Wild poliovirus has been discovered in sewage samples in Hamburg, Germany, authorities reported on Thursday (11/13). This is the first time that type 1 poliovirus has been detected in Europe since 2010.
Polio can lead to permanent paralysis and death. Since exposure to the virus usually occurs in childhood, the disease is also called infantile paralysis. Other possible symptoms include fever, nausea, sore throat, abdominal pain, muscle pain, headache, and meningitis.
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Approximately 1 in 200 people infected develops irreversible paralysis, and up to 10% of these patients die. Although there is no cure, the disease is preventable with a vaccine, and since mass vaccination campaigns began in 1988, global cases have fallen by 99%.
In the case of Germany, the risk to the population is considered to be very low due to the high vaccination rate and the isolated occurrence of detection in wastewater. There are no reports of infection within the country.
The last case was confirmed 30 years ago
There are two forms of polio in circulation. One is wild polio, which is the natural form of the virus, and the other is polio, which is derived from an oral vaccine with a weakened pathogen. Both can cause paralysis and death, but wild polio is even rarer and is now endemic only in Afghanistan and Pakistan.
According to the Robert Koch Institute (RKI), Germany’s federal agency responsible for disease prevention and control, the strain found in German sewage is related to a strain circulating in Afghanistan.
According to the RKI, the last two confirmed cases of wild polio in a European country were registered in 1992.
Poliovirus type 2, the vaccine-derived type, is more common. It has been detected in sewage samples in several locations in Germany and other European countries since late last year.
This form results from the use of an oral polio vaccine containing live attenuated virus. After vaccination, children shed the virus in their stool for several weeks. In communities with low vaccination rates, the pathogen can spread, mutate, and revert to a harmful virus, causing hundreds of cases a year around the world, primarily in countries such as Yemen and Nigeria.
Samples in wastewater
Wastewater samples from major German cities are continuously tested for poliovirus by the RKI and the German Environment Agency.
Many countries collect sewage samples to monitor the spread of polio. Experts say the detection in Germany is a sign that the system is working well.
Polio has recently been detected in other areas where wild polio is not present, or outbreaks have occurred when the virus was imported. For example, in 2022 Malawi and Mozambique experienced an outbreak of wild polio cases linked to the polio outbreak in Pakistan, which had not been recorded for years. The last outbreak of wild poliovirus infection in Brazil was in 1989.
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