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Surveillance during an era of rapidly changing poliovirus epidemiology in India: the role of one vs. two stool specimens in poliovirus detection, 2000–2010

  • C. V. CARDEMIL (a1) (a2), M. RATHEE (a3), H. GARY (a1), K. WANNEMUEHLER (a1), A. ANAND (a1), O. MACH (a1), S. BAHL (a3), S. WASSILAK (a1), S.Y. CHU (a1), A. KHERA (a4), H. S. JAFARI (a3) and M. A. PALLANSCH (a5)...
Abstract
SUMMARY

Since 2004, efforts to improve poliovirus detection have significantly increased the volume of specimen testing from acute flaccid paralysis (AFP) patients in India. One option to decrease collection and testing burden would be collecting only a single stool specimen instead of two. We investigated stool specimen sensitivity for poliovirus detection in India to estimate the contribution of the second specimen. We reviewed poliovirus isolation data for 303984 children aged <15 years with AFP during 2000–2010. Using maximum-likelihood estimation, we determined specimen sensitivity of each stool specimen, combined sensitivity of both specimens, and sensitivity added by the second specimen. Of 5184 AFP patients with poliovirus isolates, 382 (7·4%) were identified only by the second specimen. Sensitivity was 91·4% for the first specimen and 84·5% for the second specimen; the second specimen added 7·3% sensitivity, giving a combined sensitivity of 98·7%. Combined sensitivity declined, and added sensitivity increased, as the time from paralysis onset to stool collection increased (P = 0·032). The sensitivity added by the second specimen is important to detect the last chains of poliovirus transmission and to achieve certification of polio eradication. For sensitive surveillance, two stool specimens should continue to be collected from each AFP patient in India.

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*Author for correspondence: Dr C. V. Cardemil, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA. (Email: ccardemil@cdc.gov)
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4. FP Pinheiro , Eradication of wild poliovirus from the Americas: wild poliovirus surveillance – laboratory issues. Journal of Infectious Diseases 1997; 175 (Suppl. 1): S4349.

11. HE Gary Jr., R Sanders , MA Pallansch . A theoretical framework for evaluating the sensitivity of surveillance for detecting wild poliovirus: I. Factors affecting the detection sensitivity in a person with acute flaccid paralysis. Journal of Infectious Diseases 1997; 175 (Suppl. 1): S135140.

12. JP Alexander Jr., HE Gary Jr., MA Pallansch . Duration of poliovirus excretion and its implications for acute flaccid paralysis surveillance: a review of the literature. Journal of Infectious Diseases 1997; 175 (Suppl. 1): S176182.

20. CA de Quadros , Eradication of wild poliovirus from the Americas: acute flaccid paralysis surveillance, 1988–1995. Journal of Infectious Diseases 1997; 175 (Suppl. 1): S3742.

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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
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