the impact of surveillance and other factors on detection of emergent and circulating CORD-Papers-2022-06-02 (Version 1)

Title: The impact of surveillance and other factors on detection of emergent and circulating vaccine derived polioviruses
Abstract: Background: Circulating vaccine derived poliovirus (cVDPV) outbreaks remain a threat to polio eradication. To reduce cases of polio from cVDPV of serotype 2 the serotype 2 component of the vaccine has been removed from the global vaccine supply but outbreaks of cVDPV2 have continued. The objective of this work is to understand the factors associated with later detection in order to improve detection of these unwanted events. Methods: The number of nucleotide differences between each cVDPV outbreak and the oral polio vaccine (OPV) strain was used to approximate the time from emergence to detection. Only independent emergences were included in the analysis. Variables such as serotype surveillance quality and World Health Organization (WHO) region were tested in a negative binomial regression model to ascertain whether these variables were associated with higher nucleotide differences upon detection. Results: In total 74 outbreaks were analysed from 24 countries between 2004 and 2019. For serotype 1 (n=10) the median time from seeding until outbreak detection was 284 (95% uncertainty interval (UI) 284-2008) days for serotype 2 (n=59) 276 (95% UI 172-765) days and for serotype 3 (n=5) 472 (95% UI 392-603) days. Significant improvement in the time to detection was found with increasing surveillance of non-polio acute flaccid paralysis (AFP) and adequate stool collection. Conclusions: cVDPVs remain a risk globally; all WHO regions have reported at least one VDPV outbreak since the first outbreak in 2001. Maintaining surveillance for poliomyelitis after local elimination is essential to quickly respond to both emergence of VDPVs and potential importations. Considerable variation in the time between emergence and detection of VDPVs were apparent and other than surveillance quality and inclusion of environmental surveillance the reasons for this remain unclear.
Published: 2021-06-11
Journal: Gates Open Res
DOI: 10.12688/gatesopenres.13272.1
DOI_URL: http://doi.org/10.12688/gatesopenres.13272.1
Author Name: Auzenbergs Megan
Author link: https://covid19-data.nist.gov/pid/rest/local/author/auzenbergs_megan
Author Name: Fountain Holly
Author link: https://covid19-data.nist.gov/pid/rest/local/author/fountain_holly
Author Name: Macklin Grace
Author link: https://covid19-data.nist.gov/pid/rest/local/author/macklin_grace
Author Name: Lyons Hil
Author link: https://covid19-data.nist.gov/pid/rest/local/author/lyons_hil
Author Name: O aposReilly Kathleen M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/o_aposreilly_kathleen_m
sha: 13bb835dbfa38d3a47645158b8e86b42c0cc66b8
license: cc-by
license_url: https://creativecommons.org/licenses/by/4.0/
source_x: Medline; PMC
source_x_url: https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 35299831
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/35299831
pmcid: PMC8913522
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8913522
url: https://www.ncbi.nlm.nih.gov/pubmed/35299831/ https://doi.org/10.12688/gatesopenres.13272.1
has_full_text: TRUE
Keywords Extracted from Text Content: 1648-52 14(8 Vaccine X. Annu polio vaccine-derived poliovirus serotype 2 mauzenbergs/polio_vdpv PA poliovirus Vincent A 16(4 401-5 Shaw J poliovirus vaccine Auzenbergs M 82(9 5(1 nucleotide Anal Duintjer Tebbens RJ BMC Med. Pons-Salort M UI 172-765 cVDPVs AFP Kew OM oral polio Vaccine-derived polioviruses KA Jorba J Bandyopadhyay AS cVDPV2 oral poliovirus vaccine 148-58 Fountain H Chabot-Couture G Lyons H Cowger TL cVDPV 394(10193 COVID-19 Burman AL vaccine-derived poliomyelitis children mucosal oral poliovirus 368(6489 Khan S Roivainen M Campagnoli R VDPV John TJ NPJ Vaccines Am J Epidemiol poliovirus serotype 2 UI 392-603 Poliomyelitis type 2 vaccine-derived polioviruses MM Diop OM non-polio acute flaccid poliomyelitis Fine PE Morb e1005728 Carneiro IA GR Polio Virus Pallansch M e2002468 stool Pakistan -2011-2013 S183-S92 Pallansch MA Rev Vaccines Sharif S Famulare M Poliovirus Polio VDPVs Voorman A Oral Poliovirus Vaccine Gourville EM SEAR typo vaccine-derived poliovirus* line stool specimen cVDPVs bOPV AFP polio 1-15 stool gut mucosa 27,28 SIAs type 1 oral polio polioviruses θ serotypes 25,26 aVDPVs neurovirulence shifted-left zero-to-one-year cVDPV2 line 10 intestinal OPV 7 mOPV polio vaccine stool specimens ≥1 serotypes 1 poliovirus vaccine-derived polioviruses poliovirus serotype stool samples 9,16 OPV vaccines non-polio acute flaccid DPT3 cVDPV tOPV Sabin strain ES OPV2 cVDPV type 2 stool collection-can left column iVDPVs post-Switch Polio Laboratory Network specimens VDPV isolates Diphtheria-Pertussis-Tetanus OPV Polio Endgame Strategy 2019-2023 children VP1 Sabin 2 Figure 1a acute flaccid non-polio AFP Figure 1b VDPV serotypes MA Polio VDPVs vaccine-derived poliovirus* OR VDPV × serotypes 2 Figure 1 zones VDPV nucleotide serotypes OPV2 vaccine Bill HF's MSc non-polio acute flaccid cVDPV serotypes 1 nOPV take-aways text?1.In cVDPVs AFP polio stool polioviruses
Extracted Text Content in Record: First 5000 Characters:Background: Circulating vaccine derived poliovirus (cVDPV) outbreaks remain a threat to polio eradication. To reduce cases of polio from cVDPV of serotype 2, the serotype 2 component of the vaccine has been removed from the global vaccine supply, but outbreaks of cVDPV2 have continued. The objective of this work is to understand the factors associated with later detection in order to improve detection of these unwanted events. Methods: The number of nucleotide differences between each cVDPV outbreak and the oral polio vaccine (OPV) strain was used to approximate the time from emergence to detection. Only independent emergences were included in the analysis. Variables such as serotype, surveillance quality, and World Health Organization (WHO) region were tested in a negative binomial regression model to ascertain whether these variables were associated with higher nucleotide differences upon detection. Results: In total, 74 outbreaks were analysed from 24 countries between 2004 and 2019. For serotype 1 (n=10), the median time from seeding until outbreak detection was 284 (95% uncertainty interval (UI) 284-2008) days, for serotype 2 (n=59), 276 (95% UI 172-765) days, and for serotype 3 (n=5), 472 (95% UI 392-603) days. Significant improvement in the time to detection was found with increasing surveillance of non-polio acute flaccid paralysis (AFP) and adequate stool collection. Conclusions: cVDPVs remain a risk globally; all WHO regions have reported at least one VDPV outbreak since the first outbreak in 2001. Maintaining surveillance for poliomyelitis after local elimination is essential to quickly respond to both emergence of VDPVs and potential importations. Considerable variation in the time between emergence and detection of VDPVs were apparent, and other than surveillance quality and inclusion of environmental surveillance, the reasons for this remain unclear. Source Parker EP, Molodecky NA, Pons-Salort M, et al.: Impact of inactivated poliovirus vaccine on mucosal immunity: implications for the polio eradication endgame. Expert Rev Vaccines. 2015; 14(8): 1113-23. PubMed Abstract | Publisher Full Text | Free Full Text 6. O'Reilly KM, Lamoureux C, Molodecky NA, et al.: An assessment of the geographical risks of wild and vaccine-derived poliomyelitis outbreaks in Africa and Asia. BMC Infect Dis. 2017; 17(1): 367. PubMed Abstract | Publisher Full Text | Free Full Text 7. Fine PE, Carneiro IA: Transmissibility and persistence of oral polio vaccine viruses: implications for the global poliomyelitis eradication initiative. Am J Epidemiol. 1999; 150(10): 1001-21. PubMed Abstract | Publisher Full Text 8. Burns CC, Diop OM, Sutter RW, et al.: Vaccine-derived polioviruses. J Infect Dis. 2014; 210 Suppl 1: S283-93. PubMed Abstract | Publisher Full Text 9. Pons-Salort M, Burns CC, Lyons H, et al.: Preventing vaccine-derived poliovirus emergence during the polio endgame. PLoS Pathog. 2016; 12(7): e1005728. PubMed Abstract | Publisher Full Text | Free Full Text 10. Global Polio Eradication Initiative: Polio eradication and endgame: strategic plan Source 12. Thompson KM, Duintjer Tebbens RJ: Modeling the dynamics of oral poliovirus vaccine cessation. J Infect Dis. 2014; 210 Suppl 1: S475-84. PubMed Abstract | Publisher Full Text 13. Ramirez Gonzalez A, Farrell M, Menning L, et al.: Implementing the synchronized global switch from trivalent to bivalent oral polio vaccineslessons learned from the global perspective. J Infect Dis. 2017; 216(suppl_ 1): S183-S92. PubMed Abstract | Publisher Full Text | Free Full Text 14. World Health Organization: Polio Post-Certification Strategy: a risk mitigation strategy for a polio-free world. 2018. 15. Eichner M, Dietz K: Eradication of Poliomyelitis: When Can One Be Sure That Polio Virus Transmission Has Been Terminated? Am J Epidemiol. 1996; 143(8): 816-22. PubMed Abstract | Publisher Full Text 16. McCarthy KA, Chabot-Couture G, Famulare M, et al.: The risk of type 2 oral polio vaccine use in post-cessation outbreak response. BMC Med. 2017; 15(1): 175. PubMed Abstract | Publisher Full Text | Free Full Text 17. Konopka-Anstadt JL, Campagnoli R, Vincent A, et al.: Development of a new oral poliovirus vaccine for the eradication end game using codon deoptimization. NPJ Vaccines. 2020; 5(1): 26. PubMed Abstract | Publisher Full Text 18. van Damme P, de Coster I, Bandyopadhyay AS, et al.: The safety and immunogenicity of two novel live attenuated monovalent (serotype 2) oral poliovirus vaccines in healthy adults: a double-blind, single-centre phase 1 study. Lancet. 2019; 394(10193): 148-58. PubMed Abstract | Publisher Full Text | Free Full Text 19. Kalkowska DA, Pallansch MA, Wilkinson A, et al.: Updated Characterization of Outbreak Response Strategies for 2019-2029: Impacts of Using a Novel Type 2 Oral Poliovirus Vaccine Strain. Risk Anal. 2021; 41(2): 329-348. PubMed Abstract | Publisher Full Text | Free Full Text 20. World Health Organization: WHO-recommended standards for surveillan
Keywords Extracted from PMC Text: iVDPVs CC0 1.0 Public domain acute flaccid SEAR gut mucosa VDPV isolates p<0.01 zero-to-one-year vaccine-derived poliovirus* OR VDPV poliovirus θ vaccine-derived polioviruses neurovirulence stool specimens mOPV polioviruses Sabin strain MA × tOPV serotypes 2 cVDPV2 cVDPV type 2 oral polio children Diphtheria-Pertussis-Tetanus stool specimen shifted-left OPV DPT3 line " stool polio post-Switch 2021–2022 AFP serotypes OPV2 OPV vaccines polio vaccine 3 SIAs specimens OPV2 vaccine VDPV ≥1 vaccine-derived poliovirus* nucleotide type 1 aVDPVs – progenitors UI 172.3-764.8 bOPV UI 392.1-603.1 serotypes 1 poliovirus serotype VDPVs VDPV serotypes Sabin 2 Zenodo cVDPVs non-polio acute flaccid stool samples VP1 UI 284.3-2007.8 aVDPVs ES intestinal poliovirus Polio Polio Laboratory Network non-polio AFP VDPV mauzenbergs/polio_vdpv zones cVDPV Polio Endgame Strategy
Extracted PMC Text Content in Record: First 5000 Characters:Polio has been targeted for eradication since 1988 when countries represented within the World Health Assembly committed to eradication 1 . Whilst the initial goal to eradicate all poliovirus by 2000 was not achieved, two of the three wild serotypes have been eliminated, most recently type 3 in 2018 2– 4 . The main driver in this reduction of cases has been vaccination achieved through both routine and supplementary immunisation activities (SIAs), largely with the oral polio vaccine (OPV), a live attenuated vaccine. OPV is important for polio eradication, as it provides both humoral and intestinal immunity. However, the genetic instability of the attenuated virus can result in mutations that increase transmissibility and neurovirulence of infections 5, 6 . Consequently, circulating vaccine-derived polioviruses (cVDPVs) can arise and cause paralysis in affected individuals. Prior to 2001, these outbreaks had not been reported in any countries using OPV 7 , and recent analysis has suggested that cVDPV emergence and spread is more common in populations with low to moderate mucosal immunity against poliovirus 8, 9 . Since observing this unwanted effect of OPV vaccination, along with vaccine-associated paralytic polio (VAPP) and immunodeficiency-associated VDPVs (iVDPVs), removal of OPV from use has been prioritised within the Global Polio Eradication Initiative (GPEI) 10, 11 . Especially for serotype 2, the risks of OPV have begun to outweigh the benefits because OPV use can seed additional outbreaks in susceptible populations, and the continued use of OPV2 was deemed unnecessary 12 . The Switch from trivalent OPV (tOPV) to bivalent OPV (bOPV), removing serotype 2, was accomplished globally in a two-week period at the end of April 2016 13 . Instead of the anticipated decrease in circulating VDPVs, in the third- and fourth-years post-Switch, outbreaks and geographic spread of outbreaks have increased. The strategy for eradication described in the 2013–2018 GPEI Strategic Plan outlines that wild poliovirus should be interrupted whilst strengthening immunization systems, including the introduction of inactivated polio vaccine (IPV) 10 . Alongside, considerable investment has been made towards transition to a polio-free world that includes containment of all polioviruses, including minimising the risks of unintended release from laboratory facilities, and eventual removal of the OPV (known as cessation) 14 . This transition phase is needed to ensure that the chances of poliovirus transmission in a susceptible population would be a low as manageable, and that populations would remain protected from outbreaks. The Polio Post-Certification Strategy 14 , describes the many facets of containing polioviruses, protecting populations, cessation of the OPV and detecting and responding to a polio threat. The Switch from tOPV to bOPV provided the first trial of removing one of the serotypes from the global vaccine supply. Within the Polio Post-Certification Strategy, the pre-cessation (zero-to-one-year post-certification) and immediate post-cessation (two to five years post-certification) were regarded as the time periods where VDPVs were most likely to emerge, where the risk was thought to be highest 12–18 months after (in the most recent example) bOPV withdrawal. The period of time until detection is based on modelling which suggests that the cumulative probability of detecting circulating poliovirus is over 99.9% by four years 15 , but the modelling did not account for weaknesses in surveillance or include specific aspects of VDPV transmission. cVDPVs are of particular concern in areas with low to moderate OPV induced immunity, as the virus is able to emerge and maintain transmission 9, 16 . In (mostly high-income) countries with no OPV vaccination, there is minimal risk of VDPV emergence because the source is largely absent, transmission risk is lower, and vaccination coverage with the IPV is usually high. However, other risk factors for cVDPVs include: continued OPV use at low rates of coverage, prior elimination of the corresponding wild poliovirus serotype, insensitive acute flaccid paralysis (AFP) surveillance, and use of monovalent OPV (mOPV) and bOPV in SIAs due to the emergent risk of the live attenuated vaccine 6, 8, 17 . A novel, genetically stable OPV2 that is a modified version of the existing OPV2 but better retains attenuation is currently in development and has been approved and deployed for emergency use in 2021 in order to mitigate these risk factors 18, 19 . Here we provide a retrospective analysis of cVDPV outbreaks between 2004 and 2019 and estimate the time from emergence to detection using publicly available data. We explore the differences in time to detection across VDPV serotypes and examine the effect of AFP surveillance and other factors on the time to detection. The aim is to provide useful information on the time to detection of VDPV outbreaks by serotype and the factors that af
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