based epidemiology (WBE) research. Genetic mutations associated with variants of concern (VOCs) were also monitored. The emergence of the Alpha variant on campus was identified, which contributed to the second wave of COVID-19 cases at UofSC. The study was able to identify sub-community transmission hotspots for targeted intervention in real-time, making WBE cost-effective and creating less of a burden on the general public compared to repeated individual testing methods.
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Affiliation(s)
- Sarah C Sellers
- Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Suite 401, Columbia, SC, USA
| | - Emily Gosnell
- Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Suite 401, Columbia, SC, USA
| | - Dillon Bryant
- Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Suite 401, Columbia, SC, USA
| | - Stefano Belmonte
- Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Suite 401, Columbia, SC, USA
| | - Stella Self
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Green Street, Columbia, SC, USA
| | - Maggie S J McCarter
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Green Street, Columbia, SC, USA
| | - Kirsten Kennedy
- Student Housing and Sustainability, Division of Student Affairs and Academic Support, University of South Carolina, 1520 Devine Street, Columbia, SC, USA
| | - R Sean Norman
- Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Suite 401, Columbia, SC, USA.
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4
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Klapsa D, Wilton T, Zealand A, Bujaki E, Saxentoff E, Troman C, Shaw AG, Tedcastle A, Majumdar M, Mate R, Akello JO, Huseynov S, Zeb A, Zambon M, Bell A, Hagan J, Wade MJ, Ramsay M, Grassly NC, Saliba V, Martin J. Sustained detection of type 2 poliovirus in London sewage between February and July, 2022, by enhanced environmental surveillance. Lancet 2022; 400:1531-1538. [PMID: 36243024 PMCID: PMC9627700 DOI: 10.1016/s0140-6736(22)01804-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The international spread of poliovirus exposes all countries to the risk of outbreaks and is designated a Public Health Emergency of International Concern by WHO. This risk can be exacerbated in countries using inactivated polio vaccine, which offers excellent protection against paralysis but is less effective than oral vaccine against poliovirus shedding, potentially allowing circulation without detection of paralytic cases for long periods of time. Our study investigated the molecular properties of type 2 poliovirus isolates found in sewage with an aim to detect virus transmission in the community. METHODS We performed environmental surveillance in London, UK, testing sewage samples using WHO recommended methods that include concentration, virus isolation in cell culture, and molecular characterisation. We additionally implemented direct molecular detection and determined whole-genome sequences of every isolate using novel nanopore protocols. FINDINGS 118 genetically linked poliovirus isolates related to the serotype 2 Sabin vaccine strain were detected in 21 of 52 sequential sewage samples collected in London between Feb 8 and July 4, 2022. Expansion of environmental surveillance sites in London helped localise transmission to several boroughs in north and east London. All isolates have lost two key attenuating mutations, are recombinants with a species C enterovirus, and an increasing proportion (20 of 118) meet the criterion for a vaccine-derived poliovirus, having six to ten nucleotide changes in the gene coding for VP1 capsid protein. INTERPRETATION Environmental surveillance allowed early detection of poliovirus importation and circulation in London, permitting a rapid public health response, including enhanced surveillance and an inactivated polio vaccine campaign among children aged 1-9 years. Whole-genome sequences generated through nanopore sequencing established linkage of isolates and confirmed transmission of a unique recombinant poliovirus lineage that has now been detected in Israel and the USA. FUNDING Medicines and Healthcare products Regulatory Agency, UK Health Security Agency, Bill & Melinda Gates Foundation, and National Institute for Health Research Medical Research Council.
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Affiliation(s)
- Dimitra Klapsa
- Division of Vaccines, National Institute for Biological Standards and Control, Medicines and Healthcare products Regulatory Agency, Potters Bar, UK
| | - Thomas Wilton
- Division of Vaccines, National Institute for Biological Standards and Control, Medicines and Healthcare products Regulatory Agency, Potters Bar, UK
| | - Andrew Zealand
- Environmental Monitoring for Health Protection, Data, Analytics and Surveillance Group, UK Health Security Agency, Nobel House, London, UK
| | - Erika Bujaki
- Division of Vaccines, National Institute for Biological Standards and Control, Medicines and Healthcare products Regulatory Agency, Potters Bar, UK
| | - Eugene Saxentoff
- World Health Organization Regional Office for Europe, Regional Polio Laboratory Network, Copenhagen, Denmark
| | - Catherine Troman
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Alexander G Shaw
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Alison Tedcastle
- Division of Vaccines, National Institute for Biological Standards and Control, Medicines and Healthcare products Regulatory Agency, Potters Bar, UK
| | - Manasi Majumdar
- Division of Vaccines, National Institute for Biological Standards and Control, Medicines and Healthcare products Regulatory Agency, Potters Bar, UK
| | - Ryan Mate
- Division of Analytical and Biological Science, National Institute for Biological Standards and Control, Medicines and Healthcare products Regulatory Agency, Potters Bar, UK
| | - Joyce O Akello
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Shahin Huseynov
- World Health Organization Regional Office for Europe, Regional Polio Laboratory Network, Copenhagen, Denmark
| | - Ali Zeb
- Environmental Monitoring for Health Protection, Data, Analytics and Surveillance Group, UK Health Security Agency, Nobel House, London, UK
| | - Maria Zambon
- National Polio Laboratory, Reference Services Division, UK Health Security Agency, London, UK
| | - Anita Bell
- North East and North Central London Health Protection Team, UK Health Security Agency, London, UK
| | - José Hagan
- World Health Organization Regional Office for Europe, Regional Polio Laboratory Network, Copenhagen, Denmark
| | - Matthew J Wade
- Environmental Monitoring for Health Protection, Data, Analytics and Surveillance Group, UK Health Security Agency, Nobel House, London, UK
| | - Mary Ramsay
- Immunisation and Vaccine Preventable Disease Division, UK Health Security Agency, London, UK
| | - Nicholas C Grassly
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Vanessa Saliba
- Immunisation and Vaccine Preventable Disease Division, UK Health Security Agency, London, UK
| | - Javier Martin
- Division of Vaccines, National Institute for Biological Standards and Control, Medicines and Healthcare products Regulatory Agency, Potters Bar, UK.
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5
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Kilaru P, Hill D, Anderson K, Collins MB, Green H, Kmush BL, Larsen DA. Wastewater Surveillance for Infectious Disease: A Systematic Review. Am J Epidemiol 2022; 192:305-322. [PMID: 36227259 PMCID: PMC9620728 DOI: 10.1093/aje/kwac175] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 08/25/2022] [Accepted: 10/05/2022] [Indexed: 02/07/2023] Open
Abstract
Wastewater surveillance for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been shown to be a valuable source of information regarding SARS-CoV-2 transmission and coronavirus disease 2019 (COVID-19) cases. Although the method has been used for several decades to track other infectious diseases, there has not been a comprehensive review outlining all of the pathogens that have been surveilled through wastewater. Herein we identify the infectious diseases that have been previously studied via wastewater surveillance prior to the COVID-19 pandemic. Infectious diseases and pathogens were identified in 100 studies of wastewater surveillance across 38 countries, as were themes of how wastewater surveillance and other measures of disease transmission were linked. Twenty-five separate pathogen families were identified in the included studies, with the majority of studies examining pathogens from the family Picornaviridae, including polio and nonpolio enteroviruses. Most studies of wastewater surveillance did not link what was found in the wastewater to other measures of disease transmission. Among those studies that did, the value reported varied by study. Wastewater surveillance should be considered as a potential public health tool for many infectious diseases. Wastewater surveillance studies can be improved by incorporating other measures of disease transmission at the population-level including disease incidence and hospitalizations.
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Affiliation(s)
- Pruthvi Kilaru
- Department of Public Health, Syracuse University, Syracuse, New York, United States,Des Moines University College of Osteopathic Medicine, Des Moines, Iowa, United States
| | - Dustin Hill
- Department of Public Health, Syracuse University, Syracuse, New York, United States,Graduate Program in Environmental Science, State University of New York College of Environmental Science and Forestry, Syracuse, New York, United States
| | - Kathryn Anderson
- Department of Medicine, State University of New York Upstate Medical University, Syracuse, New York, United States
| | - Mary B Collins
- Department of Environmental Studies, State University of New York College of Environmental Science, Syracuse, New York, United States
| | - Hyatt Green
- Department of Environmental Biology, State University of New York College of Environmental Science, Syracuse, New York, United States
| | - Brittany L Kmush
- Department of Public Health, Syracuse University, Syracuse, New York, United States
| | - David A Larsen
- Correspondence to Dr. Dave Larsen, Department of Public Health, Syracuse University, 430C White Hall, Syracuse, NY 13244 ()
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6
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Dzinamarira T, Pierre G, Iradukunda PG, Tungwarara N, Mukwenha S, Mpabuka E, Mataruka K, Chitungo I, Musuka G, Murewanhema G. Epidemiological surveillance of enteric viral diseases using wastewater in Africa - A rapid review. J Infect Public Health 2022; 15:703-707. [PMID: 35661916 DOI: 10.1016/j.jiph.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/27/2022] [Accepted: 05/19/2022] [Indexed: 12/24/2022] Open
Abstract
Viral enteric pathogens remain an important cause of diarrhoeal outbreaks among children in sub-Saharan Africa (SSA). Consequently, diarrhoeal illness remains a significant cause of morbidity and mortality in the under-fives in SSA. These outbreaks associated with viral pathogens tend to be seasonal and early warning systems for impending outbreaks could be very crucial for triggering preventive public health response and building public health resilience to deal with increased demand for medical services. Wastewater surveillance for pathogens is an important epidemiological component that could inform early warning systems. The objective of this rapid review was to evaluate the use of wastewater for epidemiology surveillance of enteric viral pathogens. Nine studies met the inclusion criteria. Eight viral pathogens were reviewed and analysed from 6 countries that performed wastewater analysis. Six studies explored the epidemiologic significance of viral pathogens in wastewater. The findings of this review revealed that monitoring of wastewater can provide an additional tool to determine the epidemiology of viral pathogens circulating in the community thereby providing early warning of potential outbreaks using wastewater-based epidemiology methods. Five of the included studies revealed the occurrence of viral pathogens in raw sewage and treated wastewater as an indication of inefficient elimination of viruses leading to potential release into water sources which presents a public health risk, increasing the risk of inducing gastroenteritis in the population. Six studies revealed the need for public health authorities to realise the potential benefit of environmental surveillance (ES) as an additional tool to determine the epidemiology of viral pathogens circulating in each community. Despite the significant public health challenge associated with enteric viral pathogens in sub-Saharan Africa, there remains remarkable underinvestment in potentially epidemiologically beneficial research, including wastewater-based epidemiology for these infections.
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Affiliation(s)
- Tafadzwa Dzinamarira
- School of Health Systems & Public Health, University of Pretoria, Pretoria 0002, South Africa; ICAP at Columbia University, Kigali, Rwanda.
| | - Gashema Pierre
- College of Medicine and Veterinary Medicine, University of Edinburgh, UK
| | | | - Nigel Tungwarara
- Department of Health Studies, University of South Africa, South Africa
| | | | | | - Kidson Mataruka
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Itai Chitungo
- College of Medicine and Health Sciences, Faculty of Medicine, University of Zimbabwe, Harare, Zimbabwe
| | | | - Grant Murewanhema
- College of Medicine and Health Sciences, Faculty of Medicine, University of Zimbabwe, Harare, Zimbabwe
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7
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Ahmed SH, Nguku P, Gidado SO, Bawa MK, Shehu UL, Abdullahi A, Obansa RU, Getso KI, Mahmoud MN, Bello IW, Sharif YM, Abba B, Umar S, Waziri NE, Ohunabunwo C. Progress toward poliomyelitis eradication in Kano State, Nigeria, 2010 - 2017. Pan Afr Med J 2021; 40:9. [PMID: 36157557 PMCID: PMC9474848 DOI: 10.11604/pamj.supp.2021.40.1.19318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 02/13/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Kano State in Northern Nigeria was a major source of Wild Polio Virus (WPV) cases in Nigeria up until 2015. In 2009, the State reported 168 WPV cases out of the 388 reported nationally. This paper characterizes the progress made by Kano State in polio eradication. Methods In December 2017, we conducted a descriptive review of Routine Immunization (RI) from both the District Vaccine Data Management Tool (DVD-MT) and District Health Information System (DHIS2) from 2010 to 2017. Also, we reviewed the Acute Flaccid Paralysis (AFP) and Supplementary Immunization Activities (SIAs) data reported for Kano State from 2010 to 2017. Also, we obtained the number of reported WPV cases by serotypes. Results From 2010 to 2017, a total of 65 confirmed WPV cases were reported in Kano State. Of these, 58 (89%) were WPV1 and 7 (11%) WPV3. Almost half of these cases were reported in 2012 from 14 LGAs. The number of reported cases fell to 15 (23%) in 10 LGAs in 2013, and further decreased to 5 (8%) in four LGAs in 2014. No new WPV cases have been detected in Kano since 2015. During the same period, 23 circulating Vaccine Derived Polio Viruses (cVDPV2) cases were reported in Kano. Specifically, 10 LGAs reported 10 cases in 2011. Three LGAs reported three cases in 2012, while eight LGAs reported 10 total cases in 2014. During the 2010 to 2017 period 61 SIAs were conducted. Conclusion Kano State made progress toward polio eradication. Sustained eradication efforts, in form of high quality RI, SIAs and AFP surveillance are necessary to avert possible importation from 2016 polio resurgence in nearby Borno State, Nigeria.
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Affiliation(s)
- Suleiman Haladu Ahmed
- Field Epidemiology Network, Abuja, Nigeria,,Corresponding author: Suleiman Haladu Ahmed, African Field Epidemiology Network, Abuja, Nigeria.
| | | | | | | | | | | | | | | | | | | | | | - Bashir Abba
- World Health Organization, Kano Office, Nigeria
| | - Sani Umar
- World Health Organization, Kano Office, Nigeria
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8
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Okeke IN, Ihekweazu C. The importance of molecular diagnostics for infectious diseases in low-resource settings. Nat Rev Microbiol 2021; 19:547-548. [PMID: 34183821 PMCID: PMC8237771 DOI: 10.1038/s41579-021-00598-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 02/03/2023]
Abstract
In settings with limited resources and a wide range of possible etiologies, molecular technologies offer an effective solution for infectious disease diagnostics, because they are agile, fast and flexible. Health systems that routinely use molecular diagnostics will achieve economies of scale, maximize limited expertize and rapidly respond to new threats.
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Affiliation(s)
- Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Oyo State, Nigeria.
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9
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Alleman MM, Coulliette-Salmond AD, Wilnique P, Belgasmi-Wright H, Sayyad L, Wong K, Gue E, Barrais R, Rey-Benito G, Burns CC, Vega E. Environmental Surveillance for Polioviruses in Haïti (2017-2019): The Dynamic Process for the Establishment and Monitoring of Sampling Sites. Viruses 2021; 13:v13030505. [PMID: 33803868 PMCID: PMC8003210 DOI: 10.3390/v13030505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023] Open
Abstract
Haïti is at risk for wild poliovirus (WPV) importation and circulation, as well as vaccine-derived poliovirus (VDPV) emergence. Environmental surveillance (ES) for polioviruses was established in Port au Prince and Gonaïves in 2016. During 2017–2019, initial ES sites were re-evaluated, and ES was expanded into Cap Haïtien and Saint Marc. Wastewater samples and data on weather, hour of collection, and sample temperature and pH were collected every 4 weeks during March 2017–December 2019 (272 sampling events) from 21 sites in Cap Haïtien, Gonaïves, Port au Prince, and Saint Marc. Samples were processed for the detection of polio and non-polio enteroviruses using the two-phase and “Concentration and Filter Elution” methodologies. Polioviruses were serotyped and underwent intra-typic characterization. No WPV or VDPVs were isolated. Sabin-like polioviruses (oral vaccine strain) of serotypes 1 and 3 were sporadically detected. Five of six (83%), one of six (17%), five of six (83%), and two of three (67%) sites evaluated in Cap Haïtien, Gonaïves, Port au Prince, and Saint Marc, respectively, had enterovirus isolation from >50% of sampling events; these results and considerations, such as watershed population size and overlap, influence of sea water, and excessive particulates in samples, were factors in site retention or termination. The evaluation of 21 ES sampling sites in four Haïtian cities led to the termination of 11 sites. Every-four-weekly sampling continues at the remaining 10 sites across the four cities as a core Global Polio Eradication Initiative activity.
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Affiliation(s)
- Mary M. Alleman
- Polio Eradication Branch, Centers for Disease Control and Prevention, Global Immunization Division, Atlanta, GA 30329, USA
- Correspondence: ; Tel.: +1-404-639-8703
| | - Angela D. Coulliette-Salmond
- Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA 30329, USA; (A.D.C.-S.); (C.C.B.); (E.V.)
- United States Public Health Service, Rockville, MD 20852, USA
| | - Pierre Wilnique
- Laboratory and Research, Division of Epidemiology, Ministère de la Santé Publique et de la Population (Ministry of Public Health and Population (MSPP)), Port au Prince HT6110, Haiti; (P.W.); (R.B.)
| | | | | | - Kimberly Wong
- IHRC, Inc., Atlanta, GA 30346, USA; (H.B.-W.); (K.W.)
- Cherokee Nation Assurance, Catoosa, OK 74015, USA;
| | - Edmund Gue
- Pan American Health Organization, World Health Organization, Region of the Americas, Port au Prince HT6110, Haiti;
| | - Robert Barrais
- Laboratory and Research, Division of Epidemiology, Ministère de la Santé Publique et de la Population (Ministry of Public Health and Population (MSPP)), Port au Prince HT6110, Haiti; (P.W.); (R.B.)
| | - Gloria Rey-Benito
- Pan American Health Organization, World Health Organization, Washington, DC 20037, USA;
| | - Cara C. Burns
- Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA 30329, USA; (A.D.C.-S.); (C.C.B.); (E.V.)
| | - Everardo Vega
- Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA 30329, USA; (A.D.C.-S.); (C.C.B.); (E.V.)
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Scott RP, Cullen AC, Chabot‐Couture G. Disease Surveillance Investments and Administration: Limits to Information Value in Pakistan Polio Eradication. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2021; 41:273-288. [PMID: 32822075 PMCID: PMC7984073 DOI: 10.1111/risa.13580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 07/28/2020] [Accepted: 08/01/2020] [Indexed: 05/04/2023]
Abstract
In Pakistan, annual poliovirus investment decisions drive quantities of supplemental immunization campaigns districts receive. In this article, we assess whether increased spending on poliovirus surveillance is associated with greater likelihood of correctly identifying districts at high risk of polio with assignment of an elevated "risk ranking." We reviewed programmatic documents from Pakistan for the period from 2012-2017, recording whether districts had been classified as "high risk" or "low risk" in each year. Through document review, we developed a decision tree to describe the ranking decisions. Then, integrating data from the World Health Organization and Global Polio Eradication Initiative, we constructed a Bayesian decision network reflecting investments in polio surveillance and immunization campaigns, surveillance metrics, disease incidence, immunization rates, and occurrence of polio cases. We test these factors for statistical association with the outcome of interest-a change in risk rank between the beginning and the end of the one-year time period. We simulate different spending scenarios and predict their impact on district risk ranking in future time periods. We find that per district spending increases are associated with increased identification of cases of acute flaccid paralysis (AFP). However, the low specificity of AFP investment and the largely invariant ranking of district risk means that even large increases in surveillance spending are unlikely to promote major changes in risk rankings at the current stage of the Pakistan polio eradication campaign.
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Affiliation(s)
- Ryan P. Scott
- Daniel J. Evans School of Public Policy and GovernanceUniversity of WashingtonSeattleWAUSA
- Political ScienceColorado State UniversityFort CollinsCOUSA
| | - Alison C. Cullen
- Daniel J. Evans School of Public Policy and GovernanceUniversity of WashingtonSeattleWAUSA
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Schleiff M, Olateju A, Decker E, Neel AH, Oke R, Peters MA, Rao A, Alonge O. A multi-pronged scoping review approach to understanding the evolving implementation of the Smallpox and Polio eradication programs: what can other Global Health initiatives learn? BMC Public Health 2020; 20:1698. [PMID: 33339517 PMCID: PMC7747000 DOI: 10.1186/s12889-020-09439-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 08/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous initiatives have aimed to document the history and legacy of the Smallpox Eradication Program (SEP) and the Global Polio Eradication Initiative (GPEI). In this multi-pronged scoping review, we explored the evolution and learning from SEP and GPEI implementation over time at global and country levels to inform other global health programs. METHODS Three related reviews of literature were conducted; we searched for documents on 1) the SEP and 2) GPEI via online database searches and also conducted global and national-level grey literature searches for documents related to the GPEI in seven purposively selected countries under the Synthesis and Translation of Research and Innovations from Polio Eradication (STRIPE) project. We included documents relevant to GPEI implementation. We conducted full text data analysis and captured data on Expert Recommendations for Implementing Change (ERIC) implementation strategies and principles, tools, outcomes, target audiences, and relevance to global health knowledge areas. RESULTS 200 articles were included in the SEP scoping review, 1885 articles in the GPEI scoping review, and 963 documents in the grey literature review. M&E and engagement strategies were consistently translated from the SEP to GPEI; these evolved into newer approaches under the GPEI. Management strategies including setting up robust record systems also carried forward from SEP to GPEI; however, lessons around the need for operational flexibility in applying these strategies at national and sub-national levels did not. Similarly, strategies and lessons around conducting health systems readiness assessments prior to implementation were not carried forward from SEP to GPEI. Differences in the planning and communication strategies between the two programs included fidelity to implementation blueprints appeared to be higher under SEP, and independent monitoring boards and communication and media strategies were more prominent under GPEI. CONCLUSIONS Linear learning did not always occur between SEP and GPEI; several lessons were lost and had to be re-learned. Implementation and adaptation of strategies in global health programs should be well codified, including information on the contextual, time and stakeholders' issues that elicit adaptations. Such description can improve the systematic translation of knowledge, and gains in efficiency and effectiveness of future global health programs.
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Affiliation(s)
- Meike Schleiff
- International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
| | - Adetoun Olateju
- International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Ellie Decker
- International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Abigail H Neel
- International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Rasheedat Oke
- International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Michael A Peters
- International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Aditi Rao
- International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Olakunle Alonge
- International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
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12
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Ticha JM, Akpan GU, Paige LM, Senouci K, Stein A, Briand P, Tuma J, Oyaole DR, Ngofa R, Maleghemi S, Touray K, Salihu AA, Diallo M, Tegegne SG, Bello IM, Idris UK, Maduka O, Manengu C, Shuaib F, Galway M, Mkanda P. Outcomes of the Deployment of the Auto-Visual Acute Flaccid Paralysis Detection and Reporting (AVADAR) System for Strengthening Polio Surveillance in Africa From 2017 to 2018: Evaluation Study. JMIR Public Health Surveill 2020; 6:e18950. [PMID: 33263550 PMCID: PMC7744265 DOI: 10.2196/18950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/19/2020] [Accepted: 08/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background As we move toward a polio-free world, the challenge for the polio program is to create an unrelenting focus on smaller areas where the virus is still present, where children are being repeatedly missed, where immunity levels are low, and where surveillance is weak. Objective This article aimed to describe a possible solution to address weak surveillance systems and document the outcomes of the deployment of the Auto-Visual Acute Flaccid Paralysis Detection and Reporting (AVADAR) project. Methods This intervention was implemented in 99 targeted high-risk districts with concerns for silent polio circulation from eight countries in Africa between August 1, 2017, and July 31, 2018. A total of 6954 persons (5390 community informants and 1564 health workers) were trained and equipped with a smartphone on which the AVADAR app was configured to allow community informants to send alerts on suspected acute flaccid paralysis (AFP) and allow health worker to use electronic checklists for investigation of such alerts. The AVADAR and Open Data Kit ONA servers were at the center of the entire process. A dashboard system and coordination teams for monitoring and supervision were put in place at all levels. Results Overall, 96.44% (24,142/25,032) of potential AFP case alerts were investigated by surveillance personnel, yielding 1414 true AFP cases. This number (n=1414) reported through AVADAR was higher than the 238 AFP cases expected during the study period in the AVADAR districts and the 491 true AFP cases reported by the traditional surveillance system. A total of 203 out of the 1414 true AFP cases reported were from special population settings, such as refugee camps and insecure areas. There was an improvement in reporting in silent health areas in all the countries using the AVADAR system. Finally, there were 23,473 reports for other diseases, such as measles, diarrhea, and cerebrospinal meningitis, using the AVADAR platform. Conclusions This article demonstrates the added value of AVADAR to rapidly improve surveillance sensitivity. AVADAR is capable of supporting countries to improve surveillance sensitivity within a short interval before and beyond polio-free certification.
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Affiliation(s)
| | - Godwin Ubong Akpan
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Lara Mf Paige
- Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - Kamel Senouci
- Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - Andrew Stein
- Bill and Melinda Gates Foundation, Seattle, WA, United States
| | | | - Jude Tuma
- World Health Organization, Geneva, Switzerland
| | | | - Reuben Ngofa
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | - Kebba Touray
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | - Mamadou Diallo
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | | | | | | | - Casimir Manengu
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Faisal Shuaib
- National Primary Health Care Delivery Agency (NPHCDA), Abuja, Nigeria
| | - Michael Galway
- Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - Pascal Mkanda
- World Health Organization Regional Office for Africa, Brazzaville, Congo
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13
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Odih EE, Afolayan AO, Akintayo I, Okeke IN. Could Water and Sanitation Shortfalls Exacerbate SARS-CoV-2 Transmission Risks? Am J Trop Med Hyg 2020; 103:554-557. [PMID: 32524953 PMCID: PMC7410451 DOI: 10.4269/ajtmh.20-0462] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
SARS-CoV-2, the etiologic agent of COVID-19, is shed in stool. SARS coronaviruses have been detected in wastewater during outbreaks in China, Europe, and the United States. In this perspective, we outline the risk fecal shedding poses at locations without safely managed sanitation, as in most of Nigeria where we work. We believe that feco-oral transmission could occur if community transmission becomes high and sustained in densely populated cities without proper sanitation in Nigeria and many other African and Asian settings. In the absence of basic sanitation, or where existing sanitation is not safely managed, groundwater, which is often drawn up from wells and boreholes for drinking and household use, can become contaminated with enteric bacteria and viruses from fecal matter. Endemic and epidemic transmission of multiple feco-oral pathogens via this route continues to be documented in areas without safely managed sanitation, and, therefore, the risk of SARS-CoV-2 transmission needs to be evaluated, tracked, and forestalled in such settings. We suggest that fecal matter from treatment facilities and recovered patients should be carefully and properly disposed. Furthermore, environmental surveillance of SARS-CoV-2 in wastewater and accumulated human waste, as well as efforts to mitigate the virus’ entry into unprotected household water sources, should be a priority part of the COVID-19 response in settings without safely managed sanitation for the duration of the pandemic.
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Affiliation(s)
- Erkison E Odih
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Ayorinde O Afolayan
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - IfeOluwa Akintayo
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
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14
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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-MORBIDITY AND MORTALITY WEEKLY REPORT 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] [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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Majumdar M, Klapsa D, Wilton T, Akello J, Anscombe C, Allen D, Mee ET, Minor PD, Martin J. Isolation of Vaccine-Like Poliovirus Strains in Sewage Samples From the United Kingdom. J Infect Dis 2019; 217:1222-1230. [PMID: 29309594 DOI: 10.1093/infdis/jix667] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 12/20/2017] [Indexed: 12/25/2022] Open
Abstract
Background Environmental surveillance (ES) is a sensitive method for detecting human enterovirus (HEV) circulation, and it is used worldwide to support global polio eradication. We describe a novel ES approach using next-generation sequencing (NGS) to identify HEVs in sewage samples collected in London, United Kingdom, from June 2016 to May 2017. Methods Two different methods were used to process raw sewage specimens: a 2-phase aqueous separation system and size exclusion by filtration and centrifugation. HEVs were isolated using cell cultures and analyzed using NGS. Results Type 1 and 3 vaccine-like poliovirus (PV) strains were detected in samples collected from September 2016 through January 2017. NGS analysis allowed us to rapidly obtain whole-genome sequences of PV and non-PV HEV strains. As many as 6 virus strains from different HEV serotypes were identified in a single cell culture flask. PV isolates contained only a small number of mutations from vaccine strains commonly seen in early isolates from vaccinees. Conclusions Our ES setup has high sensitivity for polio and non-PV HEV detection, generating nearly whole-genome sequence information. Such ES systems provide critical information to assist the polio eradication endgame and contribute to the improvement of our understanding of HEV circulation patterns in humans.
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Affiliation(s)
- Manasi Majumdar
- Division of Virology, National Institute for Biological Standards and Control, South Mimms
| | - Dimitra Klapsa
- Division of Virology, National Institute for Biological Standards and Control, South Mimms
| | - Thomas Wilton
- Division of Virology, National Institute for Biological Standards and Control, South Mimms
| | - Joyce Akello
- Enterovirus Unit, Public Health England, London, United Kingdom
| | | | - David Allen
- Enterovirus Unit, Public Health England, London, United Kingdom
| | - Edward T Mee
- Division of Virology, National Institute for Biological Standards and Control, South Mimms
| | - Philip D Minor
- Division of Virology, National Institute for Biological Standards and Control, South Mimms
| | - Javier Martin
- Division of Virology, National Institute for Biological Standards and Control, South Mimms
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16
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Ticha JM, Matthew KO, Hamisu AW, Fiona B, Mkanda P, Nsubuga P, Tesfaye E, Craig K, Andrew E, Emelife O, Shuaib F, Folasade A, Adeniji J, Adamu U, Dallatu M, Oyeyinka G, Brown H, Nnamah N, Okwori J, Chinedu C, Anibijuwon I, Olubusuyi A, Emmanuel D, Bagana M, Baba M, Nicksy G, Banda R, Tegegne SG, Oyetunji A, Diop O, Tomori O, Vaz RG. Towards an effective poliovirus laboratory containment strategy in Nigeria. BMC Public Health 2018; 18:1304. [PMID: 30541484 PMCID: PMC6291910 DOI: 10.1186/s12889-018-6181-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Global Commission for the Certification of the Eradication of Poliomyelitis will declare the world free of wild poliovirus transmission when no wild virus has been found in at least 3 consecutive years, and all laboratories possessing wild poliovirus materials have adopted appropriate measures of containment. Nigeria has made progress towards poliomyelitis eradication with the latest reported WPV type 1 on 21 Aug 2016 after 2 years without any case. This milestone achievement was followed by an inventory of biomedical laboratories completed in November 2015 with the destruction of all identified infectious materials. This paper seeks to describe the poliovirus laboratory containment process in Nigeria on which an effective containment system has been built to minimize the risk of virus re-introduction into the population from the laboratories. METHODS A national survey of all biomedical facilities, as well as an inventory of laboratories from various sectors, was conducted from June-November 2015. National Task Force (NTF) members and staff working on polio administered an on-site questionnaire in each facility. Laboratory personnel were sensitized with all un-needed materials destroyed by autoclaving and incineration. All stakeholders were also sensitized to continue the destruction of such materials as a requirement for phase one activities. RESULTS A total of 20,638 biomedical facilities were surveyed with 9575 having laboratories. Thirty laboratories were found to contain poliovirus or potentially infectious materials. The 30 laboratories belonged to the ministries of health, education, defence and private organizations. CONCLUSIONS This article is amongst the first in Africa that relates poliovirus laboratory containment in the context of the tOPV-bOPV switch in alignment with the Global Action Plan III. All identified infectious materials were destroyed and personnel trained to continue to destroy subsequent materials, a process that needs meticulous monitoring to mitigate the risk of poliovirus re-introduction to the population.
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Affiliation(s)
| | | | | | - Braka Fiona
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Pascal Mkanda
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | - Eberto Tesfaye
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Kehinde Craig
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Etsano Andrew
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Obi Emelife
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Faisal Shuaib
- National Task Force on Polio Containment, Abuja, Nigeria
| | | | | | - Usman Adamu
- National Task Force on Polio Containment, Abuja, Nigeria
| | | | | | - Holly Brown
- National Task Force on Polio Containment, Abuja, Nigeria
| | | | - Joseph Okwori
- National Task Force on Polio Containment, Abuja, Nigeria
| | | | | | | | | | - Murtala Bagana
- National Task Force on Polio Containment, Abuja, Nigeria
| | - Marycelin Baba
- University Teaching Hospital Polio Laboratory, Maiduguri, Nigeria
| | - Gumede Nicksy
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Richard Banda
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Sisay G. Tegegne
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Ajiboye Oyetunji
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Ousmane Diop
- World Health Organization, Headquarters, Geneva, Switzerland
| | - O. Tomori
- Expert Review Committee on Polio and Routine Immunization, Abuja, Nigeria
| | - Rui G. Vaz
- World Health Organization, Country Representative Office, Abuja, Nigeria
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17
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Musa AI, Shuaib F, Braka F, Mkanda P, Banda R, Korir C, Tegegne SG, Abdullahi S, Umeh GC, Nomhwange TI, Iyal HA, Ishaku S, Adamu U, Damisa E, Bagana M, Gugong V, Balarabe H, Nsubuga P, Vaz RG. Stopping circulatory vaccine-derived poliovirus in Kaduna state by scaling up special interventions in local government areas along rivers of interest- kamacha basin experience, 2013-2015. BMC Public Health 2018; 18:1303. [PMID: 30541497 PMCID: PMC6291911 DOI: 10.1186/s12889-018-6180-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The Kamacha river is one of the five polio environmental surveillance sites in Kaduna State where 13 circulating vaccine-derived polioviruses (cVDPDs) were isolated between 2014 and 2015. Kamacha river accounted for 5 of all reported cVDPVs in Kaduna State between 2014 and 2015. Poor quality Supplemental Immunization Activities (SIAs) and low population immunity have been reported in the 10 LGAs with tributaries that flow into the river. We described the processes of implementing the various health interventions in these targeted LGAs along the Kamacha River and assessed the effectiveness of the interventions in stopping cVDPV in Kaduna, state, Nigeria. METHODS Special interventions that had been proven to be functional and effective in reaching unreached children with potent vaccines in the state were scaled up in these targeted 10 LGAs along the Kamacha River. These interventions included revision of house based microplans, scaling up of transit vaccination, scaling up of youth engagement, intensified supportive supervision, scaling up of Directly Observed Polio Vaccination (DOPV) and in-between rounds vaccination activities. We analyzed immunization plus days (IPDs) administrative tally sheet and monitoring data from 10 rounds before and 10 rounds after the special interventions. RESULTS The number of children immunized increased from 1,862,958 in December 2014 before the intervention to 1,922,940 in March 2016 after the intervention. Lot Quality Assurance Sampling (LQAS) results showed an increase in the proportion of LGAs accepted at coverage > 90% after the interventions, from 67% before intervention to 84% after intervention. The proportion of non-polio AFP children with > 4 doses of oral polio vaccine increased from 2 to 8% before to 93-98% after the interventions.. No new environmental cVDPV has been isolated since the introduction of the interventions in April 2015 until July 2016. CONCLUSION Scaling up known working interventions in the 10 LGAs with tributaries that drain to Kamacha River environmental sample site may have contributed to improved immunity and interruption of cVDPV in Kaduna state. These interventions should be replicated in LGAs and states with persistent poliovirus isolation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Usman Adamu
- National Primary Health Care Agency, Abuja, Nigeria
| | | | | | | | | | | | - Rui G. Vaz
- World Health Organization, Abuja, Nigeria
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18
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Matrajt G, Naughton B, Bandyopadhyay AS, Meschke JS. A Review of the Most Commonly Used Methods for Sample Collection in Environmental Surveillance of Poliovirus. Clin Infect Dis 2018; 67:S90-S97. [PMID: 30376094 PMCID: PMC6206110 DOI: 10.1093/cid/ciy638] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
We performed a review of the environmental surveillance methods commonly used to collect and concentrate poliovirus (PV) from water samples. We compared the sampling approaches (trap vs grab), the process methods (precipitation vs filtration), and the various tools and chemical reagents used to separate PV from other viruses and pathogens in water samples (microporous glass, pads, polyethylene glycol [PEG]/dextran, PEG/sodium chloride, NanoCeram/ViroCap, and ester membranes). The advantages and disadvantages of each method are considered, and the geographical areas where they are currently used are discussed. Several methods have demonstrated the ability to concentrate and recover PVs from environmental samples. The details of the particular sampling conditions and locations should be considered carefully in method selection.
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Affiliation(s)
- Graciela Matrajt
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Washington
| | | | | | - John Scott Meschke
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Washington
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Epidemiology of the silent polio outbreak in Rahat, Israel, based on modeling of environmental surveillance data. Proc Natl Acad Sci U S A 2018; 115:E10625-E10633. [PMID: 30337479 DOI: 10.1073/pnas.1808798115] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Israel experienced an outbreak of wild poliovirus type 1 (WPV1) in 2013-2014, detected through environmental surveillance of the sewage system. No cases of acute flaccid paralysis were reported, and the epidemic subsided after a bivalent oral polio vaccination (bOPV) campaign. As we approach global eradication, polio will increasingly be detected only through environmental surveillance. We developed a framework to convert quantitative polymerase chain reaction (qPCR) cycle threshold data into scaled WPV1 and OPV1 concentrations for inference within a deterministic, compartmental infectious disease transmission model. We used this approach to estimate the epidemic curve and transmission dynamics, as well as assess alternate vaccination scenarios. Our analysis estimates the outbreak peaked in late June, much earlier than previous estimates derived from analysis of stool samples, although the exact epidemic trajectory remains uncertain. We estimate the basic reproduction number was 1.62 (95% CI 1.04-2.02). Model estimates indicate that 59% (95% CI 9-77%) of susceptible individuals (primarily children under 10 years old) were infected with WPV1 over a little more than six months, mostly before the vaccination campaign onset, and that the vaccination campaign averted 10% (95% CI 1-24%) of WPV1 infections. As we approach global polio eradication, environmental monitoring with qPCR can be used as a highly sensitive method to enhance disease surveillance. Our analytic approach brings public health relevance to environmental data that, if systematically collected, can guide eradication efforts.
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Duintjer Tebbens RJ, Zimmermann M, Pallansch M, Thompson KM. Insights from a Systematic Search for Information on Designs, Costs, and Effectiveness of Poliovirus Environmental Surveillance Systems. FOOD AND ENVIRONMENTAL VIROLOGY 2017; 9:361-382. [PMID: 28687986 PMCID: PMC7879701 DOI: 10.1007/s12560-017-9314-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/30/2017] [Indexed: 05/20/2023]
Abstract
Poliovirus surveillance plays a critical role in achieving and certifying eradication and will play a key role in the polio endgame. Environmental surveillance can provide an opportunity to detect circulating polioviruses prior to the observation of any acute flaccid paralysis cases. We completed a systematic review of peer-reviewed publications on environmental surveillance for polio including the search terms "environmental surveillance" or "sewage," and "polio," "poliovirus," or "poliomyelitis," and compared characteristics of the resulting studies. The review included 146 studies representing 101 environmental surveillance activities from 48 countries published between 1975 and 2016. Studies reported taking samples from sewage treatment facilities, surface waters, and various other environmental sources, although they generally did not present sufficient details to thoroughly evaluate the sewage systems and catchment areas. When reported, catchment areas varied from 50 to over 7.3 million people (median of 500,000 for the 25% of activities that reported catchment areas, notably with 60% of the studies not reporting this information and 16% reporting insufficient information to estimate the catchment area population size). While numerous studies reported the ability of environmental surveillance to detect polioviruses in the absence of clinical cases, the review revealed very limited information about the costs and limited information to support quantitative population effectiveness of conducting environmental surveillance. This review motivates future studies to better characterize poliovirus environmental surveillance systems and the potential value of information that they may provide in the polio endgame.
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Affiliation(s)
| | - Marita Zimmermann
- Kid Risk, Inc., 10524 Moss Park Rd., Ste. 204-364, Orlando, FL 32832
- Correspondence to: Radboud J. Duintjer Tebbens, Kid Risk, Inc., 10524 Moss Park Rd., Ste. 204-364, Orlando, FL 32832, USA,
| | - Mark Pallansch
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA 30333
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Koopman JS, Henry CJ, Park JH, Eisenberg MC, Ionides EL, Eisenberg JN. Dynamics affecting the risk of silent circulation when oral polio vaccination is stopped. Epidemics 2017; 20:21-36. [PMID: 28283373 PMCID: PMC5608688 DOI: 10.1016/j.epidem.2017.02.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 02/20/2017] [Accepted: 02/20/2017] [Indexed: 12/15/2022] Open
Abstract
Silent circulation (SC) of wild polio viruses (WPV) when oral polio vaccine (OPV) use is stopped, could threaten eradication. We analyzed a model designed to develop theory about mechanisms and factors that lead to SC and how SC risks can be assessed using surveillance data. Prolonged low-level SC emerges as a threshold phenomenon through a mechanism related to balancing contributions of different populations to the effective reproduction number. Factors that promote this mechanism are many years of inadequate vaccination efforts, ongoing waning of immunity against transmission years after last OPV or WPV infection, low transmissibility of OPV, and high transmission conditions. Analyzing acute flaccid paralysis surveillance or environmental surveillance data by themselves cannot assess the risk that an SC threshold has been passed, but new methods to analyze them jointly could do so.
Waning immunity could allow transmission of polioviruses without causing poliomyelitis by promoting silent circulation (SC). Undetected SC when oral polio vaccine (OPV) use is stopped could cause difficult to control epidemics. Little is known about waning. To develop theory about what generates SC, we modeled a range of waning patterns. We varied both OPV and wild polio virus (WPV) transmissibility, the time from beginning vaccination to reaching low polio levels, and the infection to paralysis ratio (IPR). There was longer SC when waning continued over time rather than stopping after a few years, when WPV transmissibility was higher or OPV transmissibility was lower, and when the IPR was higher. These interacted in a way that makes recent emergence of prolonged SC a possibility. As the time to reach low infection levels increased, vaccine rates needed to eliminate polio increased and a threshold was passed where prolonged low-level SC emerged. These phenomena were caused by increased contributions to the force of infection from reinfections. The resulting SC occurs at low levels that would be difficult to detect using environmental surveillance. For all waning patterns, modest levels of vaccination of adults shortened SC. Previous modeling studies may have missed these phenomena because (1) they used models with no or very short duration waning and (2) they fit models to paralytic polio case counts. Our analyses show that polio case counts cannot predict SC because nearly identical polio case count patterns can be generated by a range of waning patterns that generate different patterns of SC. We conclude that the possibility of prolonged SC is real but unquantified, that vaccinating modest fractions of adults could reduce SC risk, and that joint analysis of acute flaccid paralysis and environmental surveillance data can help assess SC risks and ensure low risks before stopping OPV.
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Affiliation(s)
- J S Koopman
- Department of Epidemiology, University of Michigan School of Public Health, United States.
| | - C J Henry
- Department of Epidemiology, University of Michigan School of Public Health, United States
| | - J H Park
- Department of Statistics, University of Michigan School of Literature, Science, and the Arts, United States
| | - M C Eisenberg
- Department of Epidemiology, University of Michigan School of Public Health, United States
| | - E L Ionides
- Department of Statistics, University of Michigan School of Literature, Science, and the Arts, United States
| | - J N Eisenberg
- Department of Epidemiology, University of Michigan School of Public Health, United States
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Newly Identified Enterovirus C Genotypes, Identified in the Netherlands through Routine Sequencing of All Enteroviruses Detected in Clinical Materials from 2008 to 2015. J Clin Microbiol 2016; 54:2306-14. [PMID: 27358467 PMCID: PMC5005491 DOI: 10.1128/jcm.00207-16] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 06/20/2016] [Indexed: 12/29/2022] Open
Abstract
Enteroviruses (EVs) are a group of human and animal viruses that are capable of causing a variety of clinical syndromes. Different genotypes classified into species can be distinguished on the basis of sequence divergence in the VP1 capsid-coding region. Apparently new genotypes are discovered regularly, often as incidental findings in studies investigating respiratory syndromes or as part of poliovirus surveillance. Recently, some EVs have become recognized as significant respiratory pathogens, and a number of new genotypes belonging to species C have been identified. The circulation of these newly identified species C EVs, such as EV-C104, EV-C105, EV-C109, and EV-C117, nevertheless appears to be limited. In this report, we show the results of routine genotyping of all enteroviruses detected in our tertiary care hospital between January 2008 and April 2015. We detected 365 EVs belonging to 40 genotypes. Interestingly, several newly identified species C EVs were detected during the study period. Sequencing of the 5′ untranslated region (5′ UTR) of these viruses shows divergence in this region, which is a target region in many detection assays.
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