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. 2023 Apr 6;41 Suppl 1(Suppl 1):A58-A69.
doi: 10.1016/j.vaccine.2022.02.022. Epub 2022 Mar 23.

Concurrent outbreaks of circulating vaccine-derived poliovirus types 1 and 2 affecting the Republic of the Philippines and Malaysia, 2019-2021

Cynthia J Snider  1 , Liliane Boualam  2 , Graham Tallis  3 , Yoshihiro Takashima  4 , Rabindra Abeyasinghe  5 , Ying-Ru Lo  6 , Varja Grabovac  7 , Tigran Avagyan  8 , Syeda Kanwal Aslam  9 , Abu Obeida Eltayeb  10 , Khin Devi Aung  11 , Xiaojun Wang  12 , Achyut Shrestha  13 , Carla Ante-Orozco  14 , Maria Wilda T Silva  15 , Nemia Lapastora-Sucaldito  16 , Lea Necitas G Apostol  17 , Muhammad Bin Hj Jikal  18 , Waheed Miraj  19 , Faisal Lodhi  20 , Hyung Joon Kim  21 , Norhayati Rusli  22 , Bruce R Thorley  23 , Matthew B Kaye  24 , Yorihiro Nishimura  25 , Minetaro Arita  26 , Jamiatul Aida Md Sani  27 , Christina Rundi  28 , Keith Feldon  29
Affiliations

Concurrent outbreaks of circulating vaccine-derived poliovirus types 1 and 2 affecting the Republic of the Philippines and Malaysia, 2019-2021

Cynthia J Snider et al. Vaccine. .

Abstract

Concurrent outbreaks of circulating vaccine-derived poliovirus serotypes 1 and 2 (cVDPV1, cVDPV2) were confirmed in the Republic of the Philippines in September 2019 and were subsequently confirmed in Malaysia by early 2020. There is continuous population subgroup movement in specific geographies between the two countries. Outbreak response efforts focused on sequential supplemental immunization activities with monovalent Sabin strain oral poliovirus vaccine type 2 (mOPV2) and bivalent oral poliovirus vaccines (bOPV, containing Sabin strain types 1 and 3) as well as activities to enhance poliovirus surveillance sensitivity to detect virus circulation. A total of six cVDPV1 cases, 13 cVDPV2 cases, and one immunodeficiency-associated vaccine-derived poliovirus type 2 case were detected, and there were 35 cVDPV1 and 31 cVDPV2 isolates from environmental surveillance sewage collection sites. No further cVDPV1 or cVDPV2 have been detected in either country since March 2020. Response efforts in both countries encountered challenges, particularly those caused by the global COVID-19 pandemic. Important lessons were identified and could be useful for other countries that experience outbreaks of concurrent cVDPV serotypes.

Keywords: Circulating vaccine-derived poliovirus; Immunodeficiency-associated vaccine-derived poliovirus; Malaysia; Philippines; Poliovirus outbreak.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1.
Fig. 1.
Annual non-polio acute flaccid paralysis (NPAFP) rate* and stool adequacy percentage in the Philippines (A and B) and Malaysia (C and D), 2013–2021**. *Non-polio acute flaccid paralysis rate expressed as per 100,000 children under 15 years old per year. **Data as of 21 February 2022. Red hashed line indicates surveillance indicator target: NPAFP rate target of 1 per 100,000 children under 15 years old and 80% for stool adequacy.
Fig. 2.
Fig. 2.
Vaccine-derived poliovirus type 1 (VDPV1) and vaccine-derived poliovirus type 2 (VDPV2) isolated from acute flaccid paralysis (AFP) case-patients, other human samples (non-AFP)*, and environmental samples in the Philippines and Malaysia, 2019–2020. *Other human samples (non-AFP): samples collected from contacts of AFP case-patients or healthy children. Data as of 8 April 2021. AFP case-patients and other humans are placed randomly within province (Philippines) & district (Malaysia) boundaries. Environmental specimen locations are based on exact coordinates of collection sites.
Fig. 3.
Fig. 3.
Acute flaccid paralysis (AFP) case-patients by week of paralysis onset and final classification status, and environmental surveillance (ES) isolates by week of collection in the Philippines (A) and Malaysia (B), June 2019–February 2021.
Fig. 4.
Fig. 4.
Maximum-likelihood based tree from poliovirus VP1 coding region genomic sequencing analysis depicting the phylogenetic relationships between vaccine-derived poliovirus type 1 (VDPV1) isolates collected from the Philippines and Malaysia in 2019 and 2020. The tree was constructed using the PhyML program within Geneious using the K80 + G model of evolution with optimised parameters based on 906nt VP1 sequences. The Sabin1 prototype strain AY082688 was used as an out-group to root the tree. Bootstrap analysis was performed on 1000 replicates of the dataset to provide a statistical measure of the reliability of the clades depicted. Bootstrap values indicate the number of times, out of 1000 replicates, that all members of the clade descended from the individual node were grouped together, with values >90% indicated. Isolates from the Philippines are indicated in black and those from Malaysia are indicated in blue. Prepared by Victorian Infectious Disease Reference Laboratory, Australia and National Institute of Infectious Diseases, Japan.
Fig. 5.
Fig. 5.
Maximum-likelihood based tree from poliovirus VP1 coding region genomic sequencing analysis depicting the phylogenetic relationships between vaccine-derived poliovirus type 2 (VDPV2) isolates collected from the Philippines and Malaysia in 2019 and 2020. The tree was constructed using the PhyML program within Geneious using the K80 + G model of evolution with optimised parameters based on 903nt VP1 sequences. The Sabin2 prototype strain AY082679 was used as an out-group to root the tree. Bootstrap analysis was performed on 1000 replicates of the dataset to provide a statistical measure of the reliability of the clades depicted. Bootstrap values indicate the number of times, out of 1000 replicates, that all members of the clade descended from the individual node were grouped together, with values >90% indicated. Isolates from the Philippines are indicated in black and those from Malaysia are indicated in blue. Prepared by Victorian Infectious Disease Reference Laboratory, Australia and National Institute of Infectious Diseases, Japan.
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