Sustained detection of type 2 poliovirus in London sewage between February and July, 2022, by enhanced environmental surveillance
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Published version
Author(s)
Type
Journal Article
Abstract
BACKGROUND: 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 circulation without detection of paralytic cases for long periods of time. Our study investigated the molecular properties of type 2 poliovirus isolates found in sewage with an aim to detect virus transmission in the community. METHODS: We performed environmental surveillance in London, UK, testing sewage samples using WHO recommended methods that include concentration, virus isolation in cell culture, and molecular characterisation. We additionally implemented direct molecular detection and determined whole-genome sequences of every isolate using novel nanopore protocols. FINDINGS: 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 Feb 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. INTERPRETATION: 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. FUNDING: Medicines and Healthcare products Regulatory Agency, UK Health Security Agency, Bill & Melinda Gates Foundation, and National Institute for Health Research Medical Research Council.
Date Issued
2022-10-29
Date Acceptance
2022-09-14
ISSN
0140-6736
Publisher
Elsevier
Start Page
1531
End Page
1538
Journal / Book Title
The Lancet
Volume
400
Issue
10362
Copyright Statement
© 2022 Crown Copyright claimed by UK, Canadian or Australian Government employee. This is an Open
Access article under the OGL 3.0 license (http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/).
Access article under the OGL 3.0 license (http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/).
Sponsor
Medical Research Council (MRC)
Bill & Melinda Gates Foundation
Bill & Melinda Gates Foundation
Identifier
https://www.sciencedirect.com/science/article/pii/S0140673622018049?via%3Dihub
https://www.ncbi.nlm.nih.gov/pubmed/36243024
S0140-6736(22)01804-9
Grant Number
MR/R015600/1
INV-024477
OPP1171890
Subjects
General & Internal Medicine
11 Medical and Health Sciences
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2022-10-13