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Population sensitivity of acute flaccid paralysis and environmental surveillance for serotype 1 poliovirus in Pakistan: an observational study

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Title: Population sensitivity of acute flaccid paralysis and environmental surveillance for serotype 1 poliovirus in Pakistan: an observational study
Authors: O'Reilly, KM
Grassly, N
Verity, R
Item Type: Journal Article
Abstract: Background To support poliomyelitis eradication in Pakistan, environmental surveillance (ES) of wastewater has been expanded alongside surveillance for acute flaccid paralysis (AFP). ES is a relatively new method of surveillance, and the population sensitivity of detecting poliovirus within endemic settings requires estimation. Methods Data for wild serotype 1 poliovirus from AFP and ES from January 2011 to September 2015 from 14 districts in Pakistan were analysed using a multi-state model framework. This framework was used to estimate the sensitivity of poliovirus detection from each surveillance source and parameters such as the duration of infection within a community. Results The location and timing of poliomyelitis cases showed spatial and temporal variability. The sensitivity of AFP surveillance to detect serotype 1 poliovirus infection in a district and its neighbours per month was on average 30.0% (95% CI 24.8–35.8) and increased with the incidence of poliomyelitis cases. The average population sensitivity of a single environmental sample was 59.4% (95% CI 55.4–63.0), with significant variation in site-specific estimates (median varied from 33.3–79.2%). The combined population sensitivity of environmental and AFP surveillance in a given month was on average 98.1% (95% CI 97.2–98.7), assuming four samples per month for each site. Conclusions ES can be a highly sensitive supplement to AFP surveillance in areas with converging sewage systems. As ES for poliovirus is expanded, it will be important to identify factors associated with variation in site sensitivity, leading to improved site selection and surveillance system performance.
Issue Date: 13-Apr-2018
Date of Acceptance: 26-Mar-2018
URI: http://hdl.handle.net/10044/1/58611
DOI: https://dx.doi.org/10.1186/s12879-018-3070-4
ISSN: 1471-2334
Publisher: BioMed Central
Journal / Book Title: BMC Infectious Diseases
Volume: 18
Copyright Statement: © The Author(s). 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.
Sponsor/Funder: Bill & Melinda Gates Foundation
Medical Research Council (MRC)
World Health Organization (Switzerland)
Funder's Grant Number: OPP1099374
MR/J014362/1
2017/769688-0
Keywords: Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
Poliomyelitis
Pakistan
Sewage
Multi-state models
Sensitivity
ERADICATION
TRANSMISSION
CIRCULATION
SPECIMENS
RECOVERY
MODELS
SYSTEM
0605 Microbiology
1103 Clinical Sciences
1108 Medical Microbiology
Microbiology
Publication Status: Published
Article Number: ARTN 176
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care



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