Evaluating cessation of the type 2 oral polio vaccine by modeling pre- and post-cessation detection rates

Environmental surveillance was recommended for risk mitigation in a novel oral polio vaccine-2 (nOPV2) clinical trial (M5-ABMG) to monitor excretion, potential circulation, and loss of attenuation of the two nOPV2 candidates. The nOPV2 candidates were developed to address the risk of poliovirus (PV) type 2 circulating vaccine-derived poliovirus (cVDPV) as part of the global eradication strategy. Between November 2018 and January 2020, an environmental surveillance study for the clinical trial was conducted in parallel to the M5-ABMG clinical trial at five locations in Panama. The collection sites were located upstream from local treatment plant inlets, to capture the excreta from trial participants and their community. Laboratory analyses of 49 environmental samples were conducted using the two-phase separation method. Novel OPV2 strains were not detected in sewage samples collected during the study period. However, six samples were positive for Sabin-like type 3 PV, two samples were positive for Sabin-like type 1 PV, and non-polio enteroviruses NPEVs were detected in 27 samples. One of the nOPV2 candidates has been granted Emergency Use Listing by the World Health Organization and initial use started in March 2021. This environmental surveillance study provided valuable risk mitigation information to support the Emergency Use Listing application.

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Two good reasons to drop type 2 virus from oral polio vaccine

The Lancet ◽

10.1016/s0140-6736(04)17351-0 ◽

2004 ◽

Vol 364 (9446) ◽

pp. 1666 ◽

Cited By ~ 2

Author(s):

T Jacob John

Keyword(s):

Oral Polio Vaccine ◽

Polio Vaccine

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Introduction of Inactivated Polio Vaccine, Withdrawal of Type 2 Oral Polio Vaccine, and Routine Immunization Strengthening in the Eastern Mediterranean Region

The Journal of Infectious Diseases ◽

10.1093/infdis/jix133 ◽

2017 ◽

Vol 216 (suppl_1) ◽

pp. S86-S93 ◽

Cited By ~ 5

Author(s):

Kamal Fahmy ◽

Lee M. Hampton ◽

Houda Langar ◽

Manish Patel ◽

Tahir Mir ◽

...

Keyword(s):

Mediterranean Region ◽

Eastern Mediterranean ◽

Eastern Mediterranean Region ◽

Oral Polio Vaccine ◽

Routine Immunization ◽

Inactivated Polio Vaccine ◽

Polio Vaccine

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Highly Divergent Type 2 and 3 Vaccine-Derived Polioviruses Isolated from Sewage in Tallinn, Estonia

Journal of Virology ◽

10.1128/jvi.01174-13 ◽

2013 ◽

Vol 87 (23) ◽

pp. 13076-13080 ◽

Cited By ~ 16

Author(s):

Haider Al-Hello ◽

Jaume Jorba ◽

Soile Blomqvist ◽

Riina Raud ◽

Olen Kew ◽

...

Keyword(s):

Sequence Analysis ◽

Common Variable Immunodeficiency ◽

Vaccine Dose ◽

Oral Polio Vaccine ◽

Polio Vaccine ◽

Common Variable

Highly divergent vaccine-derived polioviruses (VDPVs) have been isolated from sewage in Tallinn, Estonia, since 2002. Sequence analysis of VDPVs of serotypes 2 and 3 showed that they shared common noncapsid region recombination sites, indicating origination from a single trivalent oral polio vaccine dose, estimated to have been given between 1986 and 1998. The sewage isolates closely resemble VDPVs chronically excreted by persons with common variable immunodeficiency, but no chronic excretors have yet been identified in Estonia.

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Immunity and field efficacy of type 2-containing polio vaccines after cessation of trivalent oral polio vaccine: A population-based serological study in Pakistan

Vaccine X ◽

10.1016/j.jvacx.2020.100067 ◽

2020 ◽

Vol 5 ◽

pp. 100067

Author(s):

Arie Voorman ◽

Muhammad Atif Habib ◽

Imtiaz Hussain ◽

Rana Muhammad Safdar ◽

Jamal A. Ahmed ◽

...

Keyword(s):

Oral Polio Vaccine ◽

Population Based ◽

Serological Study ◽

Polio Vaccine ◽

Field Efficacy

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The polio endgame: rationale behind the change in immunisation

Archives of Disease in Childhood ◽

10.1136/archdischild-2016-311171 ◽

2017 ◽

Vol 102 (4) ◽

pp. 362-365 ◽

Cited By ~ 3

Author(s):

Julie Garon ◽

Manish Patel

Keyword(s):

Scale Up ◽

Oral Polio Vaccine ◽

Polio Eradication ◽

World Health ◽

Routine Immunisation ◽

Wild Poliovirus ◽

Polio Vaccine ◽

Global Coordination ◽

Eradicate Polio

The decades long effort to eradicate polio is nearing the final stages and oral polio vaccine (OPV) is much to thank for this success. As cases of wild poliovirus continue to dwindle, cases of paralysis associated with OPV itself have become a concern. As type-2 poliovirus (one of three) has been certified eradicated and a large proportion of OPV-related paralysis is caused by the type-2 component of OPV, the World Health Assembly endorsed the phased withdrawal of OPV and the introduction of inactivated polio vaccine (IPV) into routine immunisation schedules as a crucial step in the polio endgame plan. The rapid pace of IPV scale-up and uptake required adequate supply, planning, advocacy, training and operational readiness. Similarly, the synchronised switch from trivalent OPV (all three types) to bivalent OPV (types 1 and 3) involved an unprecedented level of global coordination and country commitment. The important shift in vaccination policy seen through global IPV introduction and OPV withdrawal represents an historical milestone reached in the polio eradication effort.

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Australian National Enterovirus Reference Laboratory annual report, 2015

Communicable Diseases Intelligence ◽

10.33321/cdi.2020.44.24 ◽

2020 ◽

Vol 44 ◽

Author(s):

Jason A Roberts ◽

Linda K Hobday ◽

Aishah Ibrahim ◽

Thomas Aitken ◽

Bruce R Thorley

Keyword(s):

Surveillance System ◽

Oral Polio Vaccine ◽

World Health ◽

Surveillance Program ◽

Reference Laboratory ◽

Poliovirus Type ◽

Wild Poliovirus ◽

Polio Vaccine ◽

Clinical Surveillance

Australia conducts surveillance for cases of acute flaccid paralysis (AFP) in children less than 15 years as recommended by the World Health Organization (WHO) as the main method to monitor its polio-free status. 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 2015, no cases of poliomyelitis were reported from clinical surveillance and Australia reported 1.2 non-polio AFP cases per 100,000 children, meeting the WHO performance criterion for a sensitive surveillance system. Two non-polio enteroviruses, enterovirus A71 and coxsackievirus B3, were identified from clinical specimens collected from AFP cases. Australia complements the clinical surveillance program with enterovirus and environmental surveillance for poliovirus. Two Sabin-like polioviruses were isolated from sewage collected in Melbourne in 2015, which would have been imported from a country that uses the oral polio vaccine. The global eradication of wild poliovirus type 2 was certified in 2015 and Sabin poliovirus type 2 will be withdrawn from oral polio vaccine in April 2016. Laboratory containment of all remaining wild and vaccine strains of poliovirus type 2 will occur in 2016 and the National Enterovirus Reference Laboratory was designated as a polio essential facility. Globally, in 2015, 74 cases of polio were reported, only in the two remaining countries endemic for wild poliovirus: Afghanistan and Pakistan. This is the lowest number reported since the global polio eradication program was initiated.

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Moving from oral poliovirus vaccine to inactivated poliovirus vaccine: The rationale and challenges

Bangladesh Journal of Medicine ◽

10.3329/bjm.v31i1.44749 ◽

2019 ◽

Vol 31 (1) ◽

pp. 22-28 ◽

Cited By ~ 1

Author(s):

Kazi Zulfiquer Mamun ◽

Nabeela Mahboob ◽

Kazi Taib Mamun ◽

Hasina Iqbal

Keyword(s):

Oral Polio Vaccine ◽

Sole Source ◽

Polio Eradication ◽

Oral Poliovirus Vaccine ◽

Routine Immunization ◽

Inactivated Polio Vaccine ◽

Polio Vaccine ◽

The Past ◽

Global Polio Eradication Initiative

Oral polio vaccine (OPV) has served as the cornerstone of polio eradication efforts over the past 30 years, trivalent inactivated polio vaccine (IPV) has re-ascended to prominence in the past year, now acting as the sole source of protective immunity against type 2 poliovirus in routine immunization programmes. The Polio Eradication and Endgame Strategic plan 2013–2018, developed by the Global Polio Eradication Initiative (GPEI) outlines the phased removal of OPVs, starting with type 2 poliovirus–containing vaccines and introduction of inactivated polio vaccine in routine immunization to mitigate against risk of vaccine-associated paralytic polio and circulating vaccine-derived poliovirus. Bangladesh J Medicine Jan 2020; 31(1) : 22-28

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Nonhomologous Recombination between Defective Poliovirus and Coxsackievirus Genomes Suggests a New Model of Genetic Plasticity for Picornaviruses

mBio ◽

10.1128/mbio.01119-14 ◽

2014 ◽

Vol 5 (4) ◽

Cited By ~ 32

Author(s):

Barbara Holmblat ◽

Sophie Jégouic ◽

Claire Muslin ◽

Bruno Blondel ◽

Marie-Line Joffret ◽

...

Keyword(s):

Cultured Cells ◽

Oral Polio Vaccine ◽

Human Enterovirus ◽

Human Populations ◽

Intermediate Step ◽

Nonhomologous Recombination ◽

Polio Vaccine ◽

Transient Intermediate ◽

Selection Of

ABSTRACTMost of the circulating vaccine-derived polioviruses (cVDPVs) implicated in poliomyelitis outbreaks in Madagascar have been shown to be recombinants between the type 2 poliovirus (PV) strain of the oral polio vaccine (Sabin 2) and another species C human enterovirus (HEV-C), such as type 17 coxsackie A virus (CA17) in particular. We studied intertypic genetic exchanges between PV and non-PV HEV-C by developing a recombination model, making it possible to rescue defective type 2 PV RNA genomes with a short deletion at the 3′ end by the cotransfection of cells with defective or infectious CA17 RNAs. We isolated over 200 different PV/CA17 recombinants, using murine cells expressing the human PV receptor (PVR) and selecting viruses with PV capsids. We found some homologous (H) recombinants and, mostly, nonhomologous (NH) recombinants presenting duplications of parental sequences preferentially located in the regions encoding proteins 2A, 2B, and 3A. Short duplications appeared to be stable, whereas longer duplications were excised during passaging in cultured cells or after multiplication in PVR-transgenic mice, generating H recombinants with diverse sites of recombination. This suggests that NH recombination events may be a transient, intermediate step in the generation and selection of the fittest H recombinants. In addition to the classical copy-choice mechanism of recombination thought to generate mostly H recombinants, there may also be a modular mechanism of recombination, involving NH recombinant precursors, shaping the genomes of recombinant enteroviruses and other picornaviruses.IMPORTANCEThe multiplication of circulating vaccine-derived polioviruses (cVDPVs) in poorly immunized human populations can render these viruses pathogenic, causing poliomyelitis outbreaks. Most cVDPVs are intertypic recombinants between a poliovirus (PV) strain and another human enterovirus, such as type 17 coxsackie A viruses (CA17). For further studies of the genetic exchanges between PV and CA17, we have developed a model of recombination, making it possible to rescue defective PV RNA genomes with a short deletion by cotransfecting cells with the defective PV genome and CA17 genomic RNA. Numerous recombinants were found, including homologous PV/CA17 recombinants, but mostly nonhomologous recombinants presenting duplications of parental sequences preferentially located in particular regions. Long duplications were excised by passages in cultured cells or in mice, generating diverse homologous recombinants. Recombination leading to nonhomologous recombinants, which evolve into homologous recombinants, may therefore be seen as a model of genetic plasticity in enteroviruses and, possibly, in other RNA viruses.

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