Environmental Surveillance and Vaccine Derived Polio Virus type 2 Isolation, Gombe State, Nigeria.

ObjectiveTo evaluate Vaccine Derived Polio Virus 2 isolation rate from Environmental Surveillance and its contribution to Polio Eradication Initiative (PEI)IntroductionNigeria is the only country in Africa yet to be certified free of Wild Polio Virus (WPV). The country consists of 36 States and a Federal Capital Territory. Gombe is one of the 19 Polio high risk States in the North-eastern geo-political zone of the country. The last case of WPV isolated in Gombe State was in 2013.One of the strategies for Polio eradication is a sensitive Acute Flaccid Paralysis (AFP) surveillance system in which any AFP is promptly detected and timely investigated. The focus of the investigation is to analyze two faecal samples of the patient, and/or sometimes those from contacts for any possible isolation of Polio Virus1 (PV). AFP surveillance is meant to be applicable to any human population at any time; however, there are situations in which there are good reasons to suspect that negative results of AFP surveillance are not reliable. Supplementary information is required in such situations and one approach for that is Environmental Surveillance (ES), in which a search for PV is made in environmental specimens contaminated by human feaces2ES in the African region started in Nigeria in July 20113,4. Since the introduction of this strategy, it has achieved its objective of complimenting the AFP surveillance system. There has been a gradual increase in the number of ES sites in Nigeria from 2011 to date4. The increase is largely due to the successes recorded in terms of the PV isolation from the sites, PV epidemiology, the large population size and mobility4,5. The last cases of WPV1 and WPV3 from environmental samples had dates of collection in May 2014 (Kaduna) and July 2012 (Kano) respectively4.ES was initiated in Gombe State in December 2016. Four ES sites were identified and sample collection began soon after training of personnel responsible for collection of the sewage sample. The four identified ES sites are Baba Roba Valley, Unguwauku Railway Bridge, Gadan Bayan Moonshine and Dan Gusau Bridge. Since inception of ES in Gombe State, 2 ambiguous Vaccine Derived Poliovirus type 2 (aVDPV2) were confirmed from sewage samples collected from Baba Roba Valley site on the 30th January 2017 and from Dan Gusau Bridge site on the 6th March 2017. In 2018, a circulating Vaccine Derived Poliovirus type 2 (cVDPV2) was also detected from sewage samples collected on the 9th April 2018 from Baba Roba Valley site. We reviewed the laboratory results from the 2 surveillance methods so as to evaluate the VDPV2 isolation rate.MethodsES involves collection of one litre of environmental sample (sewage water) via grab sampling method in accordance with World Health Organization’s (WHO) Guidelines for Environmental Surveillance for Polioviruses2. All ES sewage samples were transported in a 1 litre container appropriately packaged in a Giostyle with 8 frozen icepacks to maintain reverse cold chain to a Polio Laboratory where the samples are analyzed as per WHO ES testing standard operating procedures. Poliovirus type 2 isolates are sent to the reference laboratory at the US Centre for Disease Control for sequencing for PV isolation.We reviewed all the results of the environmental samples (ES) and stool samples from patients with Acute flaccid paralysis (AFP) from January 2017 to June 2018. The environmental samples were from five pre-selected sites that was based on the perceived risks for polio circulation that included poor sanitation, overcrowding, extend of drainage population, availability of sewage system and absence of discharge into the sites. The stool samples were from patients detected with AFP in Gombe local government area.The results from the two methods of surveillance for PV were evaluated and compared based on yields and isolates (Negative results, VDPV2, Non-polio enterovirus (NPENT).ResultsA total of 309 sewage samples from five (5) sites and 142 AFP stool samples from Gombe LGA were collected from January 2017 to June 2018. Three 3(0.97%) of the sewage samples yielded VDPV2, 102(33.01%) had Non-polio enteroviruses (NPENT) and 41 (13.27%) negative samples. On the other hand, no VDPV was isolated from the AFP stool samples, the NPENT detection rate was 13(9.16%) and 121(85.21%) samples were negative. The Non-polio AFP (NPAFP) and stool adequacy rates for Gombe LGA during the reporting period were calculated to be 17.2 and 100% respectively.ConclusionsThe polio virus (VDPV) isolation from ES in this review is higher than in AFP surveillance. This has demonstrated amongst others benefit of ES its ability to detect polio virus even in the absence of the virus among AFP cases. ES can thus detect virus that are probably missed by AFP surveillance and hence allow for early response so as to curtail further transmission. The high NPAFP and stool adequacy rates are indication of a sensitive surveillance system nonetheless, the virus isolation from the AFP surveillance was very low. It is important to mention here that other laboratory indicators were not factored into this review. We recommend therefore that both ES and AFP surveillance be done together where facility, resources and personnel are available to implement.References[1] WHO. Field guide for supplementary activities aimed at achieving polio eradication, publication no. WHO/EPI/GEN/95.1. Geneva: World Health Organization, 1995.[2] WHO. Guidelines for environmental surveillance of poliovirus circulation. World Health Organization 2003,Department of Vaccines and Biologicals, 2003. (http://www.who.int/vaccines-documents/DoxGen/H5-Surv.htm). Accessed 6 October 2010.[3] Nicksy Gumede et al. Status of environmental surveillance in the African Regional. African health monitor. March 2015 Issue 19: Pg 38-41[4] Ticha Johnson Muluh et al. Contribution of Environmental Surveillance Toward Interruption of Poliovirus Transmission in Nigeria, 2012–2015. The Journal of Infectious Diseases, Volume 213, Issue suppl_3, 1 May 2016, Pages S131–S135, https://doi.org/10.1093/infdis/jiv767[5] Humayun Ashgar et al. Environmental Surveillance for Polioviruses in the Global Polio Eradication Initiative. The Journal of Infectious Diseases, Volume 210, Issue suppl_1, 1 November 2014, Pages S294–S303, https://doi.org/10.1017/S095026881000316X

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Australian National Enterovirus Reference Laboratory annual report, 2016

Communicable Diseases Intelligence ◽

10.33321/cdi.2020.44.25 ◽

2020 ◽

Vol 44 ◽

Author(s):

Jason A Roberts ◽

Linda K Hobday ◽

Aishah Ibrahim ◽

Bruce R Thorley

Keyword(s):

Surveillance System ◽

Disease Surveillance ◽

Oral Polio Vaccine ◽

Performance Criterion ◽

World Health ◽

Reference Laboratory ◽

Poliovirus Type ◽

Wild Poliovirus ◽

Coxsackievirus A6

Australia monitors its polio-free status by conducting surveillance for cases of acute flaccid paralysis (AFP) in children less than 15 years of age, as recommended by the World Health Organization (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 2016, no cases of poliomyelitis were reported from clinical surveillance and Australia reported 1.38 non-polio AFP cases per 100,000 children, meeting the WHO performance criterion for a sensitive surveillance system. Several non-polio enteroviruses, coxsackievirus A6, enterovirus A71, enterovirus A74 and enterovirus D68, were identified from clinical specimens collected from AFP cases. The global withdrawal of Sabin poliovirus type 2 from oral polio vaccine occurred in April 2016. This event represents the start of the polio endgame with an increased focus on the laboratory containment of all remaining wild and vaccine strains of poliovirus type 2. The National Enterovirus Reference Laboratory was designated as a polio essential facility as part of this process. In 2016, 37 cases of wild polio were reported with three countries remaining endemic: Afghanistan, Nigeria and Pakistan. Nigeria was declared polio-free in 2015, after 12 months without detection of wild poliovirus, but was reinstated as an endemic country after the reporting of four cases in August 2016. This is a salient reminder of the need to maintain sensitive surveillance for poliovirus until global eradication is certified.

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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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Environmental Surveillance Complements Case-Based Surveillance of Acute Flaccid Paralysis in Polio Endgame Strategy 2019–2023

Applied and Environmental Microbiology ◽

10.1128/aem.00702-20 ◽

2020 ◽

Vol 86 (15) ◽

Cited By ~ 1

Author(s):

Peng Chen ◽

Yao Liu ◽

Haiyan Wang ◽

Guifang Liu ◽

Xiaojuan Lin ◽

...

Keyword(s):

Acute Flaccid Paralysis ◽

Polio Eradication ◽

Flaccid Paralysis ◽

World Health ◽

Paralytic Poliomyelitis ◽

Environmental Surveillance ◽

Wild Poliovirus ◽

The World ◽

Afp Surveillance ◽

Case Based

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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Sensitivity of the acute flaccid paralysis surveillance system for poliovirus in South Africa, 2016–2019

Journal of Medical Microbiology ◽

10.1099/jmm.0.001441 ◽

2021 ◽

Vol 70 (10) ◽

Author(s):

Wayne Howard ◽

Shelina Moonsamy ◽

Lerato Seakamela ◽

Sabelle Jallow ◽

Faith Modiko ◽

...

Keyword(s):

South Africa ◽

Surveillance System ◽

Environmental Samples ◽

Acute Flaccid Paralysis ◽

Flaccid Paralysis ◽

World Health ◽

Surveillance Programme ◽

Acute Flaccid Paralysis Surveillance ◽

Afp Surveillance ◽

Type 3

Introduction. Global poliovirus eradication is a public health emergency of international concern. The acute flaccid paralysis (AFP) surveillance programme in South Africa has been instrumental in eliminating polioviruses and keeping the country poliovirus free. Gap statement. The sensitivity of surveillance for polioviruses by every African country is of global interest in the effort to ensure global health security from poliovirus re-emergence. Aim. To describe the epidemiology of polioviruses from AFP cases and environmental samples in South Africa and to report the performance of the AFP surveillance system for the years 2016–2019 against targets established by the World Health Organization (WHO). Methods. Stool specimens from AFP or suspected AFP cases were received and tested as per WHO guidelines. Environmental samples were gathered from sites across the Gauteng province using the grab collection method. Concentration was effected by the two-phase polyethylene glycol method approved by the WHO. Suspected polioviruses were isolated in RD and/or L20B cell cultures through identification of typical cytopathic effects. The presence of polioviruses was confirmed by intratypic differentiation PCR. All polioviruses were sequenced using the Sanger method, and their VP1 gene analysed for mutations. Results. Data from 4597 samples (2385 cases) were analysed from the years 2016–2019. Two cases of immunodeficiency-associated vaccine-derived poliovirus (iVDPV) type 3 were detected in 2017 and 2018. A further 24 Sabin type 1 or type 3 polioviruses were detected for the 4 years. The national surveillance programme detected an average of 3.1 cases of AFP/100 000 individuals under 15 years old (2.8/100 000–3.5/100 000). The stool adequacy of the samples received was 53.0 % (47.0–55.0%), well below the WHO target of 80 % adequacy. More than 90 % of results were released from the laboratory within the turnaround time (96.6 %) and non-polio enteroviruses were detected in 11.6 % of all samples. Environmental surveillance detected non-polio enterovirus in 87.5 % of sewage samples and Sabin polioviruses in 12.5 % of samples. Conclusion. The AFP surveillance programme in South Africa is sensitive to detect polioviruses in South Africa and provided no evidence of wild poliovirus or VDPV circulation in the country.

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Performance of Acute Flaccid Paralysis surveillance in Bauchi State, Nigeria, 2016

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v9i1.7780 ◽

2017 ◽

Vol 9 (1) ◽

Author(s):

Luka M. Ibrahim ◽

Adamu Ningi ◽

Jalal-Eddeen Saleh

Keyword(s):

Stool Specimen ◽

Acute Flaccid Paralysis ◽

Case Definition ◽

Flaccid Paralysis ◽

World Health ◽

Polio Virus ◽

Specimen Collection ◽

Afp Surveillance ◽

Stool Samples ◽

Definition Of

ObjectiveTo identify and address gaps in acute flaccid surveillance for polioeradication in Buchi stateIntroductionPoliomyelitis a disease targeted for eradication since 19881still pose public health challenge. The Eastern Mediterranean andAfrican Regions out of the six World Health Organization (WHO)Regions are yet to be certified polio free2. The certification of theWHO Africa region is largely dependent on Nigeria, while the WHOEastern Mediterranean is dependent on Pakistan and Afghanistan.Surveillance for acute flaccid paralysis (AFP) is one of the criticalelements of the polio eradication initiative. It provides the neededinformation to alert health managers and clinician to timely initiateactions to interrupt transmission of the polio disease and evidence forthe absence of the wild polio virus.3,4One of the core assignments ofthe certification committee in all regions is to review documentationto verify the absence of wild poliovirus.5Good and completedocumentation is the proxy indication of the quality of the systemwhile poor documentation translates to possibilities of missing wildpoliovirus in the past. We evaluated the performance of the AFPsurveillance system in Bauchi, which is among the 11 high risks statesfor wild polio virus in Nigeria to identify and address gaps in thesurveillance system.MethodsWe conducted a cross-sectional study in Bauchi State. We assessedthe material and documentations on AFP surveillance in eighteen of thetwenty Local Government Areas (LGAs). We assessed the knowledgeof the clinician at focal and non-focal sites on case definition of AFP,the number and method of stool specimen collection to investigate acase and types of training received for AFP surveillance. We verifiedAFP case investigations for the last three years: The caregivers(mothers) were interviewed to authenticate the reported informationof AFP cases, the method used for stool specimen collection andfeedbacks. Community leaders’ knowledge on AFP surveillance wasalso assessed. Data was entered and analyzed in excel spread sheet.ResultsReview of the expected deliverables of 18 out of the 20 LGAdisease surveillance and notification officers (DSNO) revealed thatonly 2(11%), 5(28%), 6(33%) and 7(39%) had evidence of poliooutbreak investigation, supervisory reports, minutes of meeting andsurveillance work plan respectively. Of the 31 AFP cases investigated,correct and complete information was 39% for birth day, 26% forbirth month of the child, 23% for date of onset of paralysis and 23%for date of investigation. Contacts of informants, AFP 001-3 weredeficient in the focal and non-focal sites. The non-focal also lackedguidelines for integrated disease surveillance and response (IDSR)and terms of reference for surveillance focal person.Knowledge of case definition of AFP was 71% and 30% amongclinician at the focal and non-focal sites, respectively and 88% and55% for method of stool collection among clinician at focal and non-focal sites. Among the 38 care givers (mothers) interviewed 16 (42%)did not remember the day or month the investigation for the AFPwas conducted, 36(95%) gave the correct number of stool samples,15(40%) mentioned that the stool samples were collected 24 hoursapart and only 12 (32%) received feedbacks. Majority (79%) of thecommunity leaders interviewed were aware of AFP and knew thatstool was the specimen for investigation of the AFP but 21% did notknow whom to report a case of AFP in their communityConclusionsOur study revealed knowledge and documentations gaps in AFPsurveillance for certification of polio-free in Nigeria. The stateministry of health and the WHO consultants in the polio eradicationunit should update the knowledge of the health care workers at theoperational levels on AFP surveillance. The state ministry of healthand the WHO consultants should also provide all essential documentsrequired for quality AFP surveillance and ensure their judicious use.

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Environmental Surveillance for Poliovirus and Other Enteroviruses: Long-Term Experience in Moscow, Russian Federation, 2004–2017

Viruses ◽

10.3390/v11050424 ◽

2019 ◽

Vol 11 (5) ◽

pp. 424 ◽

Cited By ~ 10

Author(s):

Olga E. Ivanova ◽

Maria S. Yarmolskaya ◽

Tatiana P. Eremeeva ◽

Galina M. Babkina ◽

Olga Y. Baykova ◽

...

Keyword(s):

Sewage Treatment ◽

Time Frame ◽

Environmental Surveillance ◽

Detection Rates ◽

Echovirus 30 ◽

Relative Value ◽

Afp Surveillance ◽

The One

Polio and enterovirus surveillance may include a number of approaches, including incidence-based observation, a sentinel physician system, environmental monitoring and acute flaccid paralysis (AFP) surveillance. The relative value of these methods is widely debated. Here we summarized the results of 14 years of environmental surveillance at four sewage treatment plants of various capacities in Moscow, Russia. A total of 5450 samples were screened, yielding 1089 (20.0%) positive samples. There were 1168 viruses isolated including types 1–3 polioviruses (43%) and 29 different types of non-polio enteroviruses (51%). Despite using the same methodology, a significant variation in detection rates was observed between the treatment plants and within the same facility over time. The number of poliovirus isolates obtained from sewage was roughly 60 times higher than from AFP surveillance over the same time frame. All except one poliovirus isolate were Sabin-like polioviruses. The one isolate was vaccine-derived poliovirus type 2 with 17.6% difference from the corresponding Sabin strain, suggesting long-term circulation outside the scope of the surveillance. For some non-polio enterovirus types (e.g., Echovirus 6) there was a good correlation between detection in sewage and incidence of clinical cases in a given year, while other types (e.g., Echovirus 30) could cause large outbreaks and be almost absent in sewage samples. Therefore, sewage monitoring can be an important part of enterovirus surveillance, but cannot substitute other approaches.

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Environmental Surveillance System To Track Wild Poliovirus Transmission

Applied and Environmental Microbiology ◽

10.1128/aem.69.5.2919-2927.2003 ◽

2003 ◽

Vol 69 (5) ◽

pp. 2919-2927 ◽

Cited By ~ 52

Author(s):

Jagadish M. Deshpande ◽

Sushmitha J. Shetty ◽

Zaeem A. Siddiqui

Keyword(s):

Environmental Samples ◽

Uttar Pradesh ◽

Immunization Coverage ◽

Paralytic Poliomyelitis ◽

Nucleotide Sequence Analysis ◽

Environmental Surveillance ◽

Poliovirus Type ◽

Wild Poliovirus ◽

Supplementary Immunization Activities ◽

Type 3

ABSTRACT Eradication of poliomyelitis from large metropolis cities in India has been difficult due to high population density and the presence of large urban slums. Three paralytic poliomyelitis cases were reported in Mumbai, India, in 1999 and 2000 in spite of high immunization coverage and good-quality supplementary immunization activities. We therefore established a systematic environmental surveillance study by weekly screening of sewage samples from three high-risk slum areas to detect the silent transmission of wild poliovirus. In 2001, from among the 137 sewage samples tested, wild poliovirus type 1 was isolated from 35 and wild poliovirus type 3 was isolated from 1. Acute flaccid paralysis (AFP) surveillance indicated one case of paralytic poliomyelitis from the city. Phylogenetic analysis with complete VP1 sequences revealed that the isolates from environmental samples belonged to four lineages of wild polioviruses recently isolated from poliomyelitis cases in Uttar Pradesh and not to those previously isolated from AFP cases in Mumbai. Wild poliovirus thus introduced caused one case of paralytic poliomyelitis. The virus was detected in environmental samples 3 months before. It was found that wild polioviruses introduced several times during the year circulated in Mumbai for a limited period before being eliminated. Environmental surveillance was found to be sensitive for the detection of wild poliovirus silent transmission. Nucleotide sequence analysis helped identify wild poliovirus reservoir areas.

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Environmental Surveillance for Risk Assessment in the Context of a Phase 2 Clinical Trial of Type 2 Novel Oral Polio Vaccine in Panama

Viruses ◽

10.3390/v13071355 ◽

2021 ◽

Vol 13 (7) ◽

pp. 1355

Author(s):

Magda Rojas-Bonilla ◽

Angela Coulliette-Salmond ◽

Hanen Belgasmi ◽

Kimberly Wong ◽

Leanna Sayyad ◽

...

Keyword(s):

Clinical Trial ◽

Risk Mitigation ◽

Oral Polio Vaccine ◽

Surveillance Study ◽

World Health ◽

Environmental Surveillance ◽

Polio Vaccine ◽

Eradication Strategy ◽

Two Samples

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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Acute Flaccid Paralysis surveillance in Polio Eradication and Beyond: Learning from Bangladesh

10.21203/rs.3.rs-680893/v1 ◽

2021 ◽

Author(s):

Humayra Binte Anwar ◽

Yameen Mazumder ◽

Sanjana Nujhat ◽

Bushra Zarin Islam ◽

Anna Kalbarczyk ◽

...

Keyword(s):

Surveillance System ◽

Disease Surveillance ◽

Technical Assistance ◽

Acute Flaccid Paralysis ◽

Grey Literature ◽

Polio Eradication ◽

Flaccid Paralysis ◽

Depth Information ◽

Acute Flaccid Paralysis Surveillance ◽

Afp Surveillance

Abstract IntroductionGlobal Polio Eradication Initiative, GPEI led by the World Health Organization (WHO), helped to develop standard acute flaccid paralysis surveillance (AFP) system worldwide, including Bangladesh, which comprises infrastructure, knowledge, expertise, funding, technical assistance, and trained personnel. AFP surveillance can complement any disease surveillance systems, and many countries are now utilizing these polio surveillance assets for monitoring other vaccine-preventable diseases. This paper outlines how AFP surveillance has evolved in Bangladesh over time, its success and challenging factors, and its potential to accomplish other health goals.MethodologyThis mixed-method study includes a grey literature review, a survey for quantitative and qualitative information on barriers and facilitators, and Key Informant Interviews (KIIs) to gather relevant in-depth information on AFP surveillance in Bangladesh. Grey literature was collected online and paper documentation from different stakeholders. Online and in-person surveys were conducted in six divisions of Bangladesh, including Dhaka, Rajshahi, Rangpur, Chittagong, Sylhet, and Khulna, to map tacit knowledge ideas, approaches, and experiences. KIIs were conducted at global, national, and sub-national levels. Data were then combined on focused emerging themes, including history, challenges, and successes of the AFP surveillance system in Bangladesh.ResultsAFP surveillance in Bangladesh was first introduced in 1990 at the district and Upazila level major hospitals. High population growth, low performance, hard-to-reach areas, and groups of people residing in risky zones were major challenges to implementing this surveillance system. Surveillance was gradually enriched by establishing certification standards and community-based AFP surveillance and improved Surveillance Immunization Medical Officer (SIMO) network activities, laboratory activities, and proper monitoring and evaluation. In Bangladesh, a national disease surveillance system and a laboratory are now being used for multiple diseases, including polio, measles, Japanese Encephalitis, Neonatal Tetanus etc.ConclusionIn Bangladesh, it is evident that the AFP surveillance system is supporting the health system more broadly by building knowledge, experience, and assets and forming a strong platform for other health programs. In addition, its strengths can be leveraged for combating new and emerging diseases like COVID-19. However, the sustainability of the AFP surveillance in Bangladesh still needs collaborative support from partners, mainly technical assistance.

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Evaluation of Acute Flaccid Paralysis Surveillance indicators in Sokoto State, Nigeria, 2012-2019: A secondary data analysis

10.21203/rs.3.rs-117324/v1 ◽

2020 ◽

Author(s):

Ismail Abdullateef Raji ◽

Auwal Abubakar Usman ◽

Abdulrahman Ahmad ◽

Saheed Gidado ◽

Abdulhakeem Abayomi Olorukooba ◽

...

Keyword(s):

Acute Flaccid Paralysis ◽

Secondary Data ◽

High Sensitivity ◽

Flaccid Paralysis ◽

World Health ◽

Surveillance Network ◽

Polio Virus ◽

Acute Flaccid Paralysis Surveillance ◽

Afp Surveillance ◽

Health Organization

Abstract Background: Nigeria and indeed, entire Africa has been certified free of Wild Polio Virus (WPV) in 2020. However, the continent is still at risk of importation of WPV, especially in states like Sokoto in Nigeria, which has an international border. Furthermore, due to low immunity in some communities in Sokoto, outbreaks of the circulating Vaccine Derived Polio Virus (cVDPV) occur. Therefore, this paper evaluates the Acute Flaccid Paralysis (AFP) surveillance indicators in Sokoto state, Nigeria. Methods: This retrospective study was an analysis of routinely collected AFP surveillance data between 2012 and 2019 by the Sokoto state surveillance network. We assessed the Sokoto state AFP surveillance system using the AFP surveillance performance indicators. We performed all analyses using Microsoft Excel 2019.Results: Cumulatively, 3001 Acute Flaccid Paralysis (AFP) cases were reported over the evaluation period, out of which 1692 (56.4%) were males, and 2478 (82.4%) were below five years. More than half, 1773 (59.1%) had a fever at the beginning of the disease, and 1911 (63.7%) had asymmetric paralysis. The non-polio AFP rate (9.1 to 23.5%) and stool adequacy rate (92.5 to 100%) indicate high sensitivity. The proportion of cases that had stool samples collected early, timely transported to the laboratory and arrived at the laboratory in optimal condition were all above the World Health Organization (WHO) minimum standard of 80%. There was inadequate profile documentation of some suspected cases.Conclusions: Sokoto State has exceeded the WHO minimum standards in most of the AFP surveillance indicators. The performance of the system is sufficient enough to detect any reintroduction of WPV into the state. However, there is a need for improvement in data quality.

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