Inferring numbers of wild poliovirus excretors using quantitative environmental surveillance

Yuri Perepliotchikov, Tomer Ziv-Baran, Musa Hindiyeh, Yossi Manor, Danit Sofer, Jacob Moran-Gilad, Laura Stephens, Ella Mendelson, Merav Weil, Ravit Bassal, Emilia Anis, Shepherd Roee Singer, Ehud Kaliner, Gillian Cooper, Manasi Majumdar, Michal Markovich, Daniela Ram, Itamar Grotto, Ronni Gamzu, Javier MartinLester M. Shulman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Response to and monitoring of viral outbreaks can be efficiently focused when rapid, quantitative, kinetic information provides the location and the number of infected individuals. Environmental surveillance traditionally provides information on location of populations with contagious, infected individuals since infectious poliovirus is excreted whether infections are asymptomatic or symptomatic. Here, we describe development of rapid (1 week turnaround time, TAT), quantitative RT-PCR of poliovirus RNA extracted directly from concentrated environmental surveillance samples to infer the number of infected individuals excreting poliovirus. The quantitation method was validated using data from vaccination with bivalent oral polio vaccine (bOPV). The method was then applied to infer the weekly number of excreters in a large, sustained, asymptomatic outbreak of wild type 1 poliovirus in Israel (2013) in a population where >90% of the individuals received three doses of inactivated polio vaccine (IPV). Evidence-based intervention strategies were based on the short TAT for direct quantitative detection. Furthermore, a TAT shorter than the duration of poliovirus excretion allowed resampling of infected individuals. Finally, the method documented absence of infections after successful intervention of the asymptomatic outbreak. The methodologies described here can be applied to outbreaks of other excreted viruses such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), where there are (1) significant numbers of asymptomatic infections; (2) long incubation times during which infectious virus is excreted; and (3) limited resources, facilities, and manpower that restrict the number of individuals who can be tested and re-tested.

Original languageEnglish
Article number870
Issue number8
StatePublished - Aug 2021


FundersFunder number
Central Virology Laboratory
Epidemiology Department of the Israel Ministry of Health
Epidemiology Department of the School of Public Health
Israel Centre for Disease Control
Israel Public Health Services
Southern District Health Office and Environmental Health Department
Tel Aviv Sanitation Engineers
WPV1-SoAS in Israel
World Health Organization Headquarters Geneva Switzerland
Centers for Disease Control and Prevention
World Health Organization
Sackler Faculty of Medicine, Tel-Aviv University


    • Asymptomatic infections
    • Composite sewage samples
    • Inactivated poliovirus vaccine
    • Oral poliovirus vaccine
    • Outbreaks
    • Poliovirus
    • Quantitative environmental surveillance
    • Sewage
    • Stools
    • Vaccination
    • Vaccine-derived poliovirus


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