LITERATURE UPDATE
interplay of virus transmission dynamics, vaccine impact on preventing paralysis and virus spread, and regulatory complexities of using oral poliovirus vaccine (OPV) and IPV options for outbreak response.
As the global eradication
programme navigates through cessation of routine OPV use with replacement by IPV and stockpiling of novel OPVs, clarity on the impact of IPV use will be important for informed decision-making by global, regional, and national policy makers.
Poliovirus returns to the UK after nearly 40 years: current efforts and future recommendations Uwishema O, Eneh SC, El Jurdi E et al. Postgrad Med J. 2022 Nov;98(1165):816– 819. doi: 10.1136/pmj-2022-142103.
On 22 June 2022, the UK Health Security Agency declared a ‘rare national incidence’ after finding poliovirus in sewage in London for the first time in nearly 40 years. Although no cases of the disease or accompanying paralysis have been documented, the general public’s risk is considered minimal. However, public health experts recommend that families are up to date on their polio vaccines to decrease the chance of harm.
This article discusses the epidemiology of poliovirus by examining the aetiology of the disease and current mitigation policies implemented to prevent the spread of type 2 vaccine-deceived poliovirus in the UK. Finally, by examining the clinical features of polio, which range from mild gastroenteritis episodes, respiratory sickness, malaise and severe paralysis type, this article offers an advice on particular therapies and tactics to avoid poliovirus outbreaks and other future outbreaks.
Sustained detection of type 2 poliovirus in London sewage between February and July, 2022, by enhanced environmental surveillance Klapsa D, Wilton T, Zealand A et al. Lancet. 2022 Oct 29;400(10362): 1531–1538.
doi: 10.1016/S0140-6736(22)01804-9.
The international spread of poliovirus exposes all countries to the risk of outbreaks and is designated a Public Health Emergency of International Concern by WHO. This risk can be exacerbated in countries using inactivated polio vaccine, which offers excellent protection against paralysis but is less effective than oral vaccine against poliovirus shedding, potentially allowing
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Poliovirus is a positive-sense single-stranded RNA virus that is classified into three serotypes: type 1, type 2, and type 3.
circulation without detection of paralytic cases for long periods of time. This study investigated the molecular properties of type 2 poliovirus isolates found in sewage with an aim to detect virus transmission in the community.
The authors performed
environmental surveillance in London, UK, testing sewage samples using WHO recommended methods that include concentration, virus isolation in cell culture, and molecular characterisation. They additionally implemented direct molecular detection and determined whole-genome sequences of every isolate using novel Nanopore protocols.
A total of 118 genetically linked poliovirus isolates related to the serotype 2 Sabin vaccine strain were detected in 21 of 52 sequential sewage samples collected in London between February 8 and July 4, 2022. Expansion of environmental surveillance sites in London helped localise transmission to several boroughs in north and east London. All isolates have lost two key attenuating mutations, are recombinants with a species C enterovirus, and an increasing proportion (20 of 118) meet the criterion for a vaccine-derived poliovirus, having six to ten nucleotide changes in the gene coding for VP1 capsid protein. Environmental surveillance allowed early detection of poliovirus importation and circulation in London, permitting a rapid public health response, including enhanced surveillance and an inactivated polio vaccine campaign among children aged 1–9 years. Whole-genome sequences generated through Nanopore sequencing established linkage of isolates and confirmed transmission of a unique recombinant poliovirus lineage that has now been detected in Israel and the USA.
Characterization of environmental and clinical surveillance inputs to support prospective integrated modeling of the polio endgame
Badizadegan K, Thompson KM. PLOS Glob Public Health. 2025 Feb 7;5(2):e0004168. doi: 10.1371/
journal.pgph.0004168.
National, regional, and global poliovirus surveillance needs continue to expand and evolve. The 1988 global resolution to eradicate polio necessitated the creation and support for a global poliovirus surveillance system able to identify poliovirus transmission anywhere and everywhere. Clinical surveillance of patients that present with acute flaccid paralysis (AFP) became an essential tool, and the need for standardised laboratory methods to detect polioviruses isolated from stool samples of AFP patients led to the development of the Global Poliovirus Laboratory Network (GPLN) in 1990. Relatively recently, the GPLN expanded to include environmental surveillance to obtain additional information about poliovirus transmission in some geographies and to increase confidence about the absence of poliovirus transmission after successful eradication and/or the cessation of use of live-attenuated oral poliovirus vaccines (OPVs). Historical polio eradication strategic plans anticipated that successful global poliovirus eradication would lead to reduced requirements for financial investments for a poliovirus-specific surveillance system, and consequent transition of capacity and resources into integrated national disease surveillance systems. However, given the state of the polio endgame with ongoing transmission in several geographies, current global strategic plans include poliovirus-specific surveillance for the foreseeable future.
In addition, the development and expansion of genetic testing technologies create new opportunities for poliovirus surveillance system designs. The expected growth (instead of decline) of poliovirus surveillance needs as of 2024, as well as innovations in laboratory technologies and expansion wastewater sampling, raise questions about the trade-offs of different options and the future of poliovirus surveillance. This descriptive review of poliovirus surveillance evidence as of late 2024 aims to provide national, regional, and global decision-makers with an understanding of prospective trade-offs and uncertainties, and to support prospective assumptions relevant for integrated policy, poliovirus transmission, and economic modelling for 2024–2035.
AUGUST 2025
WWW.PATHOLOGYINPRACTICE.COM
Manuel Almagro Rivas CC BY-SA 4.0, Wikimedia Commons
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