Key result
DDNS cuts poliovirus confirmation time by ~77% vs gold standard with comparable detection rates.
Why the study?
Timely outbreak detection is needed for poliovirus eradication, but the gold standard detection method takes a median of 30 days in the Democratic Republic of the Congo.
Does direct molecular detection and nanopore sequencing (DDNS) improve the speed and sensitivity of poliovirus detection compared to the gold standard method in stool samples from suspected cases?
Observational (n=1,221)
Single-blind
No
Does direct molecular detection and nanopore sequencing (DDNS) improve the speed and sensitivity of poliovirus detection compared to the gold standard method in stool samples from suspected cases?
Absolute Event Rate: 2.7% vs 2.2%
DDNS is a feasible, faster, and highly sensitive alternative to the gold standard for poliovirus detection, enabling more rapid outbreak confirmation.
May accelerate poliovirus surveillance; leaves open prospective validation of routine adoption.
Timely detection of outbreaks is needed for poliovirus eradication, but gold standard detection in the Democratic Republic of the Congo takes 30 days (median). Direct molecular detection and nanopore sequencing (DDNS) of poliovirus in stool samples is a promising fast method. Here we report prospective testing of stool samples from suspected polio cases, and their contacts, in the Democratic Republic of the Congo between 10 August 2021 and 4 February 2022. DDNS detected polioviruses in 62/2,339 (2.7%) of samples, while gold standard combination of cell culture, quantitative PCR and Sanger sequencing detected polioviruses in 51/2,339 (2.2%) of the same samples. DDNS provided case confirmation in 7 days (median) in routine surveillance conditions. DDNS enabled confirmation of three serotype 2 circulating vaccine-derived poliovirus outbreaks 23 days (mean) earlier (range 6-30 days) than the gold standard method. The mean sequence similarity between sequences obtained by the two methods was 99.98%. Our data confirm the feasibility of implementing DDNS in a national poliovirus laboratory.
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Shaw et al. (2023) conducted an observational in Suspected poliomyelitis (Acute flaccid paralysis) (n=1,221). Direct molecular detection and nanopore sequencing (DDNS) vs. Cell culture, quantitative PCR, and Sanger sequencing (gold standard) was evaluated on Detection of polioviruses in stool samples. Direct molecular detection and nanopore sequencing (DDNS) detected polioviruses in 2.7% of samples compared to 2.2% by the gold standard, and confirmed cases significantly faster (median 7 vs 30 days).
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