| 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
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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
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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
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serotypes 2
Figure 1
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VDPV
nucleotide
serotypes
OPV2 vaccine
Bill
HF's MSc
non-polio acute flaccid
cVDPV
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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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