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.
| Original language | English |
|---|---|
| Pages (from-to) | 1531-1538 |
| Number of pages | 8 |
| Journal | The Lancet |
| Volume | 400 |
| Issue number | 10362 |
| DOIs | |
| Publication status | Published - 29 Oct 2022 |
Bibliographical note
Funding Information:We thank Mihaela Cirdei and Julian Hand from the UK Health Security Agency (UKHSA) for arranging collection and transport of raw sewage samples. We thank members of the UKHSA NICC72 IMT–Vaccine Derived Polio Virus 2 for helpful discussions and feedback. Sewage analysis is based on independent research commissioned and funded by the National Institute for Health Research (NIHR) Policy Research Programme (National Institute for Biological Standards and Control Regulatory Science Research Unit) and Medicines and Healthcare products Regulatory Agency. This work was also supported by grants from the Bill & Melinda Gates Foundation (OPP1207299, INV-024477). NCG acknowledges funding from the UK Medical Research Council (MRC) Centre for Global Infectious Disease Analysis (reference MR/R015600/1), jointly funded by the MRC and the UK Foreign, Commonwealth, and Development Office (FCDO), under the MRC/FCDO Concordat agreement and is also part of the EDCTP2 programme supported by the EU. The views expressed in this publication are those of the authors and not necessarily those of the funders, the National Health Service, the NIHR, the Department of Health, arm's length bodies, or other government departments.
Funding Information:
We thank Mihaela Cirdei and Julian Hand from the UK Health Security Agency (UKHSA) for arranging collection and transport of raw sewage samples. We thank members of the UKHSA NICC72 IMT–Vaccine Derived Polio Virus 2 for helpful discussions and feedback. Sewage analysis is based on independent research commissioned and funded by the National Institute for Health Research (NIHR) Policy Research Programme (National Institute for Biological Standards and Control Regulatory Science Research Unit) and Medicines and Healthcare products Regulatory Agency. This work was also supported by grants from the Bill & Melinda Gates Foundation (OPP1207299, INV-024477). NCG acknowledges funding from the UK Medical Research Council (MRC) Centre for Global Infectious Disease Analysis (reference MR/R015600/1), jointly funded by the MRC and the UK Foreign, Commonwealth, and Development Office (FCDO), under the MRC/FCDO Concordat agreement and is also part of the EDCTP2 programme supported by the EU. The views expressed in this publication are those of the authors and not necessarily those of the funders, the National Health Service, the NIHR, the Department of Health, arm's length bodies, or other government departments.
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