Poliovirus

Testing Indications

For any suspected cases of Poliovirus, contact Public Health Ontario laboratory.

For any suspected cases of poliomyelitis contact the Medical Microbiologist or your local Public Health Ontario Laboratory site. 

Testing Guidelines for Patients with Acute Flaccid Paralysis (AFP)/Acute Flaccid Myelitis (AFM) or Other Acute Neurological Presentations of Possible Viral Cause:

Persons of any age presenting with AFM, or any child less than 15 years of age with AFP should have laboratory investigations to detect an infectious cause. Screening for viral pathogens may also be indicated for other neurological presentations where viral infection is on the differential diagnosis. Testing should include Enterovirus detection, as well as Enterovirus molecular serotyping if Enterovirus-positive. Additionally, testing for Campylobacter should be performed if Guillain-Barre syndrome is suspected. When submitting specimens from patients with neurological presentation, it is important to document the neurological symptoms on the laboratory requisition form, so the appropriate testing can be ordered. Specimen collection should include:

1. Stools: Collect two sets of stool samples at least 24 hours apart – divide each stool sample into a sterile container for viral testing and a bacterial (Cary-Blair) transport media container for Campylobacter testing.  The clinician should write “Enterovirus / Enterovirus Molecular Serotyping” in the “Test(s) Requested” field of one requisition, and “Campylobacter Testing” in the “Test(s) Requested” of another requisition.
2. Respiratory specimens: Collect a nasopharyngeal (NP) swab and/or throat swab (NP swab preferred) in universal transport media (UTM), or bronchoalveolar lavage in a sterile dry container. Always submit a throat swab from children under 15 years of age with AFP. The clinician should write “Enterovirus / Enterovirus Molecular Serotyping" in the “Test(s) Requested” field of the requisition.
3. Cerebrospinal Fluid (CSF): For all ages, collect cerebrospinal fluid (CSF) as appropriate for the investigation. If CSF is collected, the clinician should write “Enterovirus / Enterovirus Molecular Serotyping" in the “Test(s) Requested” field of the requisition.

Timing of Specimen Collection

To increase the probability of poliovirus isolation, obtain two stool specimens at least 24 hours apart from patients with suspected poliomyelitis. These samples should be collected ideally within 14 days after onset.

Storage and Transport

Label the specimen container with the patient’s full name, date of collection and one other unique identifier such as the patient’s date of birth or Health Card Number. Failure to provide this information may result in rejection or testing delay.

Special Instructions

Specimens should be stored at 2-8°C following collection and shipped to PHO laboratory on ice packs.

Test Frequency and Turnaround Time (TAT)

Stool specimens are forwarded to NML for poliovirus testing Monday to Thursday.

Turnaround time for molecular testing by NML is 7 to 14 days.

Specimens tested by virus culture are observed for 10 (respiratory) to 17 days (CSF) prior to reporting a negative culture result; samples that are positive can be observed at any point during this period. Turnaround time is up to 18 days.

Turnaround time will vary during the winter months.

STAT and Critical Samples Testing

For urgent/suspect cases call the Public health Laboratory prior to submitting specimens.

When poliomyelitis is suspected in persons of all ages, or acute flaccid paralysis (AFP) occurs in children less than 15 years of age, PHO laboratory will conduct Enterovirus testing by Enterovirus PCR and virus culture, and Enterovirus molecular serotyping on Enterovirus-positive specimens. For further information on Enterovirus testing, refer to the PHO laboratory Enterovirus Test Information Sheet.

Molecular serotyping conducted at PHO laboratory should identify poliovirus if present. In addition to being tested at PHO laboratory, specimens will also be forwarded for testing at the National Microbiology Laboratory (NML) by molecular detection and typing of poliovirus by PCR and sequencing. NML may also perform virus culture. 

Other specimens collected from patients with suspected poliovirus will be tested at PHO laboratory for presence of Enteroviruses, including non-polio Enteroviruses that could cause a similar clinical presentation as poliovirus. In addition, they will be forwarded to NML for further testing. Further information on poliovirus testing is available from the NML website.

Specimens tested by traditional virus culture, and are observed for 10 (respiratory) to 17 days (CSF) prior to reporting a negative culture result; samples that are positive can be observed and confirmed at any point during this period.

Algorithm

Specimens are forwarded to the National Microbiology Laboratory for molecular detection and typing of poliovirus by PCR and sequencing. NML may also perform virus culture.

Reporting

Results are reported to the ordering physician or health care provider as indicated on the requisition.

Specimens that are positive for poliovirus are reported to the Medical Officer of Health as per Health Protection and Promotion Act.