Validation of the bag-mediated filtration system for environmental surveillance of poliovirus in Nairobi, Kenya.

AIMS: This study compared the bag-mediated filtration system (BMFS) and standard WHO two-phase separation methods for poliovirus (PV) environmental surveillance, examined factors impacting PV detection and monitored Sabin-like (SL) PV type 2 presence with withdrawal of oral polio vaccine type 2 (OPV2) in April 2016. METHODS AND RESULTS: Environmental samples were collected in Nairobi, Kenya (Sept 2015-Feb 2017), concentrated via BMFS and two-phase separation methods, then assayed using the WHO PV isolation algorithm and intratypic differentiation diagnostic screening kit. SL1, SL2 and SL3 were detected at higher rates in BMFS than two-phase samples (P < 0·05). In BMFS samples, SL PV detection did not significantly differ with volume filtered, filtration time or filter shipment time (P > 0·05), while SL3 was detected less frequently with higher shipment temperatures (P = 0·027). SL2 was detected more frequently before OPV2 withdrawal in BMFS and two-phase samples (P < 1 × 10-5 ). CONCLUSIONS: Poliovirus was detected at higher rates with the BMFS, a method that includes a secondary concentration step, than using the standard WHO two-phase method. SL2 disappearance from the environment was commensurate with OPV2 withdrawal. SIGNIFICANCE AND IMPACT OF THE STUDY: The BMFS offers comparable or improved PV detection under the conditions in this study, relative to the two-phase method.

Multiplex PCR-based titration (MPBT) assay for determination of infectious titers of the three Sabin strains of live poliovirus vaccine.

BACKGROUND: Conventional assays to titrate polioviruses usually test serial dilutions inoculated into replicate cell cultures to determine a 50% cytopathic endpoint, a process that is both time-consuming and laborious. Such a method is still used to measure potency of live Oral Poliovirus Vaccine during vaccine development and production and in some clinical trials. However, the conventional method is not suited to identify and titrate virus in the large numbers of fecal samples generated during clinical trials. Determining titers of each of the three Sabin strains co-existing in Oral Poliovirus Vaccine presents an additional challenge. RESULTS: A new assay using quantitative multiplex polymerase chain reaction as an endpoint instead of cytopathic effect was developed to overcome these limitations. In the multiplex polymerase chain reaction-based titration assay, cell cultures were infected with serial dilutions of test samples, lysed after two-day incubation, and subjected to a quantitative multiplex one-step reverse-transcriptase polymerase chain reaction. All three serotypes of poliovirus were identified in single samples and titers calculated. The multiplex polymerase chain reaction-based titration assay was reproducible, robust and sensitive. Its lower limits of titration for three Sabin strains were 1-5 cell culture 50% infectious doses per ml. We prepared different combinations of three Sabin strains and compared titers obtained with conventional and multiplex polymerase chain reaction-based titration assays. Results of the two assays correlated well and showed similar results and sensitivity. Multiplex polymerase chain reaction-based titration assay was completed in two to 3 days instead of 10 days for the conventional assay. CONCLUSIONS: The multiplex polymerase chain reaction-based titration (MPBT) is the first quantitative assay that identifies and titrates each of several different infectious viruses simultaneously in a mixture. It is suitable to identify and titrate polioviruses rapidly during the vaccine manufacturing process as a quality control test, in large clinical trials of vaccines, and for environmental surveillance of polioviruses. The MPBT assay can be automated for high-throughput implementation and applied for other viruses including those with no cytopathic effect.

Sequential two-step chromatographic purification of infectious poliovirus using ceramic fluoroapatite and ceramic hydroxyapatite columns.

Infectious virus purification techniques are important for vaccine development and gene therapy applications. However, the standardized one-step purification technique using ceramic hydroxyapatite (CHAp) has proven unsuitable for poliovirus. Therefore, we designed a sequential two-step chromatographic technique for purification of the infectious Sabin type 2 vaccine strain of poliovirus from the cell culture supernatant. In the first step, we removed protein contaminants from the Sabin type 2 virus fraction by pH gradient elution on a ceramic fluoroapatite column. In the second step, we removed double-stranded DNA derived from host cells by diluting the virus fraction, directly loading it on a CHAp column, and purifying it using a phosphate gradient with 1 M sodium chloride. This process achieved removal rates of more than 99.95% and 99.99% for proteins and double-stranded DNA, respectively, and was highly reproducible and scalable. Furthermore, it is likely that it will be applicable to other virus species.

Real-time reverse transcription-polymerase chain reaction assays for identification of wild poliovirus 1 & 3.

BACKGROUND & OBJECTIVES: The poliovirus serotype identification and intratypic differentiation by real-time reverse transcription-polymerase chain reaction (rRT-PCR) assay is suitable for serotype mixtures but not for intratypic mixtures of wild and vaccine poliovirus strains. This study was undertaken to develop wild poliovirus 1 and 3 (WPV1 and WPV3) specific rRT-PCR assays for use. METHODS: Specific primers and probes for rRT-PCR were designed based on VP1 sequences of WPV1 and WPV3 isolated in India since 2000. The specificity of the rRT-PCR assays was evaluated using WPV1 and WPV3 of different genetic lineages, non-polio enteroviruses (NPEVs) and mixtures of wild/wild and wild/Sabin vaccine strains. The sensitivity of the assays was determined by testing serial 10-fold dilutions of wild poliovirus 1 and 3 stock suspensions of known titre. RESULTS: No cross-reactivity with Sabin strains, intertypic wild poliovirus isolates or 27 types of NPEVs across all the four Enterovirus species was found for both the wild poliovirus 1 and 3 rRT-PCR assays. All WPV1 and WPV3 strains isolated since 2000 were successfully amplified. The rRT-PCR assays detected 10 4.40 CCID 50 /ml of WPV1 and 10 4.00 CCID 50 /ml of WPV3, respectively either as single isolate or mixture with Sabin vaccine strains or intertypic wild poliovirus. INTERPRETATION & CONCLUSIONS: rRT-PCR assays for WPV1 and WPV3 have been validated to detect all the genetic variations of the WPV1 and WPV3 isolated in India for the last decade. When used in combination with the current rRT-PCR assay testing was complete for confirmation of the presence of wild poliovirus in intratypic mixtures.

Development of real-time PCR to detect oral vaccine-like poliovirus and its application to environmental surveillance.

In order to perform environmental surveillance to track oral poliovirus vaccine-like poliovirus sensitively and conveniently, real-time PCR was developed and applied to a raw sewage concentrate. The real-time PCR method detected 0.01-0.1 TCID50 of 3 serotypes of Sabin strain specifically. The method also detected the corresponding serotypes of oral poliovirus vaccine-like poliovirus specifically, but detected neither wild poliovirus, except Mahoney for type 1 and Saukett for type 3, nor other enteric viruses, as far as examined. When real-time PCR was applied to environmental surveillance, the overall agreement rates between real-time PCR and the cell culture were 83.3% for all serotypes. Since real-time PCR has the advantages of rapid detection of viruses and minimum requirement of sampling volume as compared with ordinary cell culture, it is suitable to monitor oral poliovirus vaccine-like poliovirus in the environment, especially in areas where an oral vaccine is being replaced by an inactivated vaccine.

PCR assays for the identification of rare recombination types from VP1 to 3D genomic region of vaccine derived poliovirus strains.

Poliomyelitis has been effectively controlled by the use of inactivated poliovirus vaccine (IPV) or trivalent live attenuated oral poliovirus vaccine (OPV). Since 1964, the use of OPV in mass vaccinations has resulted in drastic reductions of the number of poliomyelitis cases caused by wild-type polioviruses. However, the characterization of OPV derivatives with increased neurovirulence, constituted a real problem with respect to OPV safety. Mutations at attenuating sites of the genome and recombination events between Sabin strains of the trivalent OPV vaccine have been correlated with the loss of the attenuated phenotype of OPV strains and the acquisition of traits characteristic of wild polioviruses. In consequence, early detection and characterization of recombinant evolved derivatives of vaccine strains is highly important. In this report, ten PCR assays are described which allow for the identification of rare recombination events located in VP1, 2A, 2C, 3A, 3C and 3D genomic regions and predominant recombination events located in 2C and 3D genomic regions of OPV derivatives. These assays could be readily implemented in diagnostics laboratories lacking sequencing facilities as a first approach for the early detection and characterization of recombinant OPV derivatives.

Vaccine derived bi- and multi-recombinant Sabin strains.

A retrospective analysis of five Sabin intertypic recombinant strains, isolated from human feacal specimens during the time period 1978-1985 in Greece, was performed by RT-PCR, Restriction Fragment Length Polymorphism (R.F.L.P.) and sequencing. Of the studied strains, three (EPA, EPB, EPC) were found to be bi-recombinant Sabin3/Sabin2/Sabin3 (S3/S2/S3), one strain was characterized as a probable S3/S2- CAV18 or CAV21-S2/S1 multi-recombinant (EDP11) and one was identified as a tripartite one S3/S2/S1 (EDP12). Samples EPA, EPB and EPC presented a common recombination junction in the 2C genomic region. Moreover, strains EPA and EPB shared also the second recombination site in the 3D genomic region, whereas the second recombination of EPC was also determined in 3D but in a different nucleotide position. Strains EDP11 and EDP12 presented both identical recombination motifs and recombination sites. The first was detected in the 2C genomic region and the second in the 3D region. Strain EDP11 presented an interesting feature since a sequence of 120 nucleotides seems to have derived from a member of human enteroviruses species C (CAV18 or CAV21). This finding is of great importance, considering that this strain (EDP11) was isolated from an area and time period, where no Coxsackie A virus or poliovirus epidemics occurred. Our study underlines the role of specific positions and motifs of the poliovirus genomic sequences involved in recombination events and prompts that Coxsackie A viruses belonging to human enterovirus species C (genetically closely related to PV) are considered as the possible counterparts of the recombination.

Detection of unusual mutation within the VP1 region of different re-isolates of poliovirus Sabin vaccine.

In the present study, a genomic analysis of full VP1 sequence region of 15 clinical re-isolates (14 healthy vaccinees and one bone marrow tumor patient) was conducted, aiming to the identification of mutations and to the assessment of their impact on virus fitness, providing also insights relevant with the natural evolution of Sabin strains. Clinical re-isolates were analyzed by RT-PCR, sequencing and computational analysis. Some re-isolates were characterized by an unusual mutational pattern in which non-synonymous mutations outnumbered the synonymous ones. Furthermore, the majority of amino-acid substitutions were located in the capsid exterior, specifically in N-Ags, near N-Ags and in the north rim of the canyon. Also mutations, which are well-known determinants of attenuation, were identified. The results of this study propose that some re-isolates are characterized by an evolutionary pattern in which non-synonymous mutations with a direct phenotypic impact on viral fitness are fixed in viral genomes, in spite of synonymous ones with no phenotypic impact on viral fitness. Results of the present retrospective characterization of Sabin clinical re-isolates, based on the full VP1 sequence, suggest that vaccine-derived viruses may make their way through narrow breaches and may evolve into transmissible pathogens even in adequately immunized populations. For this reason increased poliovirus laboratory surveillance should be permanent and full VP1 sequence analysis should be conducted even in isolates originating from healthy vaccinees.

A highly effective method for removing suspended poliovirus from water using a positively-charged carbon felt electrode.

We developed an effective system to eliminate poliovirus from modified tap water using a positively-charged carbon felt electrode. The zeta potential of polioviruses was measured using laser microscopic electrophoresis. Poliovirus adsorption to the electrode was examined by indirect immunofluorescence. The tissue culture infective dose (TCID) of poliovirus type 2 (Sabin strain) was determined using human rhabdomyosarcoma cells (RD cells). Poliovirus VP2 gene copy numbers were assessed by reverse transcription followed by a quantitative real-time polymerase chain reaction. The mean zeta potential of the viruses was -20 mV. Relatively large numbers of polioviruses (10(3) or 4 x 10(3) TCID(50)/0.1 ml) could be removed by adsorption to the electrode, drastically decreasing TCID and copy numbers of poliovirus genome in the water. Virus elimination was dependent on electric current and time. Thus, the positively-charged carbon felt electrode effectively adsorbed polioviruses. The system may prove applicable to the elimination of certain viruses from water.

Detection and characterization of pestivirus contaminations in human live viral vaccines.

In view of the use of potentially contaminated foetal calf serum (FCS) in cell cultures pestiviruses may be present in live viral vaccines. Thirty-six lots of human live viral vaccines produced by three manufacturers were tested for the presence of pestiviruses. Bovine viral diarrhoea virus (BVDV) RNA was detected in 33% of the vaccine lots. All positive results were caused by the mumps component of a single manufacturer. Partial sequences of the 5' untranslated region of BVD viral RNA were determined. The sequences were closely related to that of the NADL strain of BVDV. The amount of BVDV RNA in the vaccines was determined by real-time RT-PCR using the LightCycler. Between 3.3*10(2) and 6.2*10(5) RNA copies per dose were found to be present in the vaccine samples.Additionally, culture tests were done with FCS and human diploid cells used in the vaccine production of the manufacturer whose vaccines were positive by PCR. All attempts to detect virus antigen in MRC-5 human diploid cells or to infect these cells with BVDV failed. This suggests that BVDV RNA detected in human live viral vaccines represents passive carry over of BVDV from contaminated FCS rather than active virus replication in human diploid cells. Our results indicate that contamination with BVDV of FCS used in vaccine production does not appear to be of immediate concern to human health. Furthermore, our results indicate that gamma-irradiation of FCS destroys BVDV particles and is also effective in preventing the presence of BVDV RNA in the vaccines.

Live oral poliovirus vaccines and simian cytomegalovirus.

Live oral poliovirus vaccines (OPV) are often produced in primary Cercopithecus monkey kidney (CMK) cells. The kidneys of these monkeys are often latently infected with simian cytomegalovirus (SCMV), and CMK cultures are frequently contaminated with SCMV. We tested human, monkey and rabbit tissue culture systems, and found that MRC-5 cells are most sensitive for detection of SCMV. To address the question of whether OPV could be contaminated with infectious SCMV, we inoculated MRC-5 cells with neutralized OPV manufactured in the United States between 1972 and 1998. Infectious SCMV was not found in any of the vaccine lots tested. We also used the polymerase chain reaction (PCR) to search for SCMV DNA in live oral poliovirus vaccines; SCMV DNA sequences were found in several of the vaccine lots manufactured prior to 1992.

Increased safety level of serotype 3 Sabin oral poliomyelitis vaccine lots by improved seed virus, and tissue culture and virus infection conditions.

The content of 472U to 472C revertant virus in serotype 3 oral poliomyelitis monovalent bulk vaccines can be quantified by MAPREC (Mutant Analysis by PCR and Restriction Enzyme Cleavage). Besides other wildtype reversions identified in propagated type 3 Sabin strain populations, the 472U to 472C reversion correlates most prominently with neurovirulence in the monkey neurovirulence test. Therefore, the results can be used for the discrimination of 'good' and 'bad' vaccines on the molecular level. In international collaborative studies it has been well established that vaccine lots containing revertant genomes below a critical threshold pass the in vivo monkey neurovirulence test (MNVT), while vaccine lots containing more revertants fail the MNVT. In this communication we show that the MAPREC test is a sensitive tool for quality control and the demonstration of consistency in large scale production. Furthermore, MAPREC offers a possibility to assess the effect of changed production conditions on the rate of reversion and to find conditions for consistent production with low reversion rates.

Comparative study of poliovirus excretion after vaccination of infants with two oral polio vaccines prepared on Vero cells or on primary monkey kidney cells.

A comparative study was designed to assess the bioequivalence of 2 oral poliovaccines (OPV) produced on 2 different cell systems: primary monkey kidney (PMK) cells and the Vero cell line. The Vero cell line has been used to overcome the problem of obtaining a regular supply of high quality monkeys that are devoid of latent viruses. For this study, 9 children were vaccinated with PMK-OPV and 12 children with Vero-OPV. The comparison covered poliovirus excretion, reversion of polioviruses in the 5'-noncoding region, and immunogenicity. Major molecular markers in the 5'-noncoding region related to neurovirulence already had been identified at position 480 for type 1, position 481 for type 2, and position 472 for type 3 poliovirus. Two nucleic-acid based methods were designed for studying these positions: a RT-PCR followed by sequencing, which required preliminary culture and cloning; and a type-specific nested PCR followed by sequencing, which enabled direct detection and genotyping of polioviruses. Twenty-eight stool specimens were analyzed by this second method with no PCR inhibition problem. The use of Vero cell line did not modify the global pattern of poliovirus excretion, reversion frequency, or seroconversion. These results provide additional support for the use of the well-characterized Vero cell line in OPV manufacturing.

Differentiation between vaccine-related and wild-type polioviruses using a heteroduplex mobility assay.

A heteroduplex mobility assay (HMA) was developed for intratypic differentiation between poliovirus isolates. The assay is based on polymerase chain reaction (PCR) amplification of a 480 base pair fragment which encodes a variable segment of VP1, followed by denaturation and reannealing of the resulting single strands with those from reference Sabin targets. Mismatches between wild-type and Sabin vaccine templates result in the formation of detectable heteroduplexes of reduced electrophoretic mobility. Poliovirus strains confirmed previously as wild-type or vaccine-like by PCR and sequencing were all correctly identified using the HMA. Mixtures of both wild-type and vaccine-like strains in a single isolate could also be detected using this technique. The results of this study demonstrate that heteroduplex analysis is a simple, rapid, and sensitive means for differentiating between vaccine-like and wild-type poliovirus isolates.

Genomic modifications in Sabin vaccine strains isolated from vaccination-associated cases, healthy contacts and healthy vaccinees.

The three attenuated strains developed by A.B. Sabin have been effectively used as an oral live poliovirus vaccine (OPV) to control poliomyelitis in many countries. Although rarely, vaccination-associated paralytic poliomyelitis (VAPP) cases occur with the type 2 and 3 strains, and less frequently with the type 1 strain. The greater number of attenuating mutations in the P1/Sabin strain is probably reflected in the higher safety of this strain in comparison to type 2 and 3 strains. For the P1/Sabin strain, many attenuating mutations were already identified in the 5'-non-coding region (5'NCR), in the capsid proteins coding region, in the 3Dpol coding region, and the 3'-non-coding region (3'NCR). For the P2/Sabin and P3/Sabin strains, one mutation in 5'NCR and another in the capsid proteins coding region have been demonstrated to be important determinations of attenuation, although it has been suggested that other mutations may also have some effect, though minor. Although reverting mutations in attenuating determinants, suppressor mutations, mutations in antigenic sites and genomic recombination have been observed in strains isolated from VAPP cases, the observation of similar genomic modifications in strains isolated from healthy contacts and from healthy vaccinees has supported the view that host factors are also involved in the establishment of the disease. Reverting mutations at nucleotides (nt) 480 (G-->A), 481 (A-->G) and 472 (U-->C) for the P1/Sabin, P2/Sabin and P3/Sabin strains, respectively, have been detected in almost all strains isolated from VAPP cases and also from healthy vaccinees. Although the Sabin vaccine strains have been implicated in rare VAPP cases, recent studies have suggested that the vaccine strains could also trigger the Guillain-Barré syndrome (GBS), transverse myelitis (TM) and facial paralysis.

Identification of vaccine-related polioviruses by hybridization with specific RNA probes.

We developed RNA probes for the identification of poliovirus isolates by blot hybridization. Two sets of vaccine strain-specific probes were prepared. They complemented variable genomic domains within (i) the 5'-untranslated region and (ii) the amino-terminal codons of VP1. An enterovirus group probe (EV/5UT) matching highly conserved 5'-untranslated region sequences was used to estimate the quantities of poliovirus (or enterovirus) RNA in the samples. Poliovirus sequences amplified from Sabin strain virion RNA templates by PCR were inserted into the pUC18 plasmid vector. The antisense PCR primer for each probe set contained sequences encoding a T7 promoter. Hybrids were detected by a sensitive nonisotopic method. RNA probes were labeled by incorporation of digoxigenin-uridylate into the transcripts. The binding of probe to immobilized poliovirus RNAs was visualized by hydrolysis of the chemiluminescent substrate 4-methoxy-4-(3-phosphate-phenyl)-spiro-(1,2-dioxetane-3,2'-adamant ane) catalyzed by alkaline phosphatase conjugated to anti-digoxigenin (Fab) fragments. The specificities of the probes were evaluated with a panel of poliovirus isolates that had previously been characterized by sequence analysis. The RNAs of vaccine-related isolates hybridized with the appropriate probe sets. Wild polioviruses representing a broad spectrum of contemporary genotypes were recognized by the inabilities of their genomes to form stable hybrids with the Sabin strain-specific probes.

Genomic characterization of type 1 Sabin-related polioviruses isolated in Brazil.

Eight strains of P1/Sabin-derived polioviruses isolated in Brazil from paralysis cases were analyzed. The serotypes of the viral isolates were identified by neutralization test with hyperimmune equine sera. The relationship of the isolates to the P1/Sabin strain was demonstrated by molecular hybridization and PCR. The isolates were partially sequenced with the objective of finding mutations at nucleotides (nt) 480 and 525 of the 5'-noncoding region (5' NCR) and at nt 6203 of the 3Dpol coding region (3Dpol), which are important for reversion towards neurovirulence. Four isolates from paralysis cases classified as Guillain Barré Syndrome (GBS; three with sequels) were analyzed; one presented G-->A (480) and C-->U (6203) mutations, one G-->A (480) mutation, one G-->A (480) and U-->C (525) mutations, and one did not mutate at the analyzed positions. Two isolates from transient facial paralysis cases were analyzed; one presented U-->C (525) mutation and the other G-->A (480) mutation. One isolate from a transient paralysis case classified as a neuroviral disease and one isolate from a paralysis case with sequels were analyzed and none mutated at the analyzed positions. Although the isolates may not be the causative agent of the disease, a temporal association between the isolation of the P1/Sabin-derived isolates and the disease was observed. The possibility that GBS and the facial paralysis were caused by these isolates could not be excluded.