Sampling schemes in poliovirus wastewater surveillance studies from European countries and their comparison to other studies: a literature review

Poliovirus wastewater surveillance (WWS) is an important complementary system to acute flaccid paralysis surveillance and a substitute surveillance for enteroviruses in stool samples of children, within global poliovirus eradication efforts. However, current guidelines provide limited data on sampling schemes for polio-free countries. This study aims to provide a summary of sampling schemes used for poliovirus WWS in studies done in countries of European Union (EU), together with an analysis of their objectives and a comparison with studies done in other countries. The study selection for this literature review was based on three sources: a World Health Organisation literature review, the PubMed database, and a systematic literature review of WWS of communicable disease agents. From 1446 studies, 72 studies published between 1 January 1995 and 5 September 2024 were included in the qualitative analysis. These studies were analysed by country of origin, objective, sampling site, catchment population size, sampling frequency, sampling method and sample volume. The results indicate that most studies from EU countries had conducted poliovirus WWS directly in line with World Health Organisation recommendations, despite these being primarily designed for developing countries. Our review may encourage countries to optimise their poliovirus WWS systems based on their own risks for poliovirus introduction and circulation.