UPDATE ON ENVIRONMENTAL STUDY IN EGYPT

1
UPDATE ON ENVIRONMENTAL STUDY IN EGYPT Tapani
Hovi National Public Health Institute Helsinki
Finland
7th Intercountry Meeting of Directors of
Poliovirus Laboratories in the WHO Eastern
Mediterranean Region, Amman, Jordan, 24-26
August, 2003
2
Initial goal An attempt to identify putative
hidden reservoirs of wild poliovirus
circulation to explain repeated occurrences of
wild poliovirus isolates from paralytic cases
suggesting failures of the AFP surveillance
3
Approach chosen - Target urban residencies with
converging sewer system - Grab sample of 1 litre
from a main collector sewer/inlet of sewage
plant - Repeated sampling from a limited number
of sites
4
SAMPLE PROCESSING - Transport to VACSERA
(refrigerated) - 50-100 fold concentration 1
ltr to 10 15 ml - Split the concentrate in
parts - Inoculation 3 x 0.5 ml (2 L20B, 1
RD(A)) - The rest frozen in 3 parts - One to
KTL (inoculation as above) - One to CDC
(RT-PCR) - One kept frozen - VACSERA isolates
sent to KTL and CDC for seq.
5
Dekahlia
Khafr el-Sheikh
Damietta
Port Said
Sharkia
Ismailia
N.Sinai
Menoufia
Beheira
Qalubia
Suez
Gharbia
Giza
S.Sinai
Fayoum
2000 -2001
Matrouh
Beni Suef
Minya
Sohag
Asyut
Qena
New Valley
Red Sea
Aswan
6
Dekahlia
Khafr el-Sheikh
Damietta
Port Said
Sharkia
Ismailia
N.Sinai
Menoufia
Beheira
Qalubia
Suez
Gharbia
Giza
S.Sinai
Fayoum
Matrouh
Beni Suef
Minya
Sohag
Asyut
Qena
Aswan
New Valley
Red Sea
7
(No Transcript)
8
(No Transcript)
9
wtPV1 IN DIFFERENT REGIONS in 2001-2002 Governorat
e Follow-up Nr. positive/all
samples Alexandria 9 months 1/8 Aswan 16
months 1/16 Asyut 24 months 33/85 Beheira
9 months 1/9 Beni Suef 21 months 14/29 Cairo
9 months 6/9 Fayoum 20 months
8/16 Gharbia 18 months 2/12 Giza 2 months
1/2 Menoufia 9 months 1/11 Minya 24
months 20/45 Qena 14 months 4/15 Qalubia
1 month 0/1 Sharkia 9 months
1/4 Sohag 20 months 10/25
10
(No Transcript)
11
STEPWISE EXPANSION - Number of samples per month,
from 8 to 32 - Number of Governorates covered,
from 2 to 18 RESULTS IN BRIEF - Intensity of
wtPV1 circulation decreasing - Yet All but one
of the 15 governorates monitored in 2001-2002
had at least one sample for wtPV1
12
(Overall agreement 60.8 for wtPV1 53.7)
13
(No Transcript)
14
(No Transcript)
15
EGY/467/02 GIZA Manshet el kanater
October 13, 2002 AFP case
EGY01-E76-K3745 Minya City August 11, 2001
EGY01-E107-K88 Dairut October 28, 2001
EGY01-E69-K131 Asyut City July 24, 2001
EGY01-E83-K33 Asyut City September 2, 2001
EGY01-E79-K16 Asyut City August 19, 2001
EGY01-E75-K33 Minya City August 11, 2001
EGY02-E54-K6609 Asyut City April 14, 2002
EGY01-E72-K3730 Asyut City August 5, 2001
EGY01-E53-K35 Abo qurqas May 27, 2001
EGY02-E85-K7617 Cairo June 26, 2002
EGY/574/02 Mashtool December 31, 2002
AFP case
EGY02-E152-K34 Cairo December 17, 2002
EGY02-E97-K4384 Cairo August 1, 2002
EGY02-E154-V1 Sharkia December 21, 2002
EGY02-E108-K24 Cairo August 31, 2002
EGY/528/02 Belbais November 26, 2002
AFP case
EGY03-E18-K2832 Sharkia Belbais February
2, 2003
EGY01-E58-K69 Beni suef June 18, 2001
EGY01-E10-K1781 Asyut City January 21,
2001
EGY/442/02 Abu teig September 24, 2002
AFP case
EGY02-E78-K7506 Asyut City June 9, 2002
EGY02-E02-K28 Sohag Jauary 5, 2002
EGY01-E116-V1 Beni suef November 19, 2001
EGY01-E66-K111 Sohag July 9, 2001
EGY02-E20-K5484 Fayum City February 13,
2002
EGY01-E64-K98 Asyut City July 8, 2001
EGY02-E53-V2 Fayum City April 14, 2002
lt- Last Minya isolate before reemergence
EGY01-E118-K16 Minya City November 26,
2001
EGY01-E108-K91 Fayum City October 31, 2001
a
EGY02-E20-K5475 Fayum City February 13,
2002
EGY/455/02 North October 10, 2002 AFP
case
EGY/566/02 Montazah December 27, 2002
AFP case
EGY01-E115-K51 Qena City November 18, 2001
EGY01-E116-K12 Beni suef November 19, 2001
EGY01-E131-K382 Aswan City December 30,
2001
EGY/208/01 Qena October 14, 2001 AFP
case
EGY02-E01-K5500 Qena City January 1, 2002
EGY01-E127-K63 Qena City December 25, 2001
EGY01-E121-K21 Fayum City November 29,
2001
EGY/219/01 Qena November 2, 2001 AFP
case
EGY01-E52-K29 Dairut May 20, 2001
EGY/010/01 Mallawi January 16, 2001
AFP case
EGY/042/01 Abo qurqas February 13, 2001
AFP case
EGY01-E121-V2 Fayum City November 29, 2001
EGY01-E87-K3043 Beni suef September 9,
2001
EGY01-E63-K94 Beni suef July 2, 2001
EGY01-E69-V1 Asyut City July 24, 2001
EGY01-E65-K102 Dairut July 9, 2001
EGY01-E24-V1 Minya City February 25, 2001
EGY01-E76-K3735 Minya City August 11,
2001
EGY/019/01 Abo qurqas January 21, 2001
AFP case
EGY01-E53-V2 Abo qurqas May 27, 2001
EGY01-E23-K75 Abo qurqas February 25, 2001
EGY01-E57-K2967 Minya City June 11, 2001
EGY01-E7-K17795 Minya City January 14,
2001
EGY01-E32-K89 Minya City March 23, 2001
EGY01-E81-K26 Fayum City August 26, 2001
EGY01-E44-K66 Asyut City May 6, 2001
EGY01-E99-V1 Minya City October 9, 2001
EGY01-E69-K134 Asyut City July 24, 2001
b
EGY01-E39-K2928 Asyut City April 29,2001
EGY02-E14-V2 Beni suef February 4, 2002
EGY01-E37-K2715 Asyut City April 17, 2001
EGY01-E50-V1 Sohag May 15, 2001
EGY01-E56-K2984 Sohag June 11, 2001
EGY01-E47-K2935 Sohag May 9, 2001
EGY02-E31-K6745 Qena City March 4, 2002
0.01
EGY01-E72-K17 Asyut City August 5, 2001
EGY01-E111-K108 Dairut November 11, 2001
EGY01-E52-V1 Dairut May 20, 2001
EGY02-E114-K60 Damanhour Behira September
18, 2002
EGY02-E150-K31 Beni suef December 2, 2002
Green 2003 Blue 2002 VII-XII Purple 2002
I-VI Black 2001 Arrow AFP case
EGY02-E136-V1 Alexandria November 3, 2002
EGY02-E125-K232 Giza October 9, 2002
EGY02-E86-K3978 Fayum City June 30, 2002
EGY02-E108-V1 Cairo August 31, 2002
EGY02-E139-K53 Asyut City November 10,
2002
EGY/444/02 Menouf September 26, 2002
AFP case
EGY03-E108-K55 Minya June 13, 2003
EGY/283/03 Minya City AFP case
EGY03-E10-V1 Sharkia January 26, 2003
EGY02-E144-V2 Shebeen elkoum Menofia
November 20, 2002
EGY03-E65-K2143 Cairo April 20, 2003
EGY01-E89-K70 Asyut City September 16,
2001
EGY01-E77-K45 Beni suef August 13, 2001
c
EGY01-E86-K45 Minya City September 8, 2001
EGY01-E112-V1 Minya City November 12, 2001
EGY01-E70-K138 Dairut July 24, 2001
EGY02-E63-V2 Asyut City May 4, 2002
EGY01-E71-K3727 Tanta July 31, 2001
EGY01-E76-K3734 Minya City August 11, 2001
wt-PV1 from Egypt AFP and ENV 2001 to 2003 N-J
tree 21.08.2003
EGY01-E14-K31 Abo qurqas January 28, 2001
EGY01-E49-V2 Minya City May 14, 2001
EGY01-E109-K98 Beni suef November 5, 2001
EGY01-E127-V1 Qena City December 25, 2001
EGY01-E102-V1 Sohag October 16, 2001
EGY01-E46-K78 Beni suef May 7, 2002
EGY01-E81-K3036 Fayum City August 26, 2001
EGY01-E54-K2974 Beni suef June 11, 2001
EGY01-E96-V1 Beni suef October 8, 2001
EGY01-E108-V1 Fayum City October 31, 2001
16
C ? C ? T U ?
T Y Y I B I S S J N ? R O P P R H H H F L F
E E F F J G G B B K K
EGY01-E49-V1 Minya City May 14, 2001
EGY01-E49-K14 Minya City May 14, 2001
EGY02-E85-K7617 Cairo June 26, 2002
EGY02-E108-K24 Cairo August 31, 2002
EGY02-E85-V1 Cairo June 26, 2002
EGY02-E154-V1 Sharkia December 21, 2002
EGY02-E154-K39 Sharkia December 21, 2002
EGY01-E72-V2 Asyut City August 5, 2001
EGY01-E44-V1 Asyut City May 6, 2001
EGY01-E72-K3730 Asyut City August 5, 2001
EGY02-E54-K6609 Asyut City April 14, 2002
EGY02-E54-V2 Asyut City April 14, 2002
EGY01-E76-K3745 Minya City August 11, 2001
EGY01-E108-K91 Fayum City October 31, 2001
EGY02-E20-K5475 Fayum City February 13, 2002
EGY01-E127-K63 Qena City December 25, 2001
EGY01-E131-K382 Aswan City December 30, 2001
Lineage 1
EGY01-E131-V2 Aswan City December 30, 2001
EGY02-E20-K5484 Fayum City February 13, 2002
EGY01-E66-V2 Sohag July 9, 2001
EGY01-E66-K111 Sohag July 9, 2001
EGY01-E66-V1 Sohag July 9, 2001
EGY01-E64-K98 Asyut City July 8, 2001
EGY01-E96-V2 Beni Suef City October 8, 2001
EGY01-E64-V1 Asyut City July 8, 2001
EGY01-E63-V2 Beni Suef City July 2, 2001
EGY01-E63-K94 Beni Suef City July 2, 2001
EGY01-E64-K99 Asyut City July 8, 2001
EGY01-E64-K97 Asyut City July 8, 2001
EGY01-E76-K3735 Minya City August 11, 2001
EGY01-E65-K102 Dairut July 9, 2001
EGY01-E65-K2982 Dairut July 9, 2001
EGY01-E44-K2932 Asyut City May 6, 2001
EGY01-E44-K66 Asyut City May 6, 2001
EGY01-E81-K26 Fayum City August 26, 2001
EGY01-E81-K22 Fayum City August 26, 2001
Lineage 2
EGY01-E50-K2987 Sohag May 15, 2001
D D
X X V U ? V I A A C ? C
? J G O Q Q L N ? K M M
EGY01-E50-V1 Sohag May 15, 2001
EGY02-E150-K31 Beni Suef December 2, 2002
EGY02-E150-V2 Beni Suef December 2, 2002
EGY02-E125-K232 Giza October 9, 2002
EGY02-E108-V1 Cairo August 31, 2002
EGY02-E125-V2 Giza October 9, 2002
EGY01-E72-K17 Asyut City August 5, 2001
EGY01-E40-K31 Dairut April 29, 2001
EGY01-E40-K2931 Dairut April 29, 2001
EGY01-E49-V2 Minya City May 14, 2001
Lineage 3
EGY01-E49-K15 Minya City May 14, 2001
VP1 sequences of parallel wt-PV1
strains EGY-ENV-2001-2002 N-J tree 19.08.2003
EGY01-E76-K3734 Minya City August 11, 2001
EGY01-E65-K103 Dairut July 9, 2001
EGY01-E127-V1 Qena City December 25, 2001
EGY01-E132-K372 Beni Suef City December 31, 2001
EGY01-E132-V1 Beni Suef City December 31, 2001

EGY01-E96-V1 Beni Suef City October 8, 2001
EGY01-E108-V1 Fayum City October 31, 2001
EGY01-E81-K3036 Fayum City August 26, 2001
EGY01-E102-V1 Sohag City October 16, 2001
EGY01-E102-K62 Sohag City October 16, 2001
17
CONCLUSIONS - Environmental surveillance has been
an important supplementary approach in
poliovirus surveillance - Intensity of wtPV1
circulation is decreasing - But Absence of
evidence is not evidence for absence - Source
population very large in some sampling sites
The larger the source population, the less
informative is a negative test result -
Follow-up time still short in several
governorates - Virus mixtures present challenges
for obtaining reproducible results
18
Dekahlia
Khafr el-Sheikh
Damietta
Port Said
Sharkia
Ismailia
N.Sinai
Menoufia
Beheira
Qalubia
Suez
Gharbia
Giza
S.Sinai
Fayoum
Matrouh
Beni Suef
Minya
Sohag
Asyut
Qena
Aswan
New Valley
Red Sea