The Conversation: Sewage surveillance is the next frontier in the fight against polio
Marisa Eisenberg, associate professor of complex systems, epidemiology, and mathematics; Andrew Brouwer, research investigator in epidemiology; and Joseph Eisenberg, professor and chair of epidemiology, all at the University of Michigan

“…Epidemiologists typically detect polio transmission based on reported cases of acute flaccid paralysis (AFP). … But AFP is a severe outcome that occurs in a very small fraction of polio infections. It’s just the tip of the iceberg — one case of AFP indicates substantial underlying polio transmission in a population. This is why now, as the world approaches the final stages of polio eradication, environmental surveillance becomes key. Looking for poliovirus in sewage is more sensitive than counting up cases of AFP. It can detect virus shed in the feces of non-paralyzed people infected with polio — what epidemiologists call the silent circulation of polio. … As we approach the final stages of polio eradication, environmental measures will become the only feasible way to detect polio transmission. … Beyond polio, environmental surveillance can and should be extended to other infectious diseases shed into sewage — enteroviruses, typhoid, and cholera are prime candidates…” (10/19).