Environmental Surveillance for Poliovirus and Other Enteroviruses: Long-Term Experience in Moscow, Russian Federation, 2004–2017

Abstract

Polio and enterovirus surveillance may include a number of approaches, including incidence-based observation, a sentinel physician system, environmental monitoring and acute flaccid paralysis (AFP) surveillance. The relative value of these methods is widely debated. Here we summarized the results of 14 years of environmental surveillance at four sewage treatment plants of various capacities in Moscow, Russia. A total of 5450 samples were screened, yielding 1089 (20.0%) positive samples. There were 1168 viruses isolated including types 1–3 polioviruses (43%) and 29 different types of non-polio enteroviruses (51%). Despite using the same methodology, a significant variation in detection rates was observed between the treatment plants and within the same facility over time. The number of poliovirus isolates obtained from sewage was roughly 60 times higher than from AFP surveillance over the same time frame. All except one poliovirus isolate were Sabin-like polioviruses. The one isolate was vaccine-derived poliovirus type 2 with 17.6% difference from the corresponding Sabin strain, suggesting long-term circulation outside the scope of the surveillance. For some non-polio enterovirus types (e.g., Echovirus 6) there was a good correlation between detection in sewage and incidence of clinical cases in a given year, while other types (e.g., Echovirus 30) could cause large outbreaks and be almost absent in sewage samples. Therefore, sewage monitoring can be an important part of enterovirus surveillance, but cannot substitute other approaches.

Case of Poliomyelitis Caused by Significantly Diverged Derivative of the Poliovirus Type 3 Vaccine Sabin Strain Circulating in the Orphanage

“…Thus, one would expect that in Russia there may be patients continuously or chronically excreting polioviruses. The validity of this assumption is evidenced by the fact that the significantly divergent poliovirus type 2 (17.6% nt substitutions in VP1) was detected in Moscow wastewater [60]. Our current observation confirms the danger of the prolonged excretion of poliovirus by persons with immunodeficiency conditions, and the need for surveillance for iVDPV.…”

Detection and Characterization of Hepatitis E Virus Genotype 3 in Wastewater and Urban Surface Waters in Germany

“…The composition of subtypes detected in the environmental waters in the present study reflects the circulation of HEV strains in humans and animals in the same region. Previous reports from other countries also demonstrated a correlation between detected viruses in wastewater and clinical cases (Hellmér et al 2014;Ivanova et al 2019).…”

Environmental Surveillance through Next-Generation Sequencing to Unveil the Diversity of Human Enteroviruses beyond the Reported Clinical Cases

“…Similarly, a previous study [ 56 ] reported the silent circulation of echovirus 30 in the environment before the onset of a large outbreak of AM accounted in 2009 in Finland. However, a study conducted in Russia [ 57 ], failed in associating clinical and environmental isolates of echovirus 30 in the same temporal and geographical scenario, reporting echovirus 30 almost exclusively from medical diagnosis of AM. This emphasizes the use of highly sensitive and effective methods to unveil the complex diversity of EVs in environmental samples when wastewater-based epidemiology approaches are conducted.…”

“…The lack of reports of AM linked to echovirus 30 in Argentina since 2012 made it impossible for us to compare the characterized environmental strains with contemporaneous clinical isolates. A link between environmental and clinical isolates of different EVs obtained in the same temporal and geographical range has been extensively documented [ 57 , 58 , 59 ]. Nevertheless, our study suggests that echovirus 30 strains detected in the environment of a specific location could predict future epidemics beyond local boundaries.…”