An eradicated type of wild polio surfaced in routine wastewater monitoring within the Netherlands final yr, providing a cautionary story on the significance of monitoring for the tenacious virus, researchers report this week within the journal Eurosurveilance.
The sewage pattern got here up optimistic for infectious poliovirus in mid-November and genome sequencing revealed a pressure of untamed poliovirus sort 3, which was declared globally eradicated in 2019. Its potential revival could be a devastating setback within the decades-long effort to stamp out extremely infectious and probably paralytic germ for good.
For transient background, there are three sorts of wild polioviruses: sort 2 and kind 3 have been eradicated, with the previous being knocked out in 2015. Wild poliovirus sort 1 continues to flow into in Afghanistan and Pakistan. There are additionally occasional vaccine-derived polioviruses that flow into in communities with low vaccination charges, which just lately occurred in New York.
The optimistic wastewater pattern final yr was the primary and solely indication of a polio an infection with the bygone pressure within the Netherlands. It occurred in an worker of a vaccine manufacturing facility run by Bilthoven Biologicals, which makes inactivated polio vaccines. The Netherlands had arrange routine wastewater surveillance across the manufacturing website to watch for such a viral escape.
The genome sequencing made clear it was an energetic an infection slightly than a case of the virus being dumped down the drain by some means. The virus isolates had two to a few mutations, suggesting human shedding. As such, officers labored to determine which staff had entry to sort 3 polio within the weeks earlier than the optimistic pattern. They narrowed it all the way down to 51 staff and examined blood and stool samples from every. Just one got here up optimistic.
It is unclear how this worker turned contaminated. The particular person was absolutely vaccinated towards polio and had no signs. Nonetheless, they have been shedding infectious virions of an in any other case eradicated virus of their stool, which may probably unfold to others. Furthermore, the particular person lived in a group with vaccination protection of lower than 90 p.c.
On December 8, the worker agreed to enter isolation with day by day supervision from native well being employees. Bilthoven Biologicals positioned its contaminated worker in a home designed for isolation, located in a group with greater than 90 p.c vaccination protection. Native well being employees made positive the particular person adopted strict hygiene measures whereas they have been nonetheless shedding viruses. The particular person’s feces have been collected in a disposable system and incinerated. The particular person was solely allowed to see individuals exterior, with no bodily contact.
The contaminated worker spent the following 33 days in isolation, together with over the vacations, till that they had three consecutive adverse stool samples. Total, the particular person shed the virus over 51 days. However contact tracing and additional worker testing discovered no proof of different infections, and wastewater sampling didn’t flip up some other optimistic samples.
In all, native well being officers emphasised the significance of surveillance on this case. “This occasion reveals that incidents that result in a breach of containment and even an an infection can stay unnoticed and never reported if routine monitoring will not be in place,” they concluded.