title: Estimation of polio infection prevalence from environmental surveillance data.
abstract: A major obstacle to eradicating polio is that poliovirus from endemic countries can be reintroduced to polio-free countries. Environmental surveillance (ES) can detect poliovirus from sewage or wastewaters samples, even in the absence of patients with paralysis. ES is underused, in part because its sensitivity is unknown. We used two unique data sets collected during a natural experiment provided by the 2013 polio outbreak in Israel: ES data from different locations and records of supplemental immunization with the live vaccine. Data from the intersecting population between the two data sets (covering more than 63,000 people) yielded a dose-dependent relationship between the number of poliovirus shedders and the amount of poliovirus in sewage. Using a mixed-effects linear regression analysis of these data, we developed several quantitative tools, such as (i) ascertainment of the number of infected individuals from ES data for application during future epidemics elsewhere, (ii) evaluation of the sensitivity of ES, and (iii) determination of the confidence level of the termination of poliovirus circulation after an outbreak. These results will be valuable in monitoring future outbreaks with ES, and this approach could be used to certify poliovirus elimination or to validate the need for more containment efforts.
authors.affiliation: Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, P. O. 653, Beer-Sheva 84105, Israel. byakir@gmail.com.
authors.forename: Yakir
authors.identifier: 0000-0002-9786-4061
authors.initials: Y
authors.lastname: Berchenko
authors.affiliation: Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.
authors.forename: Yossi
authors.initials: Y
authors.lastname: Manor
authors.affiliation: Biostatistics Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer 52621, Israel.
authors.forename: Laurence S
authors.initials: LS
authors.lastname: Freedman
authors.affiliation: Public Health Services, Ministry of Health, Jerusalem 9101002, Israel.
authors.forename: Ehud
authors.identifier: 0000-0001-7715-9309
authors.initials: E
authors.lastname: Kaliner
authors.affiliation: Public Health Services, Ministry of Health, Jerusalem 9101002, Israel.|Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
authors.forename: Itamar
authors.initials: I
authors.lastname: Grotto
authors.affiliation: Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.|School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, P. O. 39040, Tel Aviv 6997801, Israel.
authors.forename: Ella
authors.initials: E
authors.lastname: Mendelson
authors.affiliation: Biostatistics Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer 52621, Israel.|School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, P. O. 39040, Tel Aviv 6997801, Israel.
authors.forename: Amit
authors.identifier: 0000-0002-3306-185X
authors.initials: A
authors.lastname: Huppert
mesh_terms: D001499:Bayes Theorem; D002648:Child; D002675:Child, Preschool; D004784:Environmental Monitoring; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007557:Israel / Q000453:epidemiology; D008962:Models, Theoretical; D011051:Poliomyelitis / Q000453:epidemiology* / Q000821:virology; D015995:Prevalence; D012722:Sewage / Q000821:virology; D013223:Statistics as Topic; D014611:Vaccination; D014771:Virion / Q000502:physiology
chemical_list: D012722:Sewage