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Polioviruses and Other Enteroviruses GLOBAL WATER PATHOGEN PROJECT PART THREE. SPECIFIC EXCRETED PATHOGENS: ENVIRONMENTAL AND EPIDEMIOLOGY ASPECTS POLIOVIRUSES AND OTHER ENTEROVIRUSES Walter Betancourt (University of Arizona) Copyright: This publication is available in Open Access under the Attribution-ShareAlike 3.0 IGO (CC-BY-SA 3.0 IGO) license (http://creativecommons.org/licenses/by-sa/3.0/igo). By using the content of this publication, the users accept to be bound by the terms of use of the UNESCO Open Access Repository (http://www.unesco.org/openaccess/terms-use-ccbysa-en). Disclaimer: The designations employed and the presentation of material throughout this publication do not imply the expression of any opinion whatsoever on the part of UNESCO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The ideas and opinions expressed in this publication are those of the authors; they are not necessarily those of UNESCO and do not commit the Organization. Citation: Betancourt, W.Q., and Shulman, L.M. 2016. Polioviruses and other Enteroviruses. In: J.B. Rose and B. Jiménez-Cisneros, (eds) Global Water Pathogens Project. http://www.waterpathogens.org (J.S Meschke, and R. Girones (eds) Part 3 Viruses) http://www.waterpathogens.org/poliovirusesandotherenteroviruses Michigan State University, E. Lansing, MI, UNESCO. Acknowledgements: K.R.L. Young, Project Design editor; Website Design (http://www.agroknow.com) Published: January 14, 2015, 5:22 pm, Updated: April 28, 2017, 5:33 pm Polioviruses and other Enteroviruses Summary Water Supply and Sanitation indicate that despite significant progress on sanitation, in 2012, more than one third of the global population - some 2.5 billion people – do Enteroviruses (EVs), including poliovirus and nonpolio not use an improved sanitation facility, and of these 1 enteroviruses (i.e., coxsackieviruses, echoviruses,billion people still practice open defecation. Sewage enteroviruses) are among the most common genera of the represents a useful matrix to derive information on Picornaviridae family that infect humans and therefore are circulating enteroviruses in given populations and to known to circulate widely in human populations throughout describe the enterovirus epidemiology associated with the world. New genera of thePicornaviridae family (i.e., human disease, also known as environmental surveillance. Saffold cardiovirus [SAFV])Cosavirus [common stool- associated picornavirus] Salivirus [stool Aichi-like virus]) Environmental poliovirus surveillance is a major goal of the have been identified in fecal specimens and wastewaters WHO Global Poliovirus Eradication Initiative (GPEI) used to using conventional and highly-sensitive genomicmonitor pathways of poliovirus transmission of wild sequencing technologies. In addition, members of the poliovirus and circulating vaccine-derived polioviruses Echovirus genus originally known as echovirus 22 and 23 (cVDPVs). A major effort to develop new, improved, and have been reclassified within the genusParechovirus. safer live polio vaccine is being promoted by the WHO, Likewise, previous rhinovirus species have been Rotary and the Bill & Melinda Gates Foundation. Human reclassified within the Enterovirus genus. Enterovirus (EV) enteroviruses have been recovered worldwide from surface infections are a significant cause of morbidity and mortality waters including coastal waters, rivers streams, and lakes, throughout the world, primarily in infants and young from ground waters, wastewaters and finished drinking children. Nevertheless, reliable worldwide estimates of EV- water. Numerous methodological approaches have been related mortality are not currently available. recently developed for concentration of human enteric viruses from water and their isolation from the Enteroviruses like most enteric viruses have evolved environment. Selection of an appropriate filtration method stability to adverse environmental conditions, including for the primary concentration of viruses is crucial to thermal stability, acid stability, resistant to radiation as successful virus detection. However, an efficient method to well as to oxidants and proteolytic enzymes, which allow recover all viruses has not been developed yet. Integrated survival of these viruses in the environment and facilitate cell culture and PCR (ICC-PCR) developed in the late 1980s their transmission through multiple environmental routes is still applicable for detection and identification of a suite (e.g., water, food, aerosols, and virus-contaminated of infective viral pathogens recovered from environmental inanimate objects or fomites). Human wastes, such as samples. The detection of enteroviruses in sources of sewage and poorly treated effluents, urban stormwater and drinking water and recreational water bodies has been combined sewers overflows (CSO) are the primary source broadly accepted as a marker of a possible failure of the of enteroviruses released into aquatic and landsanitation systems and as an indicator of the potential role environments that subsequently contaminate raw source of water in disease outbreaks. Moreover, since the natural waters for potable supply, bathing waters, shellfish waters, host for all human enteroviruses is humans, the detection and waters used for irrigation of crops. Groundwater and quantification of amplifiable enterovirus genetic sources are also vulnerable to contamination withmaterial in environmental waters has been proposed and enteroviruses through different routes including direct successfully used as a water quality assessment tool for injection of wastes through wells, percolation of sewage tracking sources of human fecal pollution. sprayed over the land, leaking or broken sewer lines, seepage from waste lagoons, infiltration of sewage-polluted surface streams, and septic tank effluents. The biophysical properties of enteroviruses (i.e., small-size, genome type Enteroviruses and new genera and the non-enveloped capsid structure of the virion) play within the family Picornaviridae an important role on virus survival in the environment and on the physical removal and inactivation of virus particles 1.0 Epidemiology of the Disease and Pathogen through conventional wastewater treatment processes. Membrane bioreactor systems (MBRs) are becoming Human EVs, like all viruses, are obligate intracellular increasingly applied in developed regions as advanced parasites that are dependent upon living host cells for the wastewater treatment technologies to produce treated essential elements of replication (Lees, 2000). EVs effluents of very high quality applicable to wastewater including poliovirus (PV) and non-polioenteroviruses discharge and recycling solutions, including non-potable or (NPEVs) (i.e., coxsackieviruses, echoviruses, EVs) are indirect potable reuse. The distribution and persistence of among the most common genera of the Picornaviridae enteroviruses in sewage-polluted waters may varyfamily that infect humans and therefore are known to geographically depending on the epidemiological status of circulate widely in human populations throughout the world the population, population density, and the extent of (Pallansch et al., 2013). Picornaviridae is considered one of sanitation coverage (i.e., wastewater treatment and the oldest and most diversified virus families, presenting a wastewater disposal) which influence the viral load non-enveloped, single, positive-stranded RNA (ssRNA) released into the environment. Recent estimates by the genome packed in a ~30 nm icosahedral capsid (Racaniello, World Health Organization (WHO)/United Nations2013). This family includes many important enteric human Children’s Fund (UNICEF) Joint Monitoring Programme for and animal pathogens, such as poliovirus, hepatitis A virus, 3 Polioviruses and other Enteroviruses and foot-and-mouth-disease virus (Pallansch et al., 2013; the exception of poliomyelitis. Indeed, the focus for the Racaniello, 2013; Tapparel et al., 2013). Most EVs and worldwide EV surveillance network is primarily on other genera of enteric picornaviruses (Hepatovirus, neurological presentation such as acute flaccid paralysis Parechovirus, Cardiovirus, Kobuvirus, Salivirus, and (AFP), to support poliovirus eradication programs. In Cosavirus) replicate in theepithelial cells of the general, national laboratories throughout the world report gastrointestinal tract and their progeny are in fecal matter enterovirus typing results from clinical specimens to excreted into the environment. exclude poliovirus and establish the epidemiology of NPEVs. The World Health Organization (WHO) and the U.S 1.1 Global Burden of Disease Centers for Disease Control and Prevention (CDC) have guidelines for epidemiologic, clinical, and laboratory 1.1.1 Global distribution investigations of AFP to rule out poliovirus infection (WHO, 2004). Although enterovirus infections are a significant cause of morbidity and mortality throughout the world, in In the United States of America, the National particular for infants and young children, reliable Enterovirus Surveillance System (NESS) is a voluntary, worldwide estimates of EV-relatedmortality are not passive surveillance system that has monitored trends in currently available. Since enterovirus infections are not circulating EVs since 1961. Participating laboratories (state nationally notifiable and health authorities in different public health laboratories and local diagnostic laboratories countries admit that these infections
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