Population sensitivity of acute flaccid paralysis and environmental surveillance for serotype 1 poliovirus in Pakistan: an observational study
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...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-04-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12879-018-3070-4 |
| _version_ | 1828968677422137344 |
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| author | Kathleen M. O’Reilly Robert Verity Elias Durry Humayun Asghar Salmaan Sharif Sohail Z. Zaidi M. Zubair M. Wadood Ousmane M. Diop Hiro Okayasu Rana M. Safdar Nicholas C. Grassly |
| author_facet | Kathleen M. O’Reilly Robert Verity Elias Durry Humayun Asghar Salmaan Sharif Sohail Z. Zaidi M. Zubair M. Wadood Ousmane M. Diop Hiro Okayasu Rana M. Safdar Nicholas C. Grassly |
| author_sort | Kathleen M. O’Reilly |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-14T12:16:33Z |
| format | Article |
| id | doaj.art-9f9f7c70f5ce48acb471afdffff5bacc |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-14T12:16:33Z |
| publishDate | 2018-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-9f9f7c70f5ce48acb471afdffff5bacc2022-12-21T23:01:37ZengBMCBMC Infectious Diseases1471-23342018-04-0118111010.1186/s12879-018-3070-4Population sensitivity of acute flaccid paralysis and environmental surveillance for serotype 1 poliovirus in Pakistan: an observational studyKathleen M. O’Reilly0Robert Verity1Elias Durry2Humayun Asghar3Salmaan Sharif4Sohail Z. Zaidi5M. Zubair M. Wadood6Ousmane M. Diop7Hiro Okayasu8Rana M. Safdar9Nicholas C. Grassly10Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College LondonMedical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College LondonWorld Health Organization Country OfficeWorld Health Organization Eastern Mediterranean Regional OfficeDepartment of Virology, National Institute for HealthDepartment of Virology, National Institute for HealthWorld Health Organization Country OfficePolio, Emergencies and Country Collaboration Cluster, World Health OrganizationPolio, Emergencies and Country Collaboration Cluster, World Health OrganizationNational Emergency Operation Centre, Ministry of National Health Services, Regulations & CoordinationMedical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College LondonAbstract 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.http://link.springer.com/article/10.1186/s12879-018-3070-4PoliomyelitisPakistanSewageMulti-state modelsSensitivity |
| spellingShingle | Kathleen M. O’Reilly Robert Verity Elias Durry Humayun Asghar Salmaan Sharif Sohail Z. Zaidi M. Zubair M. Wadood Ousmane M. Diop Hiro Okayasu Rana M. Safdar Nicholas C. Grassly Population sensitivity of acute flaccid paralysis and environmental surveillance for serotype 1 poliovirus in Pakistan: an observational study BMC Infectious Diseases Poliomyelitis Pakistan Sewage Multi-state models Sensitivity |
| title | Population sensitivity of acute flaccid paralysis and environmental surveillance for serotype 1 poliovirus in Pakistan: an observational study |
| title_full | Population sensitivity of acute flaccid paralysis and environmental surveillance for serotype 1 poliovirus in Pakistan: an observational study |
| title_fullStr | Population sensitivity of acute flaccid paralysis and environmental surveillance for serotype 1 poliovirus in Pakistan: an observational study |
| title_full_unstemmed | Population sensitivity of acute flaccid paralysis and environmental surveillance for serotype 1 poliovirus in Pakistan: an observational study |
| title_short | Population sensitivity of acute flaccid paralysis and environmental surveillance for serotype 1 poliovirus in Pakistan: an observational study |
| title_sort | population sensitivity of acute flaccid paralysis and environmental surveillance for serotype 1 poliovirus in pakistan an observational study |
| topic | Poliomyelitis Pakistan Sewage Multi-state models Sensitivity |
| url | http://link.springer.com/article/10.1186/s12879-018-3070-4 |
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