Environmental Surveillance for wild poliovirus in sewage water becomes operational in Zahedan Capital of Sistan & Balouchstan Province, to complement acute flaccid paralysis surveillance

In 1988, the World Health Assembly resolved to eradicate poliovirus. Since then, polio incidence has decreased from an estimated 350,000 cases to 37 in 2016. The World Health Organization has included environmental Poliovirus surveillance in the new Strategic Plan of the Global Polio Eradication Initiative, as a supplement to Acute Flask Paralysis (AFP) surveillance for possible polio cases. Since polioviruses are relatively stable in aqueous environments, testing for polioviruses in sewage, or environmental surveillance (ES), has the potential to detect polioviruses circulating in the community without relying on clinical presentation of disease as does AFP surveillance.

Environmental Surveillance for wild poliovirus in sewage water becomes operational in Zahedan, Southeast of Iran, to complement acute flaccid paralysis surveillance

In 1988, the World Health Assembly resolved to eradicate poliovirus. Since then, polio incidence has decreased from an estimated 350,000 cases to 37 in 2016. The World Health Organization has included environmental Poliovirus surveillance in the new Strategic Plan of the Global Polio Eradication Initiative, as a supplement to Acute Flaccid Paralysis (AFP) surveillance for possible polio cases. Since polioviruses are relatively stable in aqueous environments, testing for polioviruses in sewage, or environmental surveillance (ES), has the potential to detect polioviruses circulating in the community without relying on clinical presentation of disease as does AFP surveillance.

Environmental surveillance is a highly sensitive method for detecting enteroviruses such as PVs in environmental samples, and this practice has been adopted by many countries and regions worldwide. ES detects poliovirus circulation in environmental sewage and is used to monitor transmission in communities. Given the benefits of ES, GPEI plans to continue and expand ES as part of its strategic plan and as a supplement to AFP surveillance.

A workshop on "annual Polio Lab Accreditation and implementation of Polio Environmental Surveillance" was conducted by WHO EMRO/HQ in Sistan & Balouchestan Province in April 2017, that was followed by training of field staff responsible for sampling (sample collection sample storage, and transportation).

Sampling of sewage in selected sewage plants in Zahedan as pilot study for feasibility of environmental surveillance, was initiated to detect early introduction and/or silent transmission of wild poliovirus or VDPV and then facilitate a rapid response/control. The first ever sewage water sample in Iran National Polio Laboratory, collected from Sistan-Baluchistan, Zahedan district, was processed in November 2017. This is land mark achievement by the Government of Islamic Republic of Iran, in polio eradication initiative.

As stated by Dr Humayun Asghar, Polio Eradication Program Coordinator, World Health Organization, Eastern Mediterranean Region; "It was a gigantic task to establish the Environmental Surveillance (ES) laboratory which included designation and renovation of new facility, provision of funding from national resource and procurement of laboratory supplies. This has been made possible by the personal interest and support of Director General CDC, National EPI Manager, National Polio Focal point and Director of PHC in SB province, of MoH; Polio and environmental Dept Field staff; Director and staff of National Polio Laboratory and Dean and vice Dean of School of Public Health, Tehran University of Medical Sciences; Pakistan Regional Reference Laboratory; WR and WRO Iran; and WHO EMRO/HQ."

Also Dr Christopher Maher, Manager of Polio Eradication and Emergency Support, WHO EMRO/HQ, has expressed that; "This will greatly strengthen the polio endgame work in Iran, and that the data on environmental samples will also add to the overall global understanding of the crucial endgame and certification period."

A team of public health experts and academic members of staff from School of Public Health, Zahedan University of Medical Sciences have been assigned undertake the preliminary assessment of the implementing ES in districts other than Zahedan. We are expecting to launch the ES in other districts in coming months.

Should you have any queries please do not hesitate to contact us by sending emails to: zu.healthdeputy@ gmail.com