Non-polio enteroviruses in acute flaccid paralysis children of India: vital assessment before polio eradication.

AIM: This study is an overview of non-polio enterovirus (NPEV) circulating in North India studied from the perspective of poliomyelitis eradication. Wild polio cases declined because of intensive oral polio vaccine immunization. As we approach global eradication of poliovirus (PV), NPEV causing acute flaccid paralysis (AFP) are equal cause of concern. METHODS: A total of 46 653 AFP samples (World Health Organization) and apparently 1000 healthy contacts living in the same geographical area were studied (2004-2007). Serological identification of NPEV was done using RIVM-specific pools (The Netherlands). Untyped (UT)-NPEVs were sequenced directly from reverse transcription-polymerase chain reaction using pan-enterovirus (Pan-EV) primer (CDC, Atlanta, GA) targeting highly conserved 5'un-translated regions of the enterovirus. RESULTS: In this study, 12 513 NPEVs were isolated from the collected stool samples. Seroneutralization had identified 67% of NPEV isolates, whereas 32.6% remained as UT- NPEV. Of the typed NPEVs, Coxsackie-B accounted for 32.3%; followed by echoviruses-11, 12, 13, 7 between 8 and 28%. In sequencing few UT-NPEVs, some were identified also as echovirus-30, 11 and 18 which were probably present in mixtures as they remained UT-NPEV in ENT. Newly classified human enterovirus virus-86 (HEV) (EU079026), HEV-97(EU071767) and HEV-B isolate (EU071768) were isolated in AFP samples. CONCLUSIONS: This study provided definitive information about circulation, prevalence and new emerging NPEV in the polio-endemic region of India, hence they should be considered in AFP surveillance. This would help in adopting and planning new strategies in post-PV eradication era in the country. This is the right time to prepare for the future tasks while we head towards a polio-free region.

Rapid detection of sewage sample polioviruses by integrated cell culture polymerase chain reaction.

The authors' objective in this study was to introduce and evaluate integrated cell culture polymerase chain reaction (ICC-PCR) as a technique for the rapid screening of poliovirus in sewage samples. Researchers are in the last stage of poliomyelitis eradication; however, in a densely populated country such as India, time is the prime factor in the identification of poliovirus circulation and transmission because this virus follows the fecal-oral route for transmission and is excreted in nature. The authors used ICC-PCR to detect poliovirus in sewage samples, and they compared this nonconventional method with conventional cell culture methods to determine sensitivity, accuracy, and the time from sample collection to final results. The ICC-PCR method provided results within 4-5 days of sewage-sample collection; in contrast, the conventional method takes more than 18 days to provide such results. The ICC-PCR method proved to be sensitive, reproducible, and accurate, as well as rapid in its screening of sewage samples for poliovirus. This diagnostic tool may indeed prove quite useful in polio eradication.