The National Polio Laboratory (NPL) of the Research Institute for Tropical Medicine (RITM) conducted its sixth Multistakeholders’ Meeting last June 23, 2022 via Zoom to cascade important updates on environmental surveillance (ES), specifically the establishment of an ES Concentration Laboratory in Mindanao and the ES transition plan for the detection of other viral pathogens aside from polioviruses, which includes SARS-CoV-2, causative pathogen for COVID-19.

NPL reported that the ES program will be expanding from regional to provincial routine sites. NPL aims to establish one (1) site per province. Specifically, NPL aims to establish ES sites in 81 provinces in the country. This follows the poliovirus outbreak response assessment (OBRA) of the World Health Organization (WHO) for the polio outbreak response in the country in 2019. To strengthen polio outbreak response, WHO recommended to expand ES operations to supplement the Acute Flaccid Paralysis (AFP) surveillance activities.

From just having two (2) regions and three (3) sites since the establishment of the ES program in 2017, the NPL is now conducting routine testing in all 17 regions with 43 routine sites, as of writing.

“Seven years ago, we entered an era of collaborative multisectoral work for environmental surveillance for polio and other enteroviruses. Five years ago, when we first conceptualized and initiated this environmental surveillance program, we never thought we will come this far. For the past five years, I can say that we have achieved our set objectives in 2017,” said NPL Technical Supervisor Dr. Lea Apostol.

Aside from ES expansion, NPL also informed stakeholders about the laboratory testing results per region and the new criteria for selection of new ES sites. The new requirement necessitates a water sample positive to the Pepper Mild Mottle Virus (PMMoV), which is an indicator of fecal contamination. This was also recommended by WHO. Other site requirements include risk assessment for poliovirus transmission, defined catchment population, evidence of household drainage to river, availability of trained collector, storage, and courier, and accessibility and security of the site. NPL has decided to discard sites in which non-isolation of viruses for a year had occurred.

With the ES expansion, an influx of water samples is expected to be collected. To aid in the processing and analysis of samples, an ES concentration laboratory is proposed to be established in Mindanao, particularly in Davao region. Davao region is chosen as the site of laboratory establishment due to its strategic location, allowing all types of transport of samples, be it via air, naval, or land delivery. The proposed Mindanao laboratory shall serve as the central hub for processing of samples from all Mindanao sites.

The establishment of the ES concentration laboratory in Mindanao will undergo four (4) phases namely, 1) advocacy and consultation, 2) capacity-building, 3) pilot implementation, and 4) sustainability, monitoring, and evaluation. Phase 1 activities have already started last May 2022. The NPL expects completion of the Mindanao laboratory by 2022. Meanwhile, plans for the establishment of a Visayas concentration laboratory is set for roll out in 2023.

The ES expansion also denotes strengthened functions for the program. The ES program is envisioned to expand its coverage to detect not just polioviruses and enteroviruses, but other viral pathogens such as SARS-CoV-2. 

“We are looking at the future and sustainability of the environmental surveillance and it’s been very useful, not only for polio. Eventually, this will be very important for other pathogens in the future,” said RITM Laboratory Research Division Chief Dr. Amado O. Tandoc III.

“Even if in the absence of any reported (COVID-19) case, ES can play a major role in COVID-19 detection, just like what we did for polio. Tracking the source of SARS-CoV-2 particles in the environment will be an excellent tool for a national government’s evidence-based policies and action,” added Dr. Apostol.

The NPL asked its stakeholders their support in the implementation of the new initiatives as they expand and transition for improved pathogen detection in the country. RITM Director Dr. Celia C. Carlos also emphasized the importance of their support in achieving the goals of NPL.

“I call on every ES stakeholder to support the targets of the NPL to expand ES in all provinces which started this year and to delegate some tasks to the regional level by establishing ES laboratories as the NPL moves also to a higher level of testing and capacity building. These set objectives can only be achieved if each individual or stakeholder takes the responsibility at hand and support this program,” said Dr. Carlos.

ES was an integral supplemental activity to the polio outbreak response in 2019 which allowed for the detection of vaccine-derived polioviruses in an environmental sample. This ES provided more evidence for the closure of the polio outbreak in the country in 2021.

The meeting was participated by representatives from the following:

• Department of Health-Epidemiology Bureau
• Department of Environment and Natural Resources-Environmental Management Bureau
• Manila Water Company Incorporated
• Maynilad Water and Sewerage Incorporated
• Metropolitan Waterworks and Sewerage System
• Laguna Lake Development Authority
• Isawad Sewage Treatment Plant
• Regional Centers for Health Development
  • Regional Epidemiology Surveillance Units
  • Regional Environmental and Occupational Health Office
• Local Government Units

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by Anel Azel Dimaano