Poliovirus surveillance by examining sewage water specimens: studies on detection probability using simulation models.

Efficiency of environmental surveillance of poliovirus circulation was studied using simulation models. First, three transmission models were defined for describing different scenarios of poliovirus infections in a large unstructured population. Second, environmental factors, such as the total volume of the sewage network and losses of viruses, were modeled for computing the virus output at the sewage sampling site. Third, the effect of sampling and laboratory procedures was accounted for in the probability of detection, given the amount of polioviruses in a specimen. The simulation model can be used for theoretical assessments of the likely efficiency of environmental surveillance, compared with acute flaccid paralysis (AFP) surveillance. Under reasonable assumptions in a vaccinated population, the AFP surveillance can be outperformed if the poliovirus outbreak is not large. However, this depends on the assumed case-to-infection ratio and on the sampling frequency of the sewage water specimens. Increasing the latter will lead to a higher detection probability, which will further enhance the method based on environmental surveillance.