Polivirus Antibody and Lameness among Individuals in the Three regions ogf Ghana
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Date
2017-07
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University of Ghana
Abstract
Introduction: In 2008, Ghana recorded the last case of poliomyelitis or polio and the
causative agent was the wild polio virus. The country has been certified free of polio and
it is at the verge of polio eradication. High levels of polio neutralizing antibodies
(immunity) must be maintained to prevent the importation of wild poliovirus. We
determined the seroprevalence of polio viruses (P1, P2, and P3) antibodies and the risk
factors for seronegativity in Greater Accra, Ashanti and Northern regions of Ghana in order
to identify any gaps for system improvement.
Methods: A cross-sectional, hospital-based seroprevalence study supplemented by a
school lameness survey was undertaken in the three study regions in 2016. Individuals,
who visited the three teaching hospitals of the regions and needed to give out blood samples
for laboratory investigation, were invited to partake in the survey. Micro-neutralization test
for poliovirus serotypes, 1, 2 and 3 antibodies was performed following WHO-standard
procedures. Antibody titers of ≥ 1:8 were considered positive. Bivariate and multivariate
analyses were conducted on subject characteristics to assess for potential factors for failure
to sero-convert. Statistical significance was set at P -values <0.05
In the school lameness survey, clinical and epidemiological data were obtained from
parents and their lamed children using a semi-structured questionnaire in the same three
regions. School lameness data was descriptively analysed by person, place and time by
employing frequency distributions, percentages, means, standard deviation and rates. Data
was analysed using STATA version 13.
Results: Neutralizing-antibodies against poliovirus types 1, 2 and 3 were detected in 86.0%
(264/307), 84% (258/307) and 75% (230/307) of samples respectively. Overall, 60.1%
(185/307) were seropositive and 2.9% (9/307) were seronegative for the three polio
serotypes. Seroprevalence of polio-neutralizing antibodies among males (P1=51.9%,
P2=51.6% and P3=52.6%) were higher than females. Seroprevalence rates of polio
neutralizing antibodies (P1, P2 and P3) were highest in the Northern Region (91.8%,
82.4%, and 77.4%). Polio neutralizing-antibodies (P1 and P2) decreased with age
[p<0.001]. Low seroprevalence of polio-neutralizing antibodies was significantly
associated with low school attendance of mothers [p=0.003 for PV1 and p<0.001 for PV2].
Prevalence of residual paralysis was 0.58/1,000 or 5.8/10,000 children aged 0-15years in
schools of the study regions.
Conclusion: This study revealed a moderate level of seroprevalence of neutralizing
antibodies to the three polio serotypes with some regional differences. Seropositivity was
generally low with increasing age and the mother’s education level was crucial to
seronegativity. The drastic reduction of paralytic poliomyelitis may be attributed to the
moderate level of polio-neutralizing antibodies.
To further strengthen the gains made in polio eradication, the Ghanaian government needs
to increase and sustain budgetary allocation on polio eradication awareness and mass
immunizations. The Expanded Programme on Immunization (EPI), Ghana, may consider
young-adult booster-dose of polio vaccine, introduce inactivated polio vaccine (IPV) to
supplement the oral polio vaccine and conduct a nationwide seroprevalence and
community based lameness survey to gauge programme performance. Female child
education and career counseling for Junior High School pupils and those older may be
intensified by all District Assemblies and by churches
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Keywords
Polio, Immunization, Seroprevalence, Microneutralization, Lameness, Ghana