India uses the Environmental Surveillance (ES) system for poliovirus detection in sewage. A positive ES sample from an urban site is best described as evidence of:

• A An AFP case in that ward, requiring immediate case notification
• B Vaccine-derived poliovirus outbreak only
• C Contamination of drinking water supply, requiring boiling advisories
• D Poliovirus circulation in the community, requiring investigation even if AFP surveillance is negative ✓

Explanation

Environmental Surveillance detects poliovirus shedding in community sewage, serving as a sensitive sentinel for circulation even before clinical AFP cases appear. A positive ES finding triggers immediate investigation (stool samples from children, immunisation coverage assessment), intensified surveillance, and supplementary immunisation activities regardless of AFP surveillance status. ES can detect both wild poliovirus and vaccine-derived polioviruses (VDPV). It is not equivalent to detecting an AFP case or a drinking water contamination event.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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