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Journal of Clinical Microbiology, March 2000, p. 945-952, Vol. 38, No. 3
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

Resolution of the Pathways of Poliovirus Type 1 Transmission during an Outbreakdagger

Lester M. Shulman,1,* Rachel Handsher,1 Chen-Fu Yang,2 Su-Ju Yang,2 Joseph Manor,1 Ami Vonsover,1 Zehava Grossman,1 Mark Pallansch,2 Ella Mendelson,1 and Olen M. Kew2

Central Virology Laboratory, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel,1 and Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 303332

Received 8 July 1999/Returned for modification 23 November 1999/Accepted 9 December 1999

An outbreak of poliomyelitis with 20 cases occurred in Israel, Gaza, and the West Bank from October 1987 to October 1988. The wild type 1 poliovirus associated with the outbreak was most closely related to viruses found in the Nile Delta. The epidemiologic links among patients involved in the outbreak and patients with community-acquired infections during the outbreak were inferred from the evolutionary relationships among isolates of the outbreak virus. Complete VP1 sequences (906 nucleotides) were determined for 12 clinical and 4 sewage isolates. A total of 58 nucleotide differences were found among the 16 isolates; 74% of all substitutions were synonymous third-position transitions. An evolutionary tree, representing both the pathways of VP1 sequence evolution and the inferred chains of virus transmission during the outbreak, was constructed under the assumption that each substitution had occurred only once. The combined epidemiologic and molecular data suggest that a single founder strain was introduced into Israel from the vicinity of Gaza in the fall of 1987. Poliovirus circulation was apparently localized to southern communities during the winter and spread north by the following summer into the Hadera subdistrict of Israel, where it radiated via multiple chains of transmission into other communities in northern Israel and the West Bank. The close sequence matches (>99%) between clinical and sewage isolates from the same communities confirm the utility of environmental sampling as a tool for monitoring wild poliovirus circulation.

* Corresponding author. Mailing address: Central Virology Laboratory, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel. Phone: 972-3-530-2341. Fax: 972-3-530-2457. E-mail: cvlsheba{at}netvision.net.il.

dagger This paper is dedicated to the memory of our friend and colleague, Ami Vonsover.

Journal of Clinical Microbiology, March 2000, p. 945-952, Vol. 38, No. 3
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.


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