Weltpoliotag 2021: Vakzine-abgeleitete Polioviren erschweren weiterhin die Polioeradikation

Seit dem vergangenen Jahr gilt Afrika als frei von durch Poliowildviren (WPV) verursachte Kinderlähmung. Es treten jedoch weiterhin viele Poliofälle auf, die durch vom Impfstoff abgelei¬tete Viren (cVDPV) verursacht werden. Davon sind nicht nur afrikanische Länder betroffen: auch in der Ukraine und in Tadschikistan (WHO-Region Europa) wurden 2021 mehrere cVDPV2-Fälle nachgewiesen. Die letzten zwei Län¬der mit einer endemischen Viruszirkulation von WPV1 sind Afghanistan und Pakistan.Peer Reviewe

Impfvirus-abgeleitete Polioviren zirkulieren auch in Europa

Fälle von durch Impfvirus abgeleiteten Polioviren (cVDPV) treten in Gebieten mit unzureichenden Impfquoten auf. Die abgeschwächten Viren in der Schluckimpfung können lange Zeit unerkannt unter ungeimpften Menschen zirkulieren, sich dabei verändern und schließlich wieder zu Erkrankungen führen. In der Westukraine war es im Oktober und Dezember 2021 zu einem cVDPV 2-Ausbruch gekommen – die Polio-Impfquote liegt in einigen Regionen des Landes bei unter 50%. Neben der verheerenden humanitären Lage, die der Krieg in der Ukraine auslöst, fordern somit auch neue infektiologische Herausforderungen und Aufgaben ihre Aufmerksamkeit.Peer Reviewe

Weltpoliotag 2023 – Vom Impfstoff abgeleitete Polioviren– weiterhin eine Herausforderung

Vor 35 Jahren beschloss die Weltgesundheitsorganisation zusammen mit ihren Partnern im Rahmen der Globalen Polioeradikationsinitiative (GPEI), die Poliomyelitis zu besiegen. Trotz aller Bemühungen ist die Erkrankung bis heute nicht endgültig eradiziert. Im GPEI-Strategieplan für 2022 – 2026 wurde das Jahr 2023 als Ziel für den letzten Nachweis von Poliowildviren Typ 1 (WPV1) und zirkulierender vakzineabgeleiteter Polioviren Typ 2 (cVDPV2) genannt. Durch den Anstieg der WPV1-Fälle im Jahr 2022 in Teilen Pakistans und Afghanistans ist dieses Ziel gefährdet. Ein noch größeres Problem als Erkrankungen durch WPV stellen in den letzten Jahren jedoch auch Infektionen mit cVDPV, insbesondere cVDPV2 dar. Fälle von cVDPV-Infektionen treten in Gebieten auf, in denen ein hoher Anteil der Bevölkerung ungeimpft ist. Die abgeschwächten Viren in der Schluckimpfung können lange Zeit unentdeckt zirkulieren, sich dabei verändern und schließlich wieder akute schlaffe Lähmungen verursachen. Anlässlich des diesjährigen Weltpoliotags soll daran erinnert werden, dass das Ziel einer Welt ohne Polio erreicht werden kann, wenn alle drei Säulen der Polioeradikation (Impfen, Surveillance und Containment) konsequent auf hohem Niveau durchgeführt werden.Peer Reviewe

Enterovirus Surveillance (EVSurv) in Germany

The major aim of the enterovirus surveillance (EVSurv) in Germany is to prove the absence of poliovirus circulation in the framework of the Global Polio Eradication Program (GPEI). Therefore, a free-of-charge enterovirus diagnostic is offered to all hospitals for patients with symptoms compatible with a polio infection. Within the quality proven laboratory network for enterovirus diagnostic (LaNED), stool and cerebrospinal fluid (CSF) samples from patients with suspected aseptic meningitis/encephalitis or acute flaccid paralysis (AFP) are screened for enterovirus (EV), typing is performed in all EV positive sample to exclude poliovirus infections. Since 2006, ≈200 hospitals from all 16 German federal states have participated annually. On average, 2500 samples (70% stool, 28% CSF) were tested every year. Overall, the majority of the patients studied are children <15 years. During the 15-year period, 53 different EV serotypes were detected. While EV-A71 was most frequently detected in infants, E30 dominated in older children and adults. Polioviruses were not detected. The German enterovirus surveillance allows monitoring of the circulation of clinically relevant serotypes resulting in continuous data about non-polio enterovirus epidemiology.Peer Reviewe

Wo steht die weltweite Polioeradikation und welche Rolle spielt die Impfung?

Poliomyelitis ist eine fäkal-oral übertragbare Erkrankung, die Kinder und Erwachsenen betrifft und lebenslange gesundheitliche Einschränkungen hervorrufen kann. Seit 2014 erklärt die WHO die Ausbreitung der Polioviren zu einer gesundheitspolitischen Notlage von internationaler Bedeutung. Obwohl durch den Einsatz des oralen Polio-Impfstoffs der Rückgang der Poliofälle weltweit um über 99 % möglich war, gestaltet sich die angestrebte Eradikation der Poliomyelitis deutlich schwieriger als zunächst angenommen. Die Impfviren können mutieren und bei nicht ausreichendendem Impfschutz in der Bevölkerung zirkulieren. Im Vorfeld des diesjährigen Weltpoliotages beschreibt der Bericht im Epidemiologischen Bulletin 41/2022 die Verbreitung von Poliowildviren und zirkulierenden impfstoffabgeleiteten Polioviren sowie die Möglichkeit der Abwassersurveillance als Frühwarnsystem

Advancing Precision Vaccinology by Molecular and Genomic Surveillance of Severe Acute Respiratory Syndrome Coronavirus 2 in Germany, 2021

Background Comprehensive pathogen genomic surveillance represents a powerful tool to complement and advance precision vaccinology. The emergence of the Alpha variant in December 2020 and the resulting efforts to track the spread of this and other severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern led to an expansion of genomic sequencing activities in Germany. Methods At Robert Koch Institute (RKI), the German National Institute of Public Health, we established the Integrated Molecular Surveillance for SARS-CoV-2 (IMS-SC2) network to perform SARS-CoV-2 genomic surveillance at the national scale, SARS-CoV-2–positive samples from laboratories distributed across Germany regularly undergo whole-genome sequencing at RKI. Results We report analyses of 3623 SARS-CoV-2 genomes collected between December 2020 and December 2021, of which 3282 were randomly sampled. All variants of concern were identified in the sequenced sample set, at ratios equivalent to those in the 100-fold larger German GISAID sequence dataset from the same time period. Phylogenetic analysis confirmed variant assignments. Multiple mutations of concern emerged during the observation period. To model vaccine effectiveness in vitro, we employed authentic-virus neutralization assays, confirming that both the Beta and Zeta variants are capable of immune evasion. The IMS-SC2 sequence dataset facilitated an estimate of the SARS-CoV-2 incidence based on genetic evolution rates. Together with modeled vaccine efficacies, Delta-specific incidence estimation indicated that the German vaccination campaign contributed substantially to a deceleration of the nascent German Delta wave. Conclusions SARS-CoV-2 molecular and genomic surveillance may inform public health policies including vaccination strategies and enable a proactive approach to controlling coronavirus disease 2019 spread as the virus evolves.Peer Reviewe

Synopse virologischer Analysen im Nationalen Referenzzentrum für Influenzaviren während der COVID-19-Pandemie

Das Nationale Referenzzentrum für Influenzaviren gewinnt durch die fortlaufende Untersuchung von Proben aus den Sentinelpraxen der Arbeitsgemeinschaft Influenza einen umfassenden Überblick über die zirkulierenden respiratorischen Erreger in Deutschland. Dazu gehören neben SARS-CoV-2 und den Influenzaviren auch das Respiratorische Synzytialvirus, Parainfluenzaviren, humane Metapneumoviren, humane saisonale Coronaviren und humane Rhinoviren. Die Analyseergebnisse von 15.660 Sentinelproben sowie weiteren Isolaten im Zeitraum von Kalenderwoche 5/2020 bis 21/2022 werden im Epidemiologischen Bulletin 22/2022 vorgestellt. Beschrieben werden außerdem die Zirkulation respiratorischer Erreger im Vergleich zu vorpandemischen Saisons, die molekulare Charakterisierung und phylogenetische Analysen, die Überprüfung der Passgenauigkeit der eingesetzten Influenzaimpfstoffe und die Resistenzprüfung von Influenzaviren

Prevalence of Transmitted Drug Resistance and Impact of Transmitted Resistance on Treatment Success in the German HIV-1 Seroconverter Cohort

BACKGROUND: The aim of this study is to analyse the prevalence of transmitted drug resistance, TDR, and the impact of TDR on treatment success in the German HIV-1 Seroconverter Cohort. METHODS: Genotypic resistance analysis was performed in treatment-naïve study patients whose sample was available 1,312/1,564 (83.9% October 2008). A genotypic resistance result was obtained for 1,276/1,312 (97.3%). The resistance associated mutations were identified according to the surveillance drug resistance mutations list recommended for drug-naïve patients. Treatment success was determined as viral suppression below 500 copies/ml. RESULTS: Prevalence of TDR was stable at a high level between 1996 and 2007 in the German HIV-1 Seroconverter Cohort (N = 158/1,276; 12.4%; CI(wilson) 10.7-14.3; p(for trend) = 0.25). NRTI resistance was predominant (7.5%) but decreased significantly over time (CI(Wilson): 6.2-9.1, p(for trend) = 0.02). NNRTI resistance tended to increase over time (NNRTI: 3.5%; CI(Wilson): 2.6-4.6; p(for trend)= 0.07), whereas PI resistance remained stable (PI: 3.0%; CI(Wilson): 2.1-4.0; p(for trend) = 0.24). Resistance to all drug classes was frequently caused by singleton resistance mutations (NRTI 55.6%, PI 68.4%, NNRTI 99.1%). The majority of NRTI-resistant strains (79.8%) carried resistance-associated mutations selected by the thymidine analogues zidovudine and stavudine. Preferably 2NRTI/1PIr combinations were prescribed as first line regimen in patients with resistant HIV as well as in patients with susceptible strains (susceptible 45.3%; 173/382 vs. resistant 65.5%; 40/61). The majority of patients in both groups were treated successfully within the first year after ART-initiation (susceptible: 89.9%; 62/69; resistant: 7/9; 77.8%). CONCLUSION: Overall prevalence of TDR remained stable at a high level but trends of resistance against drug classes differed over time. The significant decrease of NRTI-resistance in patients newly infected with HIV might be related to the introduction of novel antiretroviral drugs and a wider use of genotypic resistance analysis prior to treatment initiation

Molecular Epidemiology and Evolutionary Trajectory of Emerging Echovirus 30, Europe

In 2018, an upsurge in echovirus 30 (E30) infections was reported in Europe. We conducted a large-scale epidemiologic and evolutionary study of 1,329 E30 strains collected in 22 countries in Europe during 2016-2018. Most E30 cases affected persons 0-4 years of age (29%) and 25-34 years of age (27%). Sequences were divided into 6 genetic clades (G1-G6). Most (53%) sequences belonged to G1, followed by G6 (23%), G2 (17%), G4 (4%), G3 (0.3%), and G5 (0.2%). Each clade encompassed unique individual recombinant forms; G1 and G4 displayed >= 2 unique recombinant forms. Rapid turnover of new clades and recombinant forms occurred over time. Clades G1 and G6 dominated in 2018, suggesting the E30 upsurge was caused by emergence of 2 distinct clades circulating in Europe. Investigation into the mechanisms behind the rapid turnover of E30 is crucial for clarifying the epidemiology and evolution of these enterovirus infections.Peer reviewe

Recommendations for enterovirus diagnostics and characterisation within and beyond Europe.

Enteroviruses (EV) can cause severe neurological and respiratory infections, and occasionally lead to devastating outbreaks as previously demonstrated with EV-A71 and EV-D68 in Europe. However, these infections are still often underdiagnosed and EV typing data is not currently collected at European level. In order to improve EV diagnostics, collate data on severe EV infections and monitor the circulation of EV types, we have established European non-polio enterovirus network (ENPEN). First task of this cross-border network has been to ensure prompt and adequate diagnosis of these infections in Europe, and hence we present recommendations for non-polio EV detection and typing based on the consensus view of this multidisciplinary team including experts from over 20 European countries. We recommend that respiratory and stool samples in addition to cerebrospinal fluid (CSF) and blood samples are submitted for EV testing from patients with suspected neurological infections. This is vital since viruses like EV-D68 are rarely detectable in CSF or stool samples. Furthermore, reverse transcriptase PCR (RT-PCR) targeting the 5'noncoding regions (5'NCR) should be used for diagnosis of EVs due to their sensitivity, specificity and short turnaround time. Sequencing of the VP1 capsid protein gene is recommended for EV typing; EV typing cannot be based on the 5'NCR sequences due to frequent recombination events and should not rely on virus isolation. Effective and standardized laboratory diagnostics and characterisation of circulating virus strains are the first step towards effective and continuous surveillance activities, which in turn will be used to provide better estimation on EV disease burden