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Outbreak Response to Circulating Vaccine-Derived Poliovirus in Three Northern Regions of Ghana, 2019
John Kofi Odoom1, Emmanuel Kofi Dzotse2, Nicholas Israel Nii-Trebi3
1Department of Virology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana.
Insights
Circulating Vaccine-Derived Poliovirus Type 2 (cVDPV2) emerged in Ghana, linked to a Nigerian strain. Public health interventions, including vaccination campaigns and improved surveillance, successfully interrupted transmission.
Area of Science:
- Virology
- Epidemiology
- Public Health
Background:
- Circulating Vaccine-Derived Poliovirus Type 2 (cVDPV2) was detected in sewage and children with acute flaccid paralysis (AFP) in northern Ghana.
- This marked the first cVDPV2 circulation in Ghana since the country's polio eradication program began in 1996.
Purpose of the Study:
- To investigate the cVDPV2 outbreak in Ghana.
- To identify the source and genetic lineage of the circulating virus.
- To assess the effectiveness of control measures.
Main Methods:
- Epidemiological and laboratory investigations of environmental and stool samples.
- Genetic sequencing of poliovirus isolates.
- Review of surveillance data and vaccination records.
- Assessment of water, sanitation, and hygiene (WASH) conditions and health-seeking behaviors.
Main Results:
- Eighteen cVDPV2 cases were confirmed between 2019-2020, genetically linked to a 2018 Nigerian strain.
- The surveillance system demonstrated effective sample collection and laboratory processing.
- Poor WASH conditions, including limited potable water access and prevalent open defecation, were noted in affected communities.
Conclusions:
- The cVDPV2 outbreak in Ghana was successfully interrupted through targeted monovalent oral polio vaccine type 2 (mOPV2) mop-up campaigns and a nationwide inactivated polio vaccine (IPV) catch-up campaign.
- Enhanced surveillance measures were crucial in controlling the outbreak.
- Underlying poor WASH conditions highlight the need for integrated public health strategies.
Abstract:
Background: Circulating Vaccine-Derived Poliovirus Type 2 (cVDPV2) was isolated in sewage and later in stool samples from children with acute flaccid paralysis (AFP) in northern Ghana. Method: A multidisciplinary and multisectoral team investigated this outbreak and reported on epidemiological and laboratory investigations. Sewage/wastewater samples were collected from the environment, while stool samples were collected from AFP/contact children under 5 years of age. The samples were processed for virus isolation, and positive isolates were sequenced. We also conducted a descriptive investigation involving a review of records, active case search, and Monovalent Oral Polio Vaccine 2 campaigns. Additionally, we interviewed caregivers about the vaccination status of their children, as well as their knowledge on polio prevention. Water quality, sanitation, hygiene practices, and health-seeking behaviours were also assessed. Results: A total of 18 cVDPV2 were confirmed in the three regions of Ghana during the outbreak in 2019-2020. All strains were genetically linked to a Nigerian cVDPV2 strain NIE-KWS-KSB-18-006HC29 that circulated in 2018. Evaluation of the surveillance system shows that officers have good knowledge of AFP and know how to collect samples, package them, and ship them to the laboratory. Few communities had access to potable water. Open defecation was common, and the water supply, sanitation, and hygiene practices of the communities were poor. Conclusion: The cVDPV2 outbreak represents the first time cVDPV2 has circulated in the country since Ghana embarked on the polio eradication program in 1996. However, with quality mOPV2 mop-up campaigns, a nationwide IPV catch-up campaign coupled with enhanced surveillance measures, transmission was interrupted.
