title: Field study of fecal excretion as a decision support tool in response to silent reintroduction of wild-type poliovirus 1 into Israel.
abstract: BACKGROUND
  Israel has used an inactivated polio vaccine (IPV)-only schedule since 2005 (95% coverage). Silent reintroduction of wild type poliovirus 1 (WPV1) into Israel in early 2013 was detected in Southern Israel via routine environmental surveillance without clinical cases.
  
  
  OBJECTIVE
  To estimate the rate of WPV1 excretion by age and residence and inform decision-making regarding supplemental immunization with OPV.
  
  
  METHODS
  A convenience sample of Bedouin and Jewish residential areas in the epicenter of the incident, focusing on under 8 year-olds who not previously given OPV. Fecal samples were directly tested for WPV1 RNA using a novel qRT-PCR assay. Positive samples were confirmed by gold standard cell culture and subject to genotyping.
  
  
  RESULTS
  Overall, 2196 non-duplicate fecal samples were collected and analyzed. WPV1 was detected in 61 samples (2.8%), 55 of which (90.2%) were from Bedouins. WPV1 excretion rates were 5.4% among Bedouins and 0.6% among Jewish individuals. Respective age-specific rates among Bedouin and Jewish children were 4.9% and 0.2% for 0-2 years and 7.2% and 1.7% for 2-8 years. Molecular testing had 89.5% sensitivity (higher than culture) and 100% specificity.
  
  
  CONCLUSIONS
  The rapid performance of a field study to evaluate WPV1 excretion unequivocally demonstrated substantial WPV1 infection rates among children under 8 years in Southern Israel, thus informing the decision to vaccinate this age group with bOPV and risk communication to both healthcare personnel and the public. Rapid development and implementation of molecular screening can thus underpin risk assessment and management in complex epidemiological situations.
authors: Public Health Services, Ministry of Health, Jerusalem, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. Electronic address: giladko@post.bgu.ac.il.
authors: Jacob
authors: J
authors: Moran-Gilad
authors: Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Israel; School of Public Health, Tel-Aviv University, Tel-Aviv, Israel.
authors: Ella
authors: E
authors: Mendelson
authors: Viruses Branch, Centers for Disease Control and Prevention, Atlanta, USA.
authors: Cara C
authors: CC
authors: Burns
authors: Israel Center for Disease Control, Ministry of Health, Tel-Hashomer, Israel.
authors: Ravit
authors: R
authors: Bassal
authors: Southern District Health Office, Ministry of Health, Beer-Sheva, Israel.
authors: Michael
authors: M
authors: Gdalevich
authors: Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Israel.
authors: Danit
authors: D
authors: Sofer
authors: Viruses Branch, Centers for Disease Control and Prevention, Atlanta, USA.
authors: M Steven
authors: MS
authors: Oberste
authors: Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Israel; School of Public Health, Tel-Aviv University, Tel-Aviv, Israel.
authors: Lester M
authors: LM
authors: Shulman
authors: Public Health Services, Ministry of Health, Jerusalem, Israel.
authors: Ehud
authors: E
authors: Kaliner
authors: Musa
authors: M
authors: Hindiyeh
authors: Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Israel.
authors: Musa
authors: M
authors: Hindiye
authors: Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Israel.
authors: Orna
authors: O
authors: Mor
authors: Southern District Health Office, Ministry of Health, Beer-Sheva, Israel.
authors: Liora
authors: L
authors: Shahar
authors: Viruses Branch, Centers for Disease Control and Prevention, Atlanta, USA.
authors: Jane
authors: J
authors: Iber
authors: Department of Laboratories, Public Health Services, Ministry of Health, Jerusalem, Israel.
authors: Ruth
authors: R
authors: Yishay
authors: Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Israel.
authors: Joseph
authors: J
authors: Manor
authors: Directorate, Ministry of Health, Jerusalem, Israel.
authors: Boaz
authors: B
authors: Lev
authors: School of Public Health, Tel-Aviv University, Tel-Aviv, Israel; Directorate, Ministry of Health, Jerusalem, Israel.
authors: Ronni
authors: R
authors: Gamzu
authors: Public Health Services, Ministry of Health, Jerusalem, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors: Itamar
authors: I
authors: Grotto
mesh_terms: D000293:Adolescent; D000328:Adult; D058070:Asymptomatic Diseases / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005243:Feces / Q000821:virology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011051:Poliomyelitis / Q000453:epidemiology*; D017955:Poliovirus / Q000302:isolation & purification*; D015995:Prevalence; D060888:Real-Time Polymerase Chain Reaction; D020133:Reverse Transcriptase Polymerase Chain Reaction; D017201:Virus Shedding; D055815:Young Adult
keywords: Excretion; Poliovirus; Stool; Surveillance; Survey; Wild-type