Non- Polio Enteroviruses from Acute Flaccid Paralysis Surveillance in Sudan Among Children Under 15 Years 2016-2017
Habab Alomrani, Amel Omer, Manal Mohamed, Ehsan HassanAbstract
Background
The risk of polio importation and re-emergence persists in Sudan due to factors such as ongoing cross-border movement, Sudan climate and ongoing conflicts. Enteroviruses are associated with wide range of illnesses, from mild respiratory infections to more severe neurological complications such as meningitis and acute flaccid paralysis. These viruses are transmitted primarily through the fecal-oral route and respiratory droplets. Higher prevalence rates of NPEVs observed in developing countries due to factors like poor hygiene and sanitation. Sudan last endogenous wild poliovirus case was reported in 2001. The first importation was in 2004 -2005 from Chad caused158 polio cases. The last polio case reported in the country was in March 2009. Since then Polio like illness cases were highly reported in Sudan but no wild polio virus isolated by the National Polio Laboratory.
Methods
This study represents an overview of non-polio enteroviruses (NPEVs) isolated from acute flaccid paralysis (AFP) surveillance in Sudan from 2016 to 2017. Total coverage used, 70 NPEV were isolated from stool specimens of 521 AFP cases of children under 15 years within 14 days of onset of symptoms. Samples were subjected to laboratory diagnosis for isolation of NPEV from AFP cases. The specimens were inoculated on RD and L20B cells using conventional tube cell culture and micro-neutralization test was also used to identify the NPEV serotypes and data entry were analyzed by using EPI info 7 version.
Results
On all the 521 isolates NPEV was detected in 70 (13.4%) patients, 57% of cases in male, 60% of cases in children under 5 years. Five most common reported serotypes on Micro neutralization assay, Cox-B (44%), Echo-6(9%), Echo-9(7%), Echo-11(5%) Echo-25(3%) and GBS was the most common cause of AFP (36 % of cases). Distinct summer–fall seasonality was observed, with June–September accounting for 53% of isolation from AFP cases with known month of specimen collection. NPEVs are distributing and circulating all over the Sudan with high level in Khartoum state, south Darfur and Gezira.
Conclusion
These findings highlight the importance of NPEVs association with AFP in Sudan and emphasize the need to strengthening the surveillance system to monitor NPEV infections and their association with AFP cases. Developing and implementing long-term strategies for monitoring and prevention of non-polio enteroviruses.