Detection and distribution of culturable Human Enteroviruses through environmental surveillance in Milan, Italy

Abstract

Aims: Human Enteroviruses (HEVs) infections have a significant impact on public health, being implicated in outbreaks of meningitis, encephalitis, handfoot-mouth disease and other acute and chronic manifestation. In the strategic plan for poliomyelitis eradication, the environmental surveillance of poliovirus (PV) has been identified by the World Health Organization (WHO) as an activity that can complement the surveillance of polio. Having wastewater samples available for PV surveillance allows us to study nonpolio enteroviruses (NPEVs) circulating in the study population, which are widely spread. Methods and Results: This study was carried out according to the WHO guidelines for environmental surveillance of PV and analysed the circulation of PV and NPEVs through the isolation of viruses in cell cultures in Milan area; from 2006 to 2010, 321 wastewater samples were collected, regularly over time, at the inlet of three diverse waste water treatment plants (WWTPs). Culturable HEVs were isolated in 80% of sewage samples: all isolates belonged to the HEV-B group and those circulating more intensely were CVB5 and Echo 6, while CVB4 was the predominant serotype found in 2010. In this study, two type 2 PVs were isolated, both characterized as Sabin like. Conclusion: Environmental monitoring of HEVs in Milan has proved to be an interesting tool to investigate the circulation and distribution of viruses. Significance and Impact of the Study: The detection of PV and other NPEV could be predictive of possible re-emergence of these viruses with an impact on public health. NPEV monitoring could also be a powerful public health tool to investigate the possible role of NPEV in different clinical manifestations.

Surveillance of poliomyelitis in Northern Italy: Results of acute flaccid paralysis surveillance and environmental surveillance, 2012–2015

“…In contrast, NPEVs were detected in 65.3% of tested samples, in accord to our previous data 11 and to results obtained by ES conducted in Tehran (60.2%) in 2007 14 and in Poland (77%) 12 in 2011. In our study, all characterized NPEVs belonged to enterovirus species B and echovirus type 11, 6 and 3 were the predominant genotypes.…”

“…7,9 Since Non-Polio Enteroviruses (NPEVs) are widespread worldwide and -like PVs -can be transmitted by fecal-oral route, NPEVs detection is expected in ES and epidemiological field study on these viruses are encouraged. 5,[10][11][12][13][14] In Italy, nationwide AFPS was established in 1997, 15 whereas ES was set up in 2005 only in Milan and other 5 Italian cities (Bolzano, Parma, Sassari, Napoli and Palermo). 11 This study described the results of both AFPS and ES in the period spanning from 2012 to 2015 in Lombardy, a region of Northern Italy accounting for nearly 10 million inhabitants (out of 60 million at national level).…”

“…5,[10][11][12][13][14] In Italy, nationwide AFPS was established in 1997, 15 whereas ES was set up in 2005 only in Milan and other 5 Italian cities (Bolzano, Parma, Sassari, Napoli and Palermo). 11 This study described the results of both AFPS and ES in the period spanning from 2012 to 2015 in Lombardy, a region of Northern Italy accounting for nearly 10 million inhabitants (out of 60 million at national level). Critical aspects of the surveillance systems (such as data quality, sensitivity and timeliness) were also discussed.…”

Detection of Pathogenic Viruses in Sewage Provided Early Warnings of Hepatitis A Virus and Norovirus Outbreaks

“…Most studies on enteric viruses in sewage only detect the viruses and do not relate the virus sequences identified in sewage to those from patients from the same sampling time and region (27,(35)(36)(37)(38)(39)(40)(41)(42). Several of the techniques for virus detection in sewage have also been developed for detection of poliovirus in line with the WHO polio eradication program (36,(43)(44)(45)(46)(47)(48)(49).…”

Sporadic Isolation of Sabin-Like Polioviruses and High-Level Detection of Non-Polio Enteroviruses during Sewage Surveillance in Seven Italian Cities, after Several Years of Inactivated Poliovirus Vaccination

“…Data on the distribution of specific EV serotypes in sewage in Italy are currently limited (32,33,34).…”