The Global Polio Eradication Initiative (GPEI) has been informed of a case of paralytic polio in an unvaccinated individual in Rockland County, New York, United States.
The US Centers for Disease Control and Prevention (CDC) are coordinating with New York State health authorities on their investigation. Initial sequencing confirmed by CDC indicates that the case is type 2 VDPV.
Following the detection, the Global Polio Laboratory Network (GPLN) has confirmed that the VDPV2 isolated from the case is genetically linked to two Sabin-like type 2 (SL2) isolates, collected from environmental samples in early June in both New York and greater Jerusalem, Israel, as well as to the recently-detected VDPV2 from environmental samples in London, UK. Further investigations – both genetic and epidemiological – are ongoing to determine possible spread of the virus and potential risk associated with these various isolates detected from different locations around the world.
It is vital that all countries, in particular those with a high volume of travel and contact with polio-affected countries and areas, strengthen surveillance in order to rapidly detect any new virus importation and to facilitate a rapid response. Countries, territories, and areas should also maintain uniformly high routine immunization coverage at the district level and at the lowest administrative level to protect children from polio and to minimize the consequences of any new virus being introduced.
Any form of poliovirus anywhere is a threat to children everywhere. It is critical that the GPEI Polio Eradication Strategy 2022-2026 is fully resourced and fully implemented everywhere, to ensure a world free of all forms of poliovirus can be achieved.
Could you please provide some background on your labs and the polio-related work carried out there?
SO: CDC’s polio and picornavirus lab is a global specialized laboratory in the WHO Global Polio Laboratory Network. It was set up in the mid-1950s and is US-government funded, with CDC being an agency under the Department of Health and Human Services. Our polio lab is one of the largest out there with approximately 55 staff dedicated to polio. We largely deal with the more complex side of polio diagnostics – sequencing, which is the molecular testing of poliovirus-positive samples to determine genetic connections to other known polioviruses.
We also act as a ‘lab of last resort’ when countries, for whatever reason, are unable to carry out preliminary diagnostic tests on their samples. We’re involved in the development of a new and even safer form of oral polio vaccine, and have a team which looks at population immunity through examining blood samples from communities (serosurveys). Importantly, we also develop and distribute reagent kits for testing samples for polio, to labs across the Network.
PB: The polio laboratory at KEMRI is combined with the measles and rubella laboratory and has been in operation since the 1980s under the general virology programme. The lab became formally accredited as one of the WHO Global Polio Laboratory Network labs in 2000. Our primary role in relation to polio is supporting surveillance through detection, i.e. isolation of poliovirus from samples we receive. We also conduct intratypic differentiation to identify strains of polioviruses isolated. KEMRI has 12 staff working on polio. WHO funds our routine diagnostic work and supplies and the Kenyan government funds our infrastructure, staff and recurrent costs such as electricity.
What’s the geographic scope of the support you provide?
SO: CDC’s polio lab provides sequencing support to countries around the world. Some examples of countries we are currently assisting include Nigeria, Yemen and those in the Horn of Africa. In terms of serosurveys, we’ve recently done work for Nigeria, DR Congo, Sri Lanka, Ukraine, Pakistan and Lebanon to name a few. We also assisted with testing of samples from Syria during recent polio outbreaks.
PB: We test samples collected from Kenya, Somalia, Djibouti, Eritrea and occasionally from Yemen, for poliovirus. In a year, we would process roughly 4,000 samples and we’ve tested about 200 from Yemen this year. In fact, around 800 samples from Yemen arrived just yesterday. We are in the process of shipping these on to CDC in Atlanta as currently we do not have the capacity to test this quantity. We assist when we can but need to be careful of our capacity so we don’t compromise our support to the other countries.
Type 2 poliovirus (PV2) has been eradicated and WHO has called for countries to destroy unneeded PV2 stocks. However, some will continue to keep PV2 to perform critical functions. Facilities keeping the virus will need to follow GAPIII guidance and pass through a rigorous certification process to prove they can safely and securely handle and store the virus. Their governments are also responsible for putting in place safeguards to minimize risk of containment failure. CDC has decided that it will continue to work with poliovirus but KEMRI has decided to destroy its infectious materials. How were these decisions made?
SO: To do the diagnostics and research work we do, it’s a basic requirement to have a large bank of samples of known identity – PV2 or otherwise. We also need samples to produce our kits, which we distribute to around 120/146 of the Network labs worldwide. CDC has been involved in containment for about 15 years and so understands the GAPIII requirements very well. Most of our facilities meet specifications although a few modifications are needed.
The bulk of the work ahead is related to work practices and documentation ‒ essentially making sure all our i’s are dotted and t’s are crossed. We’re bringing on a containment and safety manager to help with this and with monitoring and training. CDC is also looking closely at its risk assessment models and revising protocols for use in the event of a spill.
PB: Initially, we oriented ourselves to what it means to go through this process and become a poliovirus-essential facility (PEF). We looked at costs; actually the major determinant behind the decision was cost.
The costs of maintaining the infrastructure necessary to remain a poliovirus-essential facility are not tenable as the resource demands are above the government’s capacity. The decision was not from a lab safety aspect. We operate on biosafety level 2 and are a low-risk facility from our own assessments. However, the demands of GAPIII include certain other safeguards.
The primary safeguards that we have here we could easily manage, but the secondary and tertiary safeguards including immunization of the surrounding community and high levels of immunity, the requirement for an effluent system going out of our lab… these are things that made it [becoming a PEF] untenable for us as a country to maintain. In view of the implications of resources versus the benefits, the Kenyan government decided it was not worth KEMRI becoming a PEF.
What were the arguments, if any, for keeping samples at KEMRI?
PB: As any researcher would know, the material is valuable. That was the main argument for retaining. We refer to our stool sample collection as ‘golden stool’ ‒ golden because samples really generate information. When you have isolates, these are useful to share with other facilities on request for vaccine production.
For the unprocessed samples which contain poliovirus, as a research institution, this material is very useful to us for diagnosis of other agents. But when you look at it from the perspective of committing a whole country to putting a lot of resources in [to become a PEF], you say ‘OK, fine’. You let go.
What process did KEMRI follow to destroy its infectious material? And what happens to the new positive samples that come in?
PB: We had a local containment committee in-country who oversaw the destruction activities. We had an inventory and they set a date for us. We removed all our archived wild virus materials from storage and put them in an autoclave. So it was heat deactivation; we incinerated all the materials. KEMRI management and government officials witnessed the process. Because of the large amount of archived materials, it took one full week to prepare and actual destruction took three days. We didn’t want to come back and repeat the process for types 1 and 3 materials and so destroyed all types 1, 2 and 3 wild virus materials at the same time.
For new samples, we archive those positive for types 1 and 3. For type 2, all isolates are sent to CDC for sequencing and original stools are destroyed within 72 hours of the final genomic sequence result.
Having experience with containment, does CDC’s polio lab help others reduce risk of breaches?
SO: We help answer technical questions coming from other facilities in the US looking to contain the virus. Part of preparing to become a PEF is to have emergency plans in place in case there is a spill. We assist facilities in putting together their plans, and can help out with response if there is a spill.
NEW YORK, USA, 24 October 2011 – Following a dramatic 95 per cent reduction in polio cases last year in Nigeria, the disease is once again on the rise – in large part because of lingering community resistance to polio immunization. To address this resistance, the country recently launched the Polio Free Torch Campaign. Supported by the Nigerian Olympic Committee (NOC) and a number of Nigerian Olympians, the campaign aims to mobilize wide support for the polio eradication efforts currently being made in Nigeria.
Campaigns such as these rely heavily on a range of social data that help shed light on, among other things, the reasons some communities are refusing to vaccinate their children with the oral polio vaccine (OPV). A recently launched website, www.polioinfo.org, will support and strengthen these communication efforts in all the polio priority countries by making this critical social data easier to access.
PolioInfo is linked to the official website of the Global Polio Eradication Initiative, which focuses on the epidemiological and logistical aspects of polio eradication. The two websites will work in harmony to provide a holistic picture of the polio programme to experts and community members.
“If we are to succeed in eradicating polio, we need to reach every last child with vaccine,” said Jos Vandelaer, UNICEF’s Chief of Immunization. “But first we have to reach every last parent and caregiver and ensure they have the knowledge they need to make critical choices about vaccinating their children. This is where timely access to social data is invaluable.”
Challenges and solutions
PolioInfo publishes social risk assessments for each of the eight priority polio-affected countries –Afghanistan, Angola, Chad, the Democratic Republic of the Congo, India, Nigeria, Pakistan and Sudan. These assessments show a variety of risks in each country, such as the risk of communities not being aware of immunization efforts and the risk of parents declining vaccinations.
The website also enables field workers to share and adapt strategies to raise awareness of polio and reach out to community leaders and parents. And it profiles stories collected from experts in the field, showcasing challenges to immunization as well as solutions.
In Chad, for example, where the polio virus has exploded over the last year, many parents refused to have their children vaccinated, fearing the oral polio vaccine would cause anaemia, paralysis or death. Fortunately, four months of awareness-raising by communications experts helped parents understand that vaccination protects children rather than harming them.
By sharing these successful strategies, and by ensuring the best possible data are available to experts, health workers and community leaders, PolioInfo brings the world one step closer to eradication.
Oral polio vaccine creator’s daughter, Debbe Sabin, shares her experiences of the polio eradication journey
Summertime in the 1950s came as a mixed blessing for children in the United States. Although the long sun-drenched days brought plenty of time to play and hang out with friends, they were also a time of widespread panic and fear among the parents.
In mid-20th century America, summer was known as “polio season”.
Polio was at epidemic proportions, spreading quickly and causing mass public fear. Local authorities closed the schools and public pools, and my friends would often be kept home because their parents wanted to protect against this highly infectious disease known to paralyse and, in some cases, kill otherwise healthy individuals.
In 1952, when I was just two, a record 58,000 cases were reported; over one third were paralytic. Local hospital wards began to fill with iron lungs and crutches, to support children affected by the disease…
Bill Sergeant, former Chairman of Rotary’s International’s Polio Plus Committee and true polio hero, passed away on 13 February at his home in Tennessee, USA.
The Global Polio Eradication Initiative (GPEI) today mourns the loss of Mr Bill Sergeant. Mr Sergeant was the Chairman of Rotary International’s International PolioPlus Committee (IPPC) of the Rotary Foundation, from its inception in 1994 until 2006. During his tenure and under his guidance, Rotary International committed more than US$500 million to the global polio eradication effort. His personal commitment and tireless dedication to the achievement of a polio-free world was second-to-none. He was a towering force and a legend in polio eradication. There are countless of children around the world today without lifelong polio-paralysis, as a direct result of Bill Sergeant’s dedication. Recognizing his personal engagement and drive for polio eradication, the World Health Assembly in May 2006 honoured him, as he truly represented Rotary’s motto of ‘Service Above Self’. He was a true friend to the world, and he will be sorely missed. Bill Sergeant passed away on Sunday 13 February 2011, at his home in Tennessee, USA. Memorial contributions may be made to The Rotary Foundation PolioPlus campaign at here.
Reaching the MDGs with lessons learned from global polio eradication
The UN General Assembly is convening a high-level plenary meeting from 20 to 22 September (the Millenium Development Goals Summit), with the primary objective of accelerating progress toward the achievement of the MDGs by 2015, taking into account the progress made towards the internationally agreed development goals. This landmark event provides an important opportunity to review successes, best practices and lessons learned, obstacles and gaps, challenges and opportunities, and to develop concrete strategies for action.
The International Federation of Red Cross and Red Crescent Societies (IFRC) in collaboration with the World Health Organization (WHO), GAVI Alliance, Rotary International, and the Bill & Melinda Gates Foundation, are convening a side event in the margins of the MDG Summit to address
1. the lessons learned in the eradication of polio and their application to the MDGs;
2. the challenges and opportunities for applying these lessons to other global health
3. the collaboration and partnership required to accelerate progress towards the MDGs.
The event is taking place on 20 September from 18:30 – 20:00, at the Japan Society, 333 East 47th Street, New York.
The event is open to all. RSVPs are required to the IFRC Delegation to the United Nations (email@example.com, tel. +1 (212) 338-0 or fax +1 (212) 338-9832).
In his Annual Report letter to stakeholders and partners, Bill and Melinda Gates Foundation CEO Jeff Raikes calls polio eradication one of his top priorities. With polio eradication at a critical juncture, Raikes underscores the urgent need for the international community, and in particular G8 countries, to strengthen commitment to polio eradication. “The stakes are so high, and we have come so far, which is why I am so surprised that the world is short of the funding it needs to finish the job,” he said. “It’s shocking, but funding from the G8 countries has actually gone down in the last several years. It’s very clear: this is a make-or-break time for polio eradication.”