LITERATURE UPDATE
Poliovirus surveillance: a selection of current research interest
Wastewater surveillance was one of the topics on the programme at the BSMT Anniversary Microbiology Conference, held in May. Further information on this can be found elsewhere in this issue, but here Pathology in Practice Science Editor Brian Nation selects a small sample of poliovirus research interest in this area, all of which are free to access.
Poliomyelitis is a current challenge: long-term sequelae and circulating vaccine-derived poliovirus Quarleri J. Geroscience. 2023 Apr;45(2):707-717.
doi: 10.1007/s11357-022-00672-7.
For more than 20 years, the World Health Organization Western Pacific Region (WPR) has been polio-free. However, two current challenges are still polio-related. First, around half of poliomyelitis elderly survivors suffer late poliomyelitis sequelae with a substantial impact on daily activities and quality of life, experiencing varying degrees of residual weakness as they age. The post-polio syndrome as well as accelerated ageing may be involved. Second, after the worldwide Sabin oral poliovirus (OPV) vaccination, the recent reappearance of strains of vaccine-derived poliovirus (VDPV) circulating in the environment is worrisome and able to persistent person- to-person transmission. Such VDPV strains exhibit atypical genetic characteristics and reversed neurovirulence that can cause paralysis similarly to wild poliovirus, posing a significant obstacle to the elimination of polio.
Immunisation is essential for
preventing paralysis in those who are exposed to the poliovirus. Her, the author stresses the necessity of maintaining high vaccination rates because declining immunity increases the likelihood of re- emergence. If mankind wants to eradicate polio in the near future, measures to raise immunisation rates and living conditions in poorer nations are needed, along with strict observation. New oral polio vaccine candidates offer a promissory tool for this goal.
Surveillance optimisation to detect poliovirus in the pre-eradication era: a modelling study of England and Wales
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Transmission electron micrograph of poliovirus virions.
O’Reilly KM, Grassly NC, Allen DJ et al. Epidemiol Infect. 2020 May 13;148:e157. doi: 10.1017/S0950268820001004.
Surveillance for acute flaccid paralysis (AFP) cases are essential for polio eradication. However, as most poliovirus infections are asymptomatic and some regions of the world are inaccessible, additional surveillance tools require development. Within England and Wales, the authors demonstrate how inclusion of environmental sampling (ENV) improves the sensitivity of detecting both wild and vaccine-derived polioviruses (VDPVs) when compared to current surveillance. Statistical modelling was used to estimate the spatial risk of wild and VDPV importation and circulation in England and Wales. They estimate the sensitivity of each surveillance mode to detect poliovirus and the probability of being free from poliovirus, defined as being below a pre-specified prevalence of infection.
Poliovirus risk was higher within local authorities in Manchester, Birmingham,
Bradford and London. The sensitivity of detecting wild poliovirus within a given month using AFP and enterovirus surveillance was estimated to be 0.096 (95% confidence interval [CI] 0.055– 0.134). Inclusion of ENV in the three highest risk local authorities and a site in London increased surveillance sensitivity to 0.192 (95% CI 0.191–0.193). The sensitivity of ENV strategies can be compared using the framework by varying sites and the frequency of sampling. The probability of being free from poliovirus slowly increased from the date of the last case in 1993. ENV within areas thought to have the highest risk improves detection of poliovirus, and has the potential to improve confidence in the polio-free status of England and Wales and detect VDPVs.
Poliovirus circulation in the WHO European region, 2015-2022: a review of data from WHO’s three core poliovirus surveillance systems Fischer TK, Johannesen CK, Benschop KSM et al. Lancet Reg Health Eur. 2024 Oct 19;47:101104. doi: 10.1016/
j.lanepe.2024.101104. eCollection 2024 Dec.
The Global Polio Eradication Initiative (GPEI) has drastically reduced the global incidence of poliomyelitis since its launch in 1988 thanks to effective vaccines and strong global surveillance systems. However, detections of wild-type as well as vaccine-derived poliovirus (VDPV) still occur, also in the WHO European Region. This study aims to describe the poliovirus detection via the acute flaccid paralysis (AFP), clinical enterovirus, and environmental surveillance systems. In this study, the authors review
data from annual reports from 2015 to 2022 from the World Health Organization (WHO)’s three core
AUGUST 2025
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