The detection of highly divergent VDPVs in Estonian sewage suggests the presence of an unidentified chronic excretor, highlighting the importance of environmental surveillance in polio eradication.
Highly divergent vaccine-derived polioviruses (VDPVs) have been isolated from sewage in Tallinn, Estonia, since 2002. Sequence analysis of VDPVs of serotypes 2 and 3 showed that they shared common noncapsid region recombination sites, indicating origination from a single trivalent oral polio vaccine dose, estimated to have been given between 1986 and 1998. The sewage isolates closely resemble VDPVs chronically excreted by persons with common variable immunodeficiency, but no chronic excretors have yet been identified in Estonia.
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Al‐Hello et al. (2013) studied this question.
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