PONE-D-22-27652Evaluation of the Environmental Polio Surveillance System - Northern Region, Ghana, 2021PLOS ONE

Dear Mr Joseph Asamoah Frimpong,

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: N/A

Reviewer #3: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The manuscript is well written though a few typo and grammatical errors have bee indicated in the attached document. Other technical issues have also bee raised in the document that will require the authors to address them.

Good job

Reviewer #2: Evaluation of the Environmental Polio Surveillance 1 System - Northern Region, Ghana, 2021

At a point in time, there was an estimated 75,000 paralysed children in Africa due to Polio. The disease remains a devastating one in children from low-income countries. The Global Polio Eradication Initiative came into being to assist affected countries devise strategies to curb the spread through continuous vaccination and strict surveillance. The use of environmental specimen to assist surveillance appears to be ahead of waiting to see symptoms in affected persons. This is the relevance of this paper.

Apart from a few comments seen below, I think this was a great attempt to assess the usefulness of environmental surveillance towards polio eradication.

55-56. Maybe add reasons for the global decrease in polio reports since 1988.

62. Neighbouring countries from the southern or northern part. I want to assume these outbreaks came from northern part of Ghana?

94. Northern region

335. What parameter are you using to determine delays. Is there a stipulated time that could be used to measure this? It would have been good if data is shown on national level delays a bit.

335-336. Is the quarterly submission of results from national or Nogushi the norm? Did you find out?

348. All year round

Reviewer #3: Summary

This is an important paper describing the environmental surveillance system in northern Ghana for poliovirus. The authors describe its justification and the role it plays to complement the gold standard acute flaccid paralysis case surveillance, alongside the quality and timeliness of the data

Major comments

The introduction has some inaccuracies that need to be corrected before publication. I have listed them below.

It would be very helpful to the reader to include a map of the Northern region showing the location of the two ES sites and the corresponding drainage settlements, and the location of the cVDPV2 AFP case.

It is not clear if the ES sites pass the WHO’s ES performance criteria (Table 5 of http://polioeradication.org/wp-content/uploads/2022/11/Field-Guidance-for-the-Implementation-of-ES-20221118-ENG.pdf) This is essential. It is important to document the detection of enterovirus and Sabin strains from ES sites but this is currently absent from the paper. The sites should be assessed whether they meet the WHO criteria.

Minor comments

Abstract: please include the precise dates of the study period

Abstract: The version of Excel seems excessive for the abstract

Abstract: ‘Feedbacks were not regular’ – can you quantify this statement. What proportion of results took longer than a month or another appropriate timeframe? Feedback to who?

Introduction:

Line56: 1988 – it would be clearer if you explained this is when the Eradication Initiative began.

Line 57 No wild type 3 Poliovirus since October 1999 in incorrect. Please correct this

Line 60: The last case of wild polio in Nigeria was in 2016 not 2014

Line 64: Please define what vaccine derived poliovirus is

Lines 81-82: Unfortunately seems the wrong choice of word. Also poliovirus isn’t in circulation in the environment (it’s detection can indicate circulation but it does not replicate in the environment).

Line 94: Northern region. Where else in the country is ES implemented? Why is the Northern region important? Because of historic WPV circulation?

Methods

Line 116 – how were the site locations selected?

Line 117 – what methods were used to assess the location of the drainage settlements? Was the sewage network mapped?

Line 131 – It would be helpful to include the questionnaire in the appendix

Line 156: What do you mean by ‘results are sent to the region’. Who in the region? Are they also sent to national representatives at the same time?

Line 168: ‘Stool turns positive’ I think you mean tests positive. A stool doesn’t turn positive

Results:

Line 227 – what are the other priority diseases?

Line 255 – delayed by how long?

Figure 3: Positive for what – cVDPV2? It would be interesting to show the number positive for Sabin 1,2,3 and non-polio enterovirus as well

Figure 4 – Suspected – do you mean non-polio AFP? Confirmed, confirmed for what? cVDPV2? It would be helpful to show the timings of the vaccination campaigns.

Discussion:

Line 277 – ES is faster – do you mean in this setting or more generally? If the latter please provide a reference.

Line 279 – On average, this is an average over what?

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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Attachments

Attachment

Submitted filename: Manuscript.docx

PONE-D-22-27652R1Evaluation of the Environmental Polio Surveillance System - Northern Region, Ghana, 2021PLOS ONE

Dear Dr. Asamoah Frimpong,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Aug 12 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Enoch Aninagyei, PhD

Academic Editor

PLOS ONE

Additional Editor Comments:

The Reviewer of the revised version actually rejected the manuscript, citing the following reasons. However, I want to give you the opportunity to address them for consideration.

This publication is a descriptive summary of findings linked to an evaluation of poliovirus wastewater surveillance in Northern Ghana from 2019 to 2020. Below are the rationale for the recommendation to reject this publication:

1)The authors state that they follow the CDC guidelines for evaluating a surveillance system but they have excluded some critical assessments such as sensitivity and predictive value positive.

2) The population of the area under surveillance is 2.3million yet the sampling is done for a population of about 70,000 people, short of the 100,000 to 300,000 recommended for global polio surveillance. It is unclear how this sampling location was selected. Is this sample size sufficient for ongoing surveillance and monitoring?

3) For the subjective aspects of the evaluation, little data was shared regarding staff surveys/interviews regarding their feedback e.g. no summary of responses to specific questions though a data collection tool was mentioned.

4) Other factors to consider in evaluating wastewater surveillance particularly where there is a low risk of wild poliovirus or vdpv include the detection of Sabin strains from OPV use (i.e. correlation with immunization days) and non-polio enteroviruses (NPEV) used as proxy indicators to regularly monitor, validate, and compare site sensitivity. These indicators were not assessed.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #4: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #4: No

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #4: No

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #4: No

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #4: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #4: This publication is a descriptive summary of findings linked to an evaluation of poliovirus wastewater surveillance in Northern Ghana from 2019 to 2020. Below are the rationale for the recommendation to reject this publication:

1)The authors state that they follow the CDC guidelines for evaluating a surveillance system but they have excluded some critical assessments such as sensitivity and predictive value positive.

2) The population of the area under surveillance is 2.3million yet the sampling is done for a population of about 70,000 people, short of the 100,000 to 300,000 recommended for global polio surveillance. It is unclear how this sampling location was selected. Is this sample size sufficient for ongoing surveillance and monitoring?

3) For the subjective aspects of the evaluation, little data was shared regarding staff surveys/interviews regarding their feedback e.g. no summary of responses to specific questions though a data collection tool was mentioned.

4) Other factors to consider in evaluating wastewater surveillance particularly where there is a low risk of wild poliovirus or vdpv include the detection of Sabin strains from OPV use (i.e. correlation with immunization days) and non-polio enteroviruses (NPEV) used as proxy indicators to regularly monitor, validate, and compare site sensitivity. These indicators were not assessed.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #4: No

**********

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While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PONE-D-22-27652R2Evaluation of the Environmental Polio Surveillance System - Northern Region, Ghana, 2021PLOS ONE

Dear Dr. Frimpong,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

ACADEMIC EDITOR:One of the reviewers made these comments. However, I did not see these revisions. Kindly respond to them for consideration. This publication is a descriptive summary of findings linked to an evaluation of poliovirus wastewater surveillance in Northern Ghana from 2019 to 2020. Below are the rationale for the recommendation to reject this publication:

1)The authors state that they follow the CDC guidelines for evaluating a surveillance system but they have excluded some critical assessments such as sensitivity and predictive value positive.

2) The population of the area under surveillance is 2.3million yet the sampling is done for a population of about 70,000 people, short of the 100,000 to 300,000 recommended for global polio surveillance. It is unclear how this sampling location was selected. Is this sample size sufficient for ongoing surveillance and monitoring?

3) For the subjective aspects of the evaluation, little data was shared regarding staff surveys/interviews regarding their feedback e.g. no summary of responses to specific questions though a data collection tool was mentioned.

4) Other factors to consider in evaluating wastewater surveillance particularly where there is a low risk of wild poliovirus or vdpv include the detection of Sabin strains from OPV use (i.e. correlation with immunization days) and non-polio enteroviruses (NPEV) used as proxy indicators to regularly monitor, validate, and compare site sensitivity. These indicators were not assessed.

==============================

Please submit your revised manuscript by Oct 21 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Enoch Aninagyei, PhD

Academic Editor

PLOS ONE

Additional Editor Comments:

This publication is a descriptive summary of findings linked to an evaluation of poliovirus wastewater surveillance in Northern Ghana from 2019 to 2020. Below are the rationale for the recommendation to reject this publication:

1)The authors state that they follow the CDC guidelines for evaluating a surveillance system but they have excluded some critical assessments such as sensitivity and predictive value positive.

2) The population of the area under surveillance is 2.3million yet the sampling is done for a population of about 70,000 people, short of the 100,000 to 300,000 recommended for global polio surveillance. It is unclear how this sampling location was selected. Is this sample size sufficient for ongoing surveillance and monitoring?

3) For the subjective aspects of the evaluation, little data was shared regarding staff surveys/interviews regarding their feedback e.g. no summary of responses to specific questions though a data collection tool was mentioned.

4) Other factors to consider in evaluating wastewater surveillance particularly where there is a low risk of wild poliovirus or vdpv include the detection of Sabin strains from OPV use (i.e. correlation with immunization days) and non-polio enteroviruses (NPEV) used as proxy indicators to regularly monitor, validate, and compare site sensitivity. These indicators were not assessed.

[Note: HTML markup is below. Please do not edit.]

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Evaluation of the Environmental Polio Surveillance System - Northern Region, Ghana, 2021

PONE-D-22-27652R3

Dear Dr. Asamoah Frimpong,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Enoch Aninagyei, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: