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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] [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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Alleman MM, Jorba J, Riziki Y, Henderson E, Mwehu A, Seakamela L, Howard W, Kadiobo Mbule A, Nsamba RN, Djawe K, Yapi MD, Mengouo MN, Gumede N, Ndoutabe M, Kfutwah AKW, Senouci K, Burns CC. Vaccine-derived poliovirus serotype 2 outbreaks and response in the Democratic Republic of the Congo, 2017-2021. Vaccine 2023; 41 Suppl 1:A35-A47. [PMID: 36907733 PMCID: PMC10427717 DOI: 10.1016/j.vaccine.2023.02.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 02/01/2023] [Accepted: 02/13/2023] [Indexed: 03/13/2023]
Abstract
Vaccine-derived polioviruses (VDPVs) can emerge from Sabin strain poliovirus serotypes 1, 2, and 3 contained in oral poliovirus vaccine (OPV) after prolonged person-to-person transmission where population vaccination immunity against polioviruses is suboptimal. VDPVs can cause paralysis indistinguishable from wild polioviruses and outbreaks when community circulation ensues. VDPV serotype 2 outbreaks (cVDPV2) have been documented in The Democratic Republic of the Congo (DRC) since 2005. The nine cVDPV2 outbreaks detected during 2005-2012 were geographically-limited and resulted in 73 paralysis cases. No outbreaks were detected during 2013-2016. During January 1, 2017-December 31, 2021, 19 cVDPV2 outbreaks were detected in DRC. Seventeen of the 19 (including two first detected in Angola) resulted in 235 paralysis cases notified in 84 health zones in 18 of DRC's 26 provinces; no notified paralysis cases were associated with the remaining two outbreaks. The DRC-KAS-3 cVDPV2 outbreak that circulated during 2019-2021, and resulted in 101 paralysis cases in 10 provinces, was the largest recorded in DRC during the reporting period in terms of numbers of paralysis cases and geographic expanse. The 15 outbreaks occurring during 2017-early 2021 were successfully controlled with numerous supplemental immunization activities (SIAs) using monovalent OPV Sabin-strain serotype 2 (mOPV2); however, suboptimal mOPV2 vaccination coverage appears to have seeded the cVDPV2 emergences detected during semester 2, 2018 through 2021. Use of the novel OPV serotype 2 (nOPV2), designed to have greater genetic stability than mOPV2, should help DRC's efforts in controlling the more recent cVDPV2 outbreaks with a much lower risk of further seeding VDPV2 emergence. Improving nOPV2 SIA coverage should decrease the number of SIAs needed to interrupt transmission. DRC needs the support of polio eradication and Essential Immunization (EI) partners to accelerate the country's ongoing initiatives for EI strengthening, introduction of a second dose of inactivated poliovirus vaccine (IPV) to increase protection against paralysis, and improving nOPV2 SIA coverage.
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Affiliation(s)
- Mary M Alleman
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, USA.
| | - Jaume Jorba
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Yogolelo Riziki
- Institut National de Recherche Biomédicale, Ministry of Public Health, Hygiene and Prevention, Democratic Republic of the Congo
| | - Elizabeth Henderson
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Anicet Mwehu
- Emergency Operations Center for Polio, Ministry of Public Health, Hygiene and Prevention, Democratic Republic of the Congo
| | - Lerato Seakamela
- National Institute for Communicable Diseases, National Health Laboratory Services, South Africa
| | - Wayne Howard
- National Institute for Communicable Diseases, National Health Laboratory Services, South Africa
| | - Albert Kadiobo Mbule
- Polio, Office of the Regional Director, World Health Organization, Democratic Republic of the Congo Country Office, Democratic Republic of the Congo
| | - Renee Ntumbannji Nsamba
- Polio, Office of the Regional Director, World Health Organization, Democratic Republic of the Congo Country Office, Democratic Republic of the Congo
| | - Kpandja Djawe
- Polio, Office of the Regional Director, World Health Organization, Democratic Republic of the Congo Country Office, Democratic Republic of the Congo
| | - Moïse Désiré Yapi
- Polio, Office of the Regional Director, World Health Organization, Democratic Republic of the Congo Country Office, Democratic Republic of the Congo
| | - Marcellin Nimpa Mengouo
- Polio, Office of the Regional Director, World Health Organization, Democratic Republic of the Congo Country Office, Democratic Republic of the Congo
| | - Nicksy Gumede
- Polio, Office of the Regional Director, World Health Organization, Regional Office for Africa, Republic of the Congo
| | - Modjirom Ndoutabe
- Polio, Office of the Regional Director, World Health Organization, Regional Office for Africa, Republic of the Congo
| | - Anfumbom K W Kfutwah
- Polio, Office of the Regional Director, World Health Organization, Regional Office for Africa, Republic of the Congo
| | | | - Cara C Burns
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA
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Snider CJ, Boualam L, Tallis G, Takashima Y, Abeyasinghe R, Lo YR, Grabovac V, Avagyan T, Aslam SK, Eltayeb AO, Aung KD, Wang X, Shrestha A, Ante-Orozco C, Silva MWT, Lapastora-Sucaldito N, Apostol LNG, Jikal MBH, Miraj W, Lodhi F, Kim HJ, Rusli N, Thorley BR, Kaye MB, Nishimura Y, Arita M, Sani JAM, Rundi C, Feldon K. Concurrent outbreaks of circulating vaccine-derived poliovirus types 1 and 2 affecting the Republic of the Philippines and Malaysia, 2019-2021. Vaccine 2023; 41 Suppl 1:A58-A69. [PMID: 35337673 PMCID: PMC10546869 DOI: 10.1016/j.vaccine.2022.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/17/2021] [Accepted: 02/02/2022] [Indexed: 01/26/2023]
Abstract
Concurrent outbreaks of circulating vaccine-derived poliovirus serotypes 1 and 2 (cVDPV1, cVDPV2) were confirmed in the Republic of the Philippines in September 2019 and were subsequently confirmed in Malaysia by early 2020. There is continuous population subgroup movement in specific geographies between the two countries. Outbreak response efforts focused on sequential supplemental immunization activities with monovalent Sabin strain oral poliovirus vaccine type 2 (mOPV2) and bivalent oral poliovirus vaccines (bOPV, containing Sabin strain types 1 and 3) as well as activities to enhance poliovirus surveillance sensitivity to detect virus circulation. A total of six cVDPV1 cases, 13 cVDPV2 cases, and one immunodeficiency-associated vaccine-derived poliovirus type 2 case were detected, and there were 35 cVDPV1 and 31 cVDPV2 isolates from environmental surveillance sewage collection sites. No further cVDPV1 or cVDPV2 have been detected in either country since March 2020. Response efforts in both countries encountered challenges, particularly those caused by the global COVID-19 pandemic. Important lessons were identified and could be useful for other countries that experience outbreaks of concurrent cVDPV serotypes.
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Affiliation(s)
- Cynthia J Snider
- Centers for Disease Control and Prevention, 1600 Clifton Road, MS H24-2, Atlanta, GA 30329, USA.
| | - Liliane Boualam
- World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland.
| | - Graham Tallis
- World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland.
| | - Yoshihiro Takashima
- World Health Organization Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines.
| | - Rabindra Abeyasinghe
- Office of the World Health Organization Representative to the Philippines, Building 3, San Lazaro Compound, Rizal Avenue, Santa Cruz, Manila 1003, Philippines.
| | - Ying-Ru Lo
- Office of the World Health Organization Representative to Malaysia, Brunei Darussalam and Singapore, 4th Floor, Prima 8, Block 3508, Jalan, Teknokrat 6, 63000 Cyberjaya, Selangor, Malaysia.
| | - Varja Grabovac
- World Health Organization Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines.
| | - Tigran Avagyan
- World Health Organization Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines.
| | - Syeda Kanwal Aslam
- World Health Organization Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines.
| | - Abu Obeida Eltayeb
- United Nations Children's Fund East Asia and Pacific Regional Office, 19 Pra Athit Rd, Chana Songkhram, Pra Nakhon, Bangkok 10200, Thailand.
| | - Khin Devi Aung
- United Nations Children's Fund East Asia and Pacific Regional Office, 19 Pra Athit Rd, Chana Songkhram, Pra Nakhon, Bangkok 10200, Thailand.
| | - Xiaojun Wang
- Office of the World Health Organization Representative to the Philippines, Building 3, San Lazaro Compound, Rizal Avenue, Santa Cruz, Manila 1003, Philippines.
| | - Achyut Shrestha
- Office of the World Health Organization Representative to the Philippines, Building 3, San Lazaro Compound, Rizal Avenue, Santa Cruz, Manila 1003, Philippines.
| | - Carla Ante-Orozco
- United Nations Children's Fund Philippines, 14th Floor- North Tower, Rockwell Business Center Sheridan, Sheridan Street Corner United Street, Highway Hills, Mandaluyong City, Philippines, 1550.
| | - Maria Wilda T Silva
- Republic of the Philippines Department of Health, Department of Health San Lazaro Compound, Rizal Ave., Santa Cruz, Manila, Philippines, 1003.
| | - Nemia Lapastora-Sucaldito
- Republic of the Philippines Department of Health, Department of Health San Lazaro Compound, Rizal Ave., Santa Cruz, Manila, Philippines, 1003.
| | - Lea Necitas G Apostol
- Republic of the Philippines Department of Health, Research Institute for Tropical Medicine, 9002 Research Drive, Filinvest Corporate City Alabang, Muntinlupa City, Philippines, 1781
| | - Muhammad Bin Hj Jikal
- Sabah State Health Department, Tingkat 3, Rumah Persekutuan, Jalan Mat Salleh, 88590 Kota Kinabalu, Sabah, Malaysia.
| | - Waheed Miraj
- Office of the World Health Organization Representative to Malaysia, Brunei Darussalam and Singapore, 4th Floor, Prima 8, Block 3508, Jalan, Teknokrat 6, 63000 Cyberjaya, Selangor, Malaysia
| | - Faisal Lodhi
- Office of the World Health Organization Representative to Malaysia, Brunei Darussalam and Singapore, 4th Floor, Prima 8, Block 3508, Jalan, Teknokrat 6, 63000 Cyberjaya, Selangor, Malaysia.
| | - Hyung Joon Kim
- United Nations Children's Fund Malaysia, Menara PJH, Level 10, No. 2, Jalan Tun Abdul Razak, Precinct 2, 62100 Putrajaya, Malaysia.
| | - Norhayati Rusli
- Ministry of Health Malaysia, Aras 3, Blok E10, Kompleks E, Pusat Pentadbiran Kerajaan Persekutuan, 62590 Wilayah Persekutuanm Putrajaya, Malaysia.
| | - Bruce R Thorley
- Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, Victoria, Australia, 3000.
| | - Matthew B Kaye
- Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, Victoria, Australia, 3000.
| | - Yorihiro Nishimura
- National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan.
| | - Minetaro Arita
- National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan.
| | - Jamiatul Aida Md Sani
- Ministry of Health Malaysia, Aras 3, Blok E10, Kompleks E, Pusat Pentadbiran Kerajaan Persekutuan, 62590 Wilayah Persekutuanm Putrajaya, Malaysia.
| | - Christina Rundi
- Sabah State Health Department, Tingkat 3, Rumah Persekutuan, Jalan Mat Salleh, 88590 Kota Kinabalu, Sabah, Malaysia.
| | - Keith Feldon
- Office of the World Health Organization Representative to the Philippines, Building 3, San Lazaro Compound, Rizal Avenue, Santa Cruz, Manila 1003, Philippines
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Kulkarni S, Sengeh P, Eboh V, Jalloh MB, Conteh L, Sesay T, Ibrahim N, Manneh PO, Kaiser R, Jinnai Y, Wallace AS, Prybylski D, Jalloh MF. Role of Information Sources in Vaccination Uptake: Insights From a Cross-Sectional Household Survey in Sierra Leone, 2019. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00237. [PMID: 35294376 PMCID: PMC8885335 DOI: 10.9745/ghsp-d-21-00237] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
Abstract
Our findings suggest that health workers and faith leaders are important sources of information to deliver vaccination messages, given their strong association with vaccination confidence and uptake. In this context, vaccination promotion efforts that integrate faith leaders and health workers may help increase vaccination uptake. Introduction: There is limited understanding of the potential impact of information sources on vaccination attitudes and behaviors in low-income countries. We examined how exposure to immunization information sources may be associated with vaccination uptake in Sierra Leone. Methods: In 2019, a household survey was conducted using multistage cluster sampling to randomly select 621 caregivers of children aged 12–23 months in 4 districts in Sierra Leone. We measured exposure to various sources of immunization information and 2 outcomes: (1) vaccination confidence using an aggregate score (from 12 Likert items, informed by previously validated scale) that was dichotomized into a binary variable; (2) uptake of the third dose of diphtheria-pertussis-tetanus-hepatitis B-Haemophilus influenzae type-b-pentavalent vaccine (penta-3) based on card record or through caregiver recall when card was unavailable. Associations between information sources and the outcomes were examined using modified Poisson regression with robust variance estimator. Results: Weighted estimate for penta-3 uptake was 81% (75.2%–85.5%). The likelihood of uptake of penta-3 was significantly greater when caregiver received information from health facilities (adjusted prevalence ratio [aPR]=1.26, 95% confidence interval [CI]=1.1, 1.5), faith leaders (aPR=1.16, 95% CI=1.1, 1.3), and community health workers (aPR=1.13, 95% CI=1.003, 1.3). Exposure to greater number of information sources was associated with high penta-3 uptake (aPR=1.05, 95% CI=1.02, 1.1). Discussion: Immunization information received during health facility visits and through engagement with religious leaders may enhance vaccination uptake. Assessments to understand context-specific information dynamics should be prioritized in optimizing immunization outcomes.
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Affiliation(s)
- Shibani Kulkarni
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | | | - Victor Eboh
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Lansana Conteh
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Tom Sesay
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Reinhard Kaiser
- U.S. Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Yuka Jinnai
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Aaron S Wallace
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dimitri Prybylski
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mohamed F Jalloh
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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Bessaud M. [New oral polio vaccine: A turning point for the global polio eradication initiative?]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2021; 1:mtsi.2021.191. [PMID: 35891919 PMCID: PMC9283809 DOI: 10.48327/mtsi.2021.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/15/2021] [Indexed: 11/27/2022]
Abstract
Launched in 1988, the Global Polio Eradication Initiative (GPEI) aims to eradicate polioviruses, which are the etiologic agents of poliomyelitis. Coordinated by the World Health Organization, this program relies on two pillars: mass vaccination campaigns that target children and active surveillance of the virus circulation. The GPEI has led to the eradication of two out of three serotypes of wild polioviruses and to the containment of the last serotype in two countries.Two polio vaccines exist: the injectable vaccine and the oral one. Both induce an efficient protection against poliomyelitis, but only the oral vaccine is able to stop poliovirus transmission chains. Therefore, the oral vaccine is essential to contain polioviruses and, finally, to eradicate them. In some contexts where the vaccine coverage is not sufficient, the attenuated strains contained in the oral vaccine can circulate for months and recover a pathogenic phenotype through genetic drift. In order to prevent this phenomenon, a new vaccine strain has been developed through genetic engineering: it has been designed to be as immunogenic as the historical vaccine strain, but more genetically stable to prevent the loss of its attenuation determinants. After being evaluated in vitro and through clinical trials, the novel strain has been rolled out in several African countries and in Tajikistan in 2021.
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Affiliation(s)
- Maël Bessaud
- Institut Pasteur, Unité pathogenèse & populations virales, 25-28, rue du Dr Roux, 75015 Paris, France
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Women's Empowerment and Children's Complete Vaccination in the Democratic Republic of the Congo: A Cross-Sectional Analysis. Vaccines (Basel) 2021; 9:vaccines9101117. [PMID: 34696225 PMCID: PMC8540931 DOI: 10.3390/vaccines9101117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The empowerment of women contributes to better child health and wellness. This study aimed to examine the association between women’s empowerment and complete vaccination of children, as recommended in the National Expanded Program on Immunization (EPI) in the Democratic Republic of the Congo (DRC). (2) Methods: In this cross-sectional study, a principal component analysis (PCA) was conducted on data from the Multiple-Indicator Cluster Survey 6 (MICS-6) to determine the dimensions of women’s empowerment. Logistic regression analysis was used to assess the association between women’s empowerment and complete vaccination of children stratified by household wealth. In total, 3524 women with children aged 12–23 months were included in the study. (3) Results: Women’s empowerment was defined by three dimensions, namely intrinsic agency, enabling resources, and social independence. Children of women with high levels of empowerment had higher odds of complete vaccination, with values of 1.63 (p = 0.002) and 1.59 (p = 0.012) for intrinsic agency and enabling resources of the empowerment, respectively, compared to the children of women with low levels of empowerment; however, social independence failed to be associated with the vaccination status of children. After stratification by household wealth, the OR of complete vaccination was higher in women from middle-income households with high levels of intrinsic agency (OR: 2.35, p = 0.021) compared to women from poor households with high levels of intrinsic agency (OR: 1.92, p = 0.004). (4) Conclusions: Higher levels of women’s empowerment, especially intrinsic agency and enabling resources, were associated with complete vaccination in children in the DRC. Household wealth status influenced the associations. The empowerment of women is crucial in promoting the complete vaccination of children and providing equal access to vaccines.
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Joffret ML, Doté JW, Gumede N, Vignuzzi M, Bessaud M, Gouandjika-Vasilache I. Vaccine-Derived Polioviruses, Central African Republic, 2019. Emerg Infect Dis 2021; 27:620-623. [PMID: 33496226 PMCID: PMC7853572 DOI: 10.3201/eid2702.203173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Since May 2019, the Central African Republic has experienced a poliomyelitis outbreak caused by type 2 vaccine-derived polioviruses (VDPV-2s). The outbreak affected Bangui, the capital city, and 10 districts across the country. The outbreak resulted from several independent emergence events of VDPV-2s featuring recombinant genomes with complex mosaic genomes. The low number of mutations (<20) in the viral capsid protein 1–encoding region compared with the vaccine strain suggests that VDPV-2 had been circulating for a relatively short time (probably <3 years) before being isolated. Environmental surveillance, which relies on a limited number of sampling sites in the Central African Republic and does not cover the whole country, failed to detect the circulation of VDPV-2s before some had induced poliomyelitis in children.
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Mbaeyi C, Moran T, Wadood Z, Ather F, Sykes E, Nikulin J, Al Safadi M, Stehling-Ariza T, Zomahoun L, Ismaili A, Abourshaid N, Asghar H, Korukluoglu G, Duizer E, Ehrhardt D, Burns CC, Sharaf M. Stopping a polio outbreak in the midst of war: Lessons from Syria. Vaccine 2021; 39:3717-3723. [PMID: 34053791 DOI: 10.1016/j.vaccine.2021.05.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/05/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Outbreaks of circulating vaccine-derived polioviruses (cVDPVs) pose a threat to the eventual eradication of all polioviruses. In 2017, an outbreak of cVDPV type 2 (cVDPV2) occurred in the midst of a war in Syria. We describe vaccination-based risk factors for and the successful response to the outbreak. METHODS We performed a descriptive analysis of cVDPV2 cases and key indicators of poliovirus surveillance and vaccination activities during 2016-2018. In the absence of reliable subnational coverage data, we used the caregiver-reported vaccination status of children with non-polio acute flaccid paralysis (AFP) as a proxy for vaccination coverage. We then estimated the relative odds of being unvaccinated against polio, comparing children in areas affected by the outbreak to children in other parts of Syria in order to establish the presence of poliovirus immunity gaps in outbreak affected areas. FINDINGS A total of 74 cVDPV2 cases were reported, with paralysis onset ranging from 3 March to 21 September 2017. All but three cases were reported from Deir-ez-Zor governorate and 84% had received < 3 doses of oral poliovirus vaccine (OPV). After adjusting for age and sex, non-polio AFP case-patients aged 6-59 months in outbreak-affected areas had 2.5 (95% CI: 1.1-5.7) increased odds of being unvaccinated with OPV compared with non-polio AFP case-patients in the same age group in other parts of Syria. Three outbreak response rounds of monovalent OPV type 2 (mOPV2) vaccination were conducted, with governorate-level coverage mostly exceeding 80%. INTERPRETATION Significant declines in both national and subnational polio vaccination coverage, precipitated by war and a humanitarian crisis, led to a cVDPV2 outbreak in Syria that was successfully contained following three rounds of mOPV2 vaccination.
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Affiliation(s)
- Chukwuma Mbaeyi
- United States Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA 30329, USA.
| | - Thomas Moran
- World Health Organization Headquarters, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Zubair Wadood
- World Health Organization Headquarters, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Fazal Ather
- Middle East and North Africa Office, United Nations Children's Fund, Abdulqader Al-Abed Street, Building No. 15, Tla'a Al-Ali, Amman, Jordan
| | - Emma Sykes
- World Health Organization, Regional Office for the Eastern Mediterranean, Mohammad Jamjoum Street, Ministry of Interior Circle Building No. 5, P.O. Box 811547, Amman 11181, Jordan
| | - Joanna Nikulin
- World Health Organization, Regional Office for the Eastern Mediterranean, Mohammad Jamjoum Street, Ministry of Interior Circle Building No. 5, P.O. Box 811547, Amman 11181, Jordan
| | - Mohammad Al Safadi
- World Health Organization Headquarters, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Tasha Stehling-Ariza
- United States Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA 30329, USA
| | - Laurel Zomahoun
- World Health Organization Headquarters, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Abdelkarim Ismaili
- World Health Organization, Regional Office for the Eastern Mediterranean, Mohammad Jamjoum Street, Ministry of Interior Circle Building No. 5, P.O. Box 811547, Amman 11181, Jordan
| | - Nidal Abourshaid
- Syria Country Office, United Nations Children's Fund, East Mazzeh, Al Shafiee St., Damascus, Syria
| | - Humayun Asghar
- World Health Organization, Regional Office for the Eastern Mediterranean, Mohammad Jamjoum Street, Ministry of Interior Circle Building No. 5, P.O. Box 811547, Amman 11181, Jordan
| | - Gulay Korukluoglu
- Public Health Institutions of Turkey, Adnan Saygun Cad. No. 55, F Blok 06100 Sihhiye, Ankara, Turkey
| | - Erwin Duizer
- National Polio Laboratory, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA, Bilthoven, the Netherlands
| | - Derek Ehrhardt
- United States Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA 30329, USA
| | - Cara C Burns
- United States Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA 30329, USA
| | - Magdi Sharaf
- World Health Organization, Regional Office for the Eastern Mediterranean, Mohammad Jamjoum Street, Ministry of Interior Circle Building No. 5, P.O. Box 811547, Amman 11181, Jordan
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Stool Serology: Development of a Non-Invasive Immunological Method for the Detection of Enterovirus-Specific Antibodies in Congo Gorilla Faeces. Microorganisms 2021; 9:microorganisms9040810. [PMID: 33921300 PMCID: PMC8068960 DOI: 10.3390/microorganisms9040810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The incidence of poliovirus has been significantly reduced by as much as 99.9% globally. Alongside this, however, vaccine-associated paralytic poliomyelitis has emerged. Previously, our team reported in the Lésio-Louna-Léfini Nature Reserve (Republic of Congo) the presence of a new Enterovirus C (Ibou002) in a male gorilla that was put away because of clinical symptoms of facial paralysis. This new virus, isolated was from the stool samples of this gorilla but also from the excrement of an eco-guardian, is very similar to Coxsackievirus (EV-C99) as well as poliovirus 1 and 2. We hypothesised that these symptoms might be due to poliovirus infection. To test our hypothesis, we developed and optimised a non-invasive immunoassay for the detection of Enterovirus-specific antibodies in gorilla faeces that could be useful for routine serosurveillance in such cases. Methods: In order to assess the potential role of poliovirus infection, we have developed and optimised a protocol, based on the lyophilisation and solubilisation of small volumes of stool extracts from 16 gorilla and 3 humans, to detect specific antibodies by western blot and ELISA. Results: First, total immunoglobulins were detected in the concentrated stool extracts. Specific antibodies were then detected in 4/16 gorilla samples and 2/3 human samples by western blot using both the polio vaccine antigen and the Ibou002 antigen and by ELISA using the polio vaccine antigen. Humoral responses were greater with the Ibou002 antigen. Conclusion: We therefore suggest that this recombinant virus could lead to a polio-like disease in the endangered western lowland gorilla. The development of a non-invasive approach to detect microorganism-specific immunoglobulins from faecal samples opens numerous prospects for application in zoonotic infectious diseases and could revolutionise the screening of animals for important emerging infections, such as Ebola fever, rabies and coronavirus infections.
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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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11
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Deressa W, Kayembe P, Neel AH, Mafuta E, Seme A, Alonge O. Lessons learned from the polio eradication initiative in the Democratic Republic of Congo and Ethiopia: analysis of implementation barriers and strategies. BMC Public Health 2020; 20:1807. [PMID: 33339529 PMCID: PMC7747367 DOI: 10.1186/s12889-020-09879-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Since its inception in 1988, the Global Polio Eradication Initiative (GPEI) has partnered with 200 countries to vaccinate over 2.5 billion children against poliomyelitis. The polio eradication approach has adapted to emerging challenges and diverse contexts. Knowledge assets gained from these experiences can inform implementation of future health programs, but only if efforts are made to systematically map barriers, identify strategies to overcome them, identify unintended consequences, and compare experiences across country contexts. METHODS A sequential explanatory mixed methods design, including an online survey followed by key informant interviews (KIIs), was utilized to map tacit knowledge derived from the polio eradication experience from 1988 to 2019. The survey and KIIs were conducted between September 2018 and March 2019. A cross-case comparison was conducted of two study countries, the Democratic Republic of Congo (DRC) and Ethiopia, which fit similar epidemiological profiles for polio. The variables of interest (implementation barriers, strategies, unintended consequences) were compared for consistencies and inconsistencies within and across the two country cases. RESULTS Surveys were conducted with 499 and 101 respondents, followed by 23 and 30 KIIs in the DRC and Ethiopia, respectively. Common implementation barriers included accessibility issues caused by political insecurity, population movement, and geography; gaps in human resources, supply chain, finance and governance; and community hesitancy. Strategies for addressing these barriers included adapting service delivery approaches, investing in health systems capacity, establishing mechanisms for planning and accountability, and social mobilization. These investments improved system infrastructure and service delivery; however, resources were often focused on the polio program rather than strengthening routine services, causing community mistrust and limiting sustainability. CONCLUSIONS The polio program investments in the DRC and Ethiopia facilitated program implementation despite environmental, system, and community-level barriers. There were, however, missed opportunities for integration. Remaining pockets of low immunization coverage and gaps in surveillance must be addressed in order to prevent importation of wild poliovirus and minimize circulating vaccine-derived poliovirus. Studying these implementation processes is critical for informing future health programs, including identifying implementation tools, strategies, and principles which can be adopted from polio eradication to ensure health service delivery among hard-to-reach populations. Future disease control or eradication programs should also consider strategies which reduce parallel structures and define a clear transition strategy to limit long-term external dependency.
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Affiliation(s)
- Wakgari Deressa
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Patrick Kayembe
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Abigail H Neel
- International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
| | - Eric Mafuta
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Assefa Seme
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Olakunle Alonge
- International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
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A novel synthetic DNA vaccine elicits protective immune responses against Powassan virus. PLoS Negl Trop Dis 2020; 14:e0008788. [PMID: 33119599 PMCID: PMC7595275 DOI: 10.1371/journal.pntd.0008788] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 09/10/2020] [Indexed: 01/07/2023] Open
Abstract
Powassan virus (POWV) infection is a tick-borne emerging infectious disease in the United States and North America. Like Zika virus, POWV is a member of the family Flaviviridae. POWV causes severe neurological sequalae, meningitis, encephalitis, and can cause death. Although the risk of human POWV infection is low, its incidence in the U.S. in the past 16 years has increased over 300%, urging immediate attention. Despite the disease severity and its growing potential for threatening larger populations, currently there are no licensed vaccines which provide protection against POWV. We developed a novel synthetic DNA vaccine termed POWV-SEV by focusing on the conserved portions of POWV pre-membrane and envelope (prMEnv) genes. A single immunization of POWV-SEV elicited broad T and B cell immunity in mice with minimal cross-reactivity against other flaviviruses. Antibody epitope mapping demonstrated a similarity between POWV-SEV-induced immune responses and those elicited naturally in POWV-infected patients. Finally, POWV-SEV induced immunity provided protection against POWV disease in lethal challenge experiments.
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13
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Investigation Report of cVDPV2 Outbreak in Bokh Woreda of Dollo Zone, Somali Regional State, Ethiopia. Case Rep Infect Dis 2020; 2020:6917313. [PMID: 32908734 PMCID: PMC7471813 DOI: 10.1155/2020/6917313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 07/27/2020] [Accepted: 08/20/2020] [Indexed: 11/29/2022] Open
Abstract
Background Poliovirus isolates detected in persons or in the environment can fall into three major categories: wild, Sabin and Sabin-like, or vaccine-derived. Detection of wild or vaccine-derived poliovirus may constitute an emergency, which can be categorized as an event that can lead to an outbreak, depending on characteristics of the isolate and the context in which it appears. The aim of the study was investigation report of cVDPV2 outbreak in Bokh woreda of Dollo Zone, Somali regional state, Ethiopia. Methods A team of experts drawn from different organizations was deployed to Bokh woreda to make detailed field investigation from May 25 to June 17, 2019. By using standard World Health Organization polio outbreak investigation checklist, document review of surveillance, immunization, and clinical data related to the case was made. Key informant's interview was made to health professionals, managers, parents of case, woreda and kebele leaders, religious leaders, and HEWs related to acute flaccid paralysis outbreak. Result The notified AFP case was a 39-month-old female from Angalo kebele of Bokh woreda, Dollo Zone. On 19th May 2019, the patient developed high grade fever and was taken to Angalo Health Post on 20th May 2019. As per the examination by a health extension worker, the child had high grade fever and neck stiffness with preliminary diagnosis of meningitis for which ceftriaxone injection was prescribed. Contact sample was taken from three children on 28th May 2019 and 29th May 2019 and was sent to Addis Ababa National Polio Laboratory. All contact stool samples were found to be positive for poliovirus type 2 and referred for sequencing in National Institute of Communicable Diseases (NICD), South Africa, the Regional Polio Reference Laboratory. Conclusion and Recommendation. The clinical presentation of the cases is compatible with poliovirus infection, improving the quality and coverage of supplementary polio immunization activities through proper planning; strict supervision and follow-up can reduce the occurrence of acute flaccid paralysis.
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Funaki T, Fukuda A, Sakamoto S, Kasahara M, Saitoh A, Miyairi I. Serostatus following polio-containing vaccination before and after liver transplantation. Pediatr Transplant 2020; 24:e13766. [PMID: 32558028 DOI: 10.1111/petr.13766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/16/2020] [Accepted: 05/26/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The strategy to eradicate polio is based on preventing infection by immunizing all children until the world is polio-free. However, data regarding efficacy of polio-containing vaccination in immunocompromised patients such as LT recipients are limited. METHODS We conducted an observational study at the largest pediatric transplant center in Japan from January 2011 to January 2015. LT recipients were enrolled after transplantation, and those who had completed the Japanese polio vaccination program were eligible for the study. Patients' demographics were collected from their medical records. Antibody titers against poliovirus serotypes 1-3 were measured using the neutralization test at the routine follow-up visits after enrollment. Factors associated with seropositivity against each type of poliovirus were evaluated. RESULTS Sixty-four patients who had received the complete polio vaccination series were enrolled in the study. Of these, 37 patients had received all series of polio-containing vaccination before LT. Median age of the patients was 75 months. Their underlying diseases included the following: 40 (63%) with cholestatic liver diseases and 11 (17%) with metabolic disorders. After a median interval of 43 months after LT, seropositivity rates against poliovirus 1, 2, and 3 were 93.8% (60/64), 92.2% (59/64), and 54.7% (35/64), respectively. Among 32 patients who had received only oral polio vaccine (OPV), seropositivity against poliovirus 3 was particularly low (25.0%). No factors associated with seropositivity against each type of poliovirus were identified. CONCLUSIONS In the LT recipients, seropositivity for poliovirus 3 was low, suggesting a need for additional inactivated polio-containing vaccination after LT, especially for patients who had received only OPV.
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Affiliation(s)
- Takanori Funaki
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Akinari Fukuda
- Transplant Center, National Center for Child Health and Development, Tokyo, Japan
| | - Seisuke Sakamoto
- Transplant Center, National Center for Child Health and Development, Tokyo, Japan
| | - Mureo Kasahara
- Transplant Center, National Center for Child Health and Development, Tokyo, Japan
| | - Akihiko Saitoh
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
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15
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Alonge O. What can over 30 years of efforts to eradicate polio teach us about global health? BMC Public Health 2020; 20:1177. [PMID: 32787897 PMCID: PMC7419726 DOI: 10.1186/s12889-020-09198-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Olakunle Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
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Environmental Surveillance Complements Case-Based Surveillance of Acute Flaccid Paralysis in Polio Endgame Strategy 2019-2023. Appl Environ Microbiol 2020; 86:AEM.00702-20. [PMID: 32444474 DOI: 10.1128/aem.00702-20] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/14/2020] [Indexed: 11/20/2022] Open
Abstract
The Polio Endgame Strategy 2019-2023 has been developed. However, more effective and efficient surveillance activities should be conducted with the preparedness of emergence for vaccine-derived poliovirus (VDPV) or wild poliovirus (WPV). We reviewed the impact of the case-based acute flaccid paralysis (AFP) surveillance (1991 to 2018) and environmental surveillance (2011 to 2018) in polio eradication in Shandong province of China. Clinical characteristics of AFP cases and enterovirus (EV) investigation of research samples were assessed. During the period, 10,224 AFP cases were investigated, and 352 sewage samples were collected. The nonpolio AFP rate sustained at over 2.0/100,000 since 1997. Of 10,224 cases, males and young children experienced a higher risk of severe diseases, and 68.5% suffered lower limb paralysis. We collected 1,707 EVs from AFP cases, including 763 polioviruses and 944 nonpolio enteroviruses (NPEVs). No WPV was isolated since 1992. The AFP surveillance showed high sensitivity in detecting 143 vaccine-associated paralytic poliomyelitis (VAPP) cases and 6 VDPVs. For environmental surveillance, 217 (61.6%) samples were positive for poliovirus, and altogether, 838 polioviruses and 2,988 NPEVs were isolated. No WPV was isolated in environmental surveillance, although one VDPV2 was identified. Phylogenetic analysis revealed environmental surveillance had the capacity to detect a large scope of NPEVs. The case-based AFP surveillance will be indispensable for detecting VAPP cases and VDPV circulation in countries using oral polio vaccine. Environmental surveillance is advantageous in identifying EV circulation and responding to ongoing circulating VDPV outbreaks and should be expanded to complement the AFP surveillance.IMPORTANCE Interrupting wild poliovirus transmission and stopping circulating vaccine-derived poliovirus (cVDPV) outbreaks have been proposed as two global goals by the World Health Organization in the Global Polio Eradication Initiative (GPEI). This analysis, based on the 28-year acute flaccid paralysis (AFP) surveillance and 8-year environmental surveillance, provides continued high-quality surveillance performance in achieving the GPEI and detecting the circulation of enterovirus. Given the ongoing cVDPV outbreaks in the world, we present the surveillance capacity of environmental surveillance in capturing enterovirus circulation. The final poliovirus (especially VDPV) elimination has become increasingly complex, and the case-based AFP surveillance alone will lead to difficulties in early detecting dynamics of poliovirus transmission and monitoring the extent of environmental circulation. This study goes beyond previous work to provide a detailed comprehensive evaluation of the enterovirus surveillance and can be used to formulate a set of implementation plan and performance indicators for environmental surveillance.
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Brouwer L, Benschop KS, Nguyen D, Kamau E, Pajkrt D, Simmonds P, Wolthers KC. Recombination Analysis of Non-Poliovirus Members of the Enterovirus C Species; Restriction of Recombination Events to Members of the Same 3DPol Cluster. Viruses 2020; 12:v12070706. [PMID: 32629843 PMCID: PMC7412211 DOI: 10.3390/v12070706] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/23/2020] [Indexed: 12/13/2022] Open
Abstract
Enteroviruses (EVs) are highly prevalent viruses worldwide. Recombination is known to occur frequently in EVs belonging to species Enterovirus A, Enterovirus B, and Enterovirus C. Although many recombinant vaccine-derived poliovirus (VDPV) strains have been reported, our knowledge on recombination in non-polio EVs in the species Enterovirus C is limited. Here, we combined a dataset consisting of 11 newly generated full-length Enterovirus C sequences and 180 publicly available sequences to study recombination dynamics in non-polio EVs. To identify recombination patterns, maximum likelihood phylogenetic trees of different genomic regions were constructed, and segregation analyses were performed. Recombination was observed between members of the same 3DPol cluster, but was rarely observed between members of different clusters. We hypothesize that this restriction may have arisen through their different compartmentalization in respiratory and enteric tracts related to differences in cellular tropisms so that the opportunity to recombine may not be available.
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Affiliation(s)
- Lieke Brouwer
- Department of Medical Microbiology, Academic Medical Center (AMC), Amsterdam University Medical Centers (Amsterdam UMC), 1105AZ Amsterdam, The Netherlands;
- Correspondence:
| | - Kimberley S.M. Benschop
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721MA Bilthoven, The Netherlands;
| | - Dung Nguyen
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 3SY, UK; (D.N.); (E.K.); (P.S.)
| | - Everlyn Kamau
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 3SY, UK; (D.N.); (E.K.); (P.S.)
| | - Dasja Pajkrt
- Department of Pediatric Infectious Diseases, Academic Medical Center (AMC), Amsterdam University Medical Centers (Amsterdam UMC), 1105AZ Amsterdam, The Netherlands;
| | - Peter Simmonds
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 3SY, UK; (D.N.); (E.K.); (P.S.)
| | - Katja C. Wolthers
- Department of Medical Microbiology, Academic Medical Center (AMC), Amsterdam University Medical Centers (Amsterdam UMC), 1105AZ Amsterdam, The Netherlands;
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Alleman MM, Jorba J, Greene SA, Diop OM, Iber J, Tallis G, Goel A, Wiesen E, Wassilak SG, Burns CC. Update on Vaccine-Derived Poliovirus Outbreaks - Worldwide, July 2019-February 2020. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:489-495. [PMID: 32324719 PMCID: PMC7188410 DOI: 10.15585/mmwr.mm6916a1] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Roberts JA, Hobday LK, Ibrahim A, Thorley BR. Australian National Enterovirus Reference Laboratory annual report, 2018. ACTA ACUST UNITED AC 2020; 44. [PMID: 32299336 DOI: 10.33321/cdi.2020.44.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Australia monitors its polio-free status by conducting surveillance for cases of AFP in children less than 15 years of age, as recommended by the WHO. Cases of AFP in children are notified to the Australian Paediatric Surveillance Unit or the Paediatric Active Enhanced Disease Surveillance System and faecal specimens are referred for virological investigation to the National Enterovirus Reference Laboratory. In 2018, no cases of poliomyelitis were reported from clinical surveillance and Australia reported 1.24 non-polio AFP cases per 100,000 children, meeting the WHO performance criterion for a sensitive surveillance system. Several non-polio enteroviruses, coxsackievirus A4, coxsackievirus B1, echovirus 9, echovirus 30, enterovirus D68 and enterovirus A71, were identified from clinical specimens collected from AFP cases. Australia also performs enterovirus and environmental surveillance to complement the clinical system focussed on children. In 2018, 33 cases of wild polio were reported with three countries remaining endemic: Afghanistan, Nigeria and Pakistan.
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Affiliation(s)
- Jason A Roberts
- National Enterovirus Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, 792 Elizabeth St, Melbourne 3000, Victoria, Australia
| | - Linda K Hobday
- National Enterovirus Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, 792 Elizabeth St, Melbourne 3000, Victoria, Australia
| | - Aishah Ibrahim
- National Enterovirus Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, 792 Elizabeth St, Melbourne 3000, Victoria, Australia
| | - Bruce R Thorley
- National Enterovirus Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, 792 Elizabeth St, Melbourne 3000, Victoria, Australia
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Wang H. Why Have cVDPV2 Outbreaks Increased Globally After the Polio Immunization Strategy Switch: Challenges for the Polio Eradication Endgame. China CDC Wkly 2020; 2:176-179. [PMID: 34594619 PMCID: PMC8393165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/09/2020] [Indexed: 10/27/2022] Open
Affiliation(s)
- Huaqing Wang
- Chinese Center for Disease Control and Prevention, Beijing, China,Huaqing Wang,
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Javelle E, Raoult D. Antibiotics against poliovirus carriage: an additional tool in the polio endgame? Clin Microbiol Infect 2020; 26:542-544. [PMID: 31935566 DOI: 10.1016/j.cmi.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/02/2020] [Accepted: 01/04/2020] [Indexed: 12/27/2022]
Affiliation(s)
- E Javelle
- Laveran Military Teaching Hospital, Department of Infectious Diseases and Tropical Medicine, French Military Medical Services, France; Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, France; IHU-Méditerranée Infection, IRD, AP-HM, SSA, MEPHI, Marseille, France.
| | - D Raoult
- IHU-Méditerranée Infection, IRD, AP-HM, SSA, MEPHI, Marseille, France; Aix-Marseille Université, IRD, AP-HM, SSA, MEPHI, Marseille, France
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Jorba J, Diop OM, Iber J, Henderson E, Zhao K, Quddus A, Sutter R, Vertefeuille JF, Wenger J, Wassilak SG, Pallansch MA, Burns CC. Update on Vaccine-Derived Poliovirus Outbreaks - Worldwide, January 2018-June 2019. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:1024-1028. [PMID: 31725706 PMCID: PMC6855511 DOI: 10.15585/mmwr.mm6845a4] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Affiliation(s)
- Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, 2610 Antwerp, Belgium.
| | - Ilse De Coster
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, 2610 Antwerp, Belgium
| | - Hilde Revets
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, 2610 Antwerp, Belgium
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Greene SA, Ahmed J, Datta SD, Burns CC, Quddus A, Vertefeuille JF, Wassilak SG. Progress Toward Polio Eradication - Worldwide, January 2017-March 2019. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:458-462. [PMID: 31120868 PMCID: PMC6532951 DOI: 10.15585/mmwr.mm6820a3] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Patel JC, Diop OM, Gardner T, Chavan S, Jorba J, Wassilak SGF, Ahmed J, Snider CJ. Surveillance to Track Progress Toward Polio Eradication - Worldwide, 2017-2018. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:312-318. [PMID: 30946737 PMCID: PMC6611474 DOI: 10.15585/mmwr.mm6813a4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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