Kenya’s AFP surveillance system surpassed the WHO recommended minimum targets for both non-polio AFP rate and stool adequacy during the period studied. AFP surveillance, or finding and reporting children with acute flaccid paralysis (AFP), is fundamental in detecting polio cases. Given the increasing threat posed by insecurity to polio eradication efforts in places like Nigeria [30] and Afghanistan [9, 31], such programs will play an increasingly prominent role in bringing the goal of disease eradication within reach. With extensive ES and continued circulation of polioviruses, Pakistan presents a unique opportunity to quantify the impact of … Identification of ≥2 nonpolio AFP (NPAFP) cases per 100000 persons aged <15 years is recommended by the World Health Organization (WHO) as a benchmark for surveillance activities in regions with active poliovirus transmission or places at significant risk of outbreaks [8, 9]. Using a Poisson regression model adjusting for geopolitical zone, the incidence rate ratio for NPAFP cases was 1.7 (95% CI, 1.4–2.1; P < .001) when comparing the NPAFP rate in 2015, the year after the outbreak, to that of 2012, the year before outbreak onset. For stool specimens taken from an AFP case to be considered adequate, 2 specimens need to be collected from the case-patient ≥24 hours apart and within 14 days of paralysis onset, and the specimens must arrive at the laboratory in good condition, that is, without leakage or desiccation and under cold conditions [9, 21]. Surveillance is one of the main pillars of the Polio Eradication Programme. Algiers (AFP) - 01/02/2021 - 16:37 Two Algerian soldiers killed in clash with jihadists: ministry. This project was undertaken as part of the process of evaluating improvements in a public health surveillance system and was not considered to be human subjects research. Most counties achieved targets for both key surveillance indicators. AFP surveillance performance indicators should be monitored at all levels Depth of analysis depends on the level at which it is being conducted. Birmingham ME, Linkins RW, Hull BP, Hull HF. Acute flaccid paralysis (AFP) is defined as a sudden onset of paralysis/weakness in any part of the body of a child less than 15 years of age. Health worker awareness on AFP surveillance and active case search should be strengthened in all aspects … We then calculated the NPAFP rates per 100000 persons aged <15 years for each of the years under review. Currently, Pakistan has a well-functioning and sensitive AFP surveillance system at national, provincial, and district levels. Once an AFP case is identified, VPVs immediately notify the district polio officer, and a case investigation is begun. The programme is able to identify where the polio virus is circulating through its highly sensitive surveillance activities. AFP case-reporting sources in Somalia, 2011–2016. The objective of this study was to determine frequency of AFP and their aetiologies in District of Bannu during time period of four years from 2007 to 2011. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. They were then trained by experienced polio program staff on key strategies for polio eradication, including AFP surveillance, and assigned to work in the communities from which they were recruited. Other reporting sources during this period included regular polio program staff, which accounted for 30% of reporting in 2012, and private healthcare providers, including traditional healers, which accounted for 21% of reporting in 2012. The success of these programs in improving AFP case detection has been demonstrated in countries such as Niger and Tanzania [28, 29]. The patterns of reporting held in 2013, the first year of the polio outbreak, with public healthcare facilities again being the main reporting source for AFP cases. They again accounted for the highest proportion of AFP cases reported in 2016 when compared with other reporting sources. Systems for AFP surveillance are particularly crucial in countries like Somalia, where the dilapidated healthcare infrastructure makes for increased vulnerability to polio outbreaks despite the elimination of indigenous WPV transmission. Low or Declining Gait Speed is Associated With Risk of Developing Dementia Over 5 Years Among People Aged 85 Years and Over. The programme conducts periodic stool surveys among children from high risk populations who may be carrying the poliovirus without any signs of paralysis, or wherein circulation has been difficult to detect through regular AFP surveillance. Progress towards poliomyelitis eradication: Pakistan, January 2016–September 2017 Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2017 17 November 2017, vol. More importantly, cases are being reported faster by both VPVs and other sources, as the mean interval from paralysis onset to reporting of a case improved from 5.4 days in 2014 to 3.7 days in 2016 for VPVs and from 4.8 to 3.8 days for other sources. The proportion of AFP cases notified within 7 days dipped to 70.3%, below the recommended benchmark of ≥80%, during 2013, but steadily improved in the following years, increasing from 81.6% in 2014 to 83.3% in 2015 and 92.8% in 2016. Each of the VPVs assigned to a district works closely with the district polio officer to actively search for and report AFP cases, in addition to other polio eradication activities, such as community sensitization ahead of vaccination campaigns. Improved AFP surveillance will also serve as a key factor for certification of the country and continent as polio free when the disease is eventually eliminated from Africa. Compared with the 194 laboratory-confirmed WPV cases identified in 2013, only 5 WPV cases were identified in 2014. In the long run, such a program could help ameliorate deficiencies in the country’s healthcare system for the prevention and control of other diseases of public health significance. Building trust at the grassroots level through community-based programs is beneficial on multiple levels because programs like the VPV program often evolve to encompass other disease surveillance and prevention activities. 92, 46 (pp. Pakistan’s polio crisis represents one of the last hurdles in a 23-year campaign run by the World Health Organization. To assess the impact of inaccessibility on case detection and the performance of VPVs, we performed additional analyses for case counts, proportions, and NPAFP rates. Delving into the detail: Greater episodic detail in narratives of a critical life event predicts an increase in adolescent depressive symptoms across one year. Environmental surveillance involves testing sewage or other environmental samples for the presence of poliovirus. Although the country’s existing AFP surveillance system has mostly achieved recommended benchmarks for case detection during the past decade, subnational gaps have persisted, as evidenced by the delays in detecting some polio cases during the aforementioned outbreaks. Methodology: This is a retrospective analysis of the cases reported in 2011. From 2011 to 2012, rates of case reporting in these areas decreased from 3.2 to 2.6 cases per 100000 persons aged <15 years in 2012. Documents reviewed include program description documents outlining terms of reference for volunteers. We stratified our results by year to decipher trends in timeliness of reporting when comparing AFP cases by reporting source. Pogka V, Labropoulou S, Emmanouil M, et al. No significant differences were observed in the adequacy of samples collected from cases reported by VPVs compared with those reported by other sources, including more experienced polio program staff. However, within this comprehensive analysis, nine countries were highlighted as having child mortality rates that were decreasing at a lower-than-expected rate. When limited by accessibility status, case reporting levels and sources in areas with security and access limitations mirrored national trends during 2011–2016. Oxford University Press is a department of the University of Oxford. Given the impact of the VPV program on improving AFP surveillance indicators in Somalia, similar community-based programs could play a crucial role in enhancing surveillance activities in countries with limited healthcare infrastructure. AFP case counts rose from 148 cases in 2012, the year before program introduction, to 279 cases in 2015, when VPVs accounted for 40% of reported cases. Surveillance for wild poliovirus through reporting and laboratory testing of all cases of acute flaccid paralysis (AFP) among children under fifteen years of age. The number of cases reported each year is used as an indicator of a country's ability to detect polio, even in countries where the disease no longer occurs. Timeliness of reporting standards, pegged at ≤7 days from paralysis onset, declined steeply from 90% to 70% in 2013, mostly owing to intensified surveillance activities and late reporting of cases that were previously undetected by the surveillance system. Hagan JE, Wassilak SG, Craig AS, et al. To determine whether there were any differences in these key indicators by reporting source, we compared the adequacy of stool specimens and timeliness of reporting rates of AFP cases reported by VPVs with those reported by all other sources during 2014–2016, using χ2 tests. Intensified surveillance activities during the outbreak led to a 132% increase in the NPAFP rate in 2013. We limited our analyses to districts with security and access limitations during the period under review. Paris (AFP) - 01/02/2021 - 14:44 Bitcoin passes $30,000 for the first time. Abbreviation: AFP, acute flaccid paralysis. By determining the exact genetic makeup of the virus, wild viruses can be compared to others and classified into genetic families which cluster in defined geographical areas. Each case of AFP acts as a signal to the polio surveillance system where polio is circulating and who it is likely to affect. The aforementioned factors led to the establishment of the Village Polio Volunteers (VPV) program in September 2013. 1 Executive Summary The Pakistani government is engaged in a protracted conflict against armed militant groups within its borders and outside its borders, it is a key player in the global ‘war on terror’. Surveillance for cases of acute flaccid paralysis (AFP) is a key strategy adopted for the eradication of polio. The objectives of this study were to US Centers for Disease Control and Prevention, Atlanta, Georgia, Correspondence: C. Mbaeyi, US Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS-A04, Atlanta, GA 30333 (. Constraints due to insecurity coupled with bans on polio activities imposed by antigovernment elements have further hindered surveillance efforts in certain parts of the country. A crucial step in the investigation is the collection of 2 stool specimens from the case patients ≥24 hours apart. AFP case counts by type and nonpolio AFP (NPAF) rates in Somalia, 2011–2016. In line with improvements in case detection, NPAFP rates rose considerably during the outbreak, increasing to 6.5 and 7.4 cases per 100000 persons aged <15 years during 2013 and 2014, respectively. VPVs accounted for only 2% of reported cases in 2013, having begun their activities in September of the same year. In Pakistan, authorities have struggled to present a cohesive national strategy to control the coronavirus. Detection of poliovirus circulation is often predicated on the ability to identify AFP cases and test their stool specimens for poliovirus infection in a timely manner. WHO recommends that ≥80% of stool specimens arriving in the laboratory must be adequate. The mean duration from paralysis onset to notification was the same (4.5 days) for AFP cases reported by both VPVs and other reporting sources during 2014–2016. Five additional WPV cases were confirmed in 2014, the last of which was identified by a VPV working in Hobyo district in the Northeast zone. If the cause is poliomyelitis, this may result in permanent disability, and outcomes could sometimes be fatal [4, 5]. ES was initiated in Pakistan in 2009 at sites within Karachi and Lahore [].Sampling has since been expanded to many regions within Pakistan (Fig. AFP case counts spiked during the polio outbreak, increasing to 546 and 420 cases during 2013 and 2014, respectively. Among AFP cases reported by VPVs, the mean duration from paralysis onset to notification improved from 5.4 (95% CI, 4.84–5.97) days in 2014 to 3.7 (3.32–4.14) days in 2016 (Table 1). 701–716) In the near term, this improvement enhances the ability of the country’s polio program to detect and respond to new polio outbreaks, albeit limited by the reliance of AFP surveillance on the emergence of paralytic polio cases to determine the circulation of poliovirus in an area. In addition to poliomyelitis, AFP cases may have several other causes, including Guillain-Barré syndrome and transverse myelitis [6]. Stool samples were collected during acute flaccid paralysis (AFP) surveillance in Pakistan between October 2019 and February 2020. Surveillance for poliovirus in sewage and wastewater. Somalia has been embroiled in a protracted civil war since 1991 [16]. These traditional reporting sources accounted for the bulk of AFP cases reported from these areas over the next 2 years, with VPVs responsible for only 3% of AFP cases reported from districts with access limitations in 2013. Surveillance performance was assessed for the five 2019 priority countries in EMR (Afghanistan, Djibouti, Pakistan, Somalia, and Sudan) for 2018 and 2019 (Table 1). Please check for further notifications by email. Overall reporting trends during 2014–2016 suggested more rapid identification of AFP cases over time by both VPVs and other reporting sources. Duration from paralysis onset to notification, d, Copyright © 2021 Infectious Diseases Society of America. All authors: No reported conflicts of interest. The Global Polio Eradication Initiative (GPEI) has made tremendous gains in the last 28 years, with over 99% reduction in wild poliovirus (WPV) [1,2,3].Poliomyelitis is characterized by sudden weakness or floppy paralysis of any of the limbs, most especially in children [4,5,6,7,8].Acute flaccid paralysis (AFP) surveillance is the gold standard for poliomyelitis control and prevention. AFP Surveillance Dr. Sunil A. Tore M.B.B.S., D.P.H.,D.H.A., M.I.P.H.A. Sindh has reported 18 cases in 2010. Just as GPEI manpower resources have played a crucial role in strengthening laboratory, disease surveillance, and outbreak response capacity in many countries in Africa [29, 35–37], VPV program assets could eventually transition into broader roles aimed at surveilling and preventing other vaccine-preventable and endemic diseases, such as measles and malaria. In addition to AFP surveillance, environmental surveillance helps enhance the sensitivity of surveillance for polioviruses. Background More than 99% of poliovirus infections are non-paralytic and therefore, not detected by acute flaccid paralysis (AFP) surveillance. A substantial increment was observed in detection rate. Community-based surveillance programs, such as the VPV program, encourage a paradigm shift from passive reporting to active detection of diseases of public health significance. The country’s healthcare system has been severely weakened by political crisis, and, as a result, the delivery of immunization services lags considerably behind recommended global standards. These NPAFP rates were derived from AFP cases from which neither wild nor vaccine-derived polioviruses were isolated. Among AFP cases with known reporting sources, VPVs accounted for 40% of the 279 cases reported in 2015, a high among reporting sources. Acute Flaccid Paralysis (AFP) Surveillance of polio virus in Pakistan is a systematic collection, analysis and interpretation of data and the dissemination of information. Fifteenth meeting of the European Regional Certification Commission, Copenhagen, Weekly Poliovirus Surveillance Bulletin. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. Much of this success is predicated on the ability of countries to track and detect the emergence of new polio cases in places with active circulation of WPV based on surveillance for AFP cases. Similarly, identification and reporting of an AFP case within 7 days of paralysis onset is an indicator of the timeliness of the surveillance system; hence, countries are required to identify and report ≥80% of AFP cases within 7 days of paralysis onset in order to meet the benchmark for timeliness [7]. AFP manifests clinically as a syndrome characterized by sudden onset of weakness or paralysis affecting a limb or limbs. Moturi EK, Porter KA, Wassilak SG, et al. Cameroun WORLD - WILD POLIO VIRUS CASES - 2010 577 CASES IN 15 COUNTRIES Pakistan Afghanistan Countries Wild cases 2010 India 25 Afghanistan 12 Angola 16 Pakistan 31 Tajikistan 437 … This project was funded and supported by the US Centers for Disease Control and Prevention. From 2018 to 2019, the number of WPV1 cases increased from 21 to 29 in Afghanistan (38% increase) and from 12 to 147 in Pakistan (1,125% increase). Despite an expansion in the number of reporting sites by the national polio program, VPVs have accounted for the majority of AFP cases detected in Somalia over the past 3 years, that is, from 2014 to 2016. In many areas, particularly those with access limitations, VPVs are actively involved in investigating the case with guidance from the district polio officer. •New countries have initial funding for pilots: Pakistan, India, China •Most countries with AFP surveillance do detect iVDPVsin paralyzed children as part of AFP or other surveillance on their own •Priority countries are being identified in each WHO region to roll-out systematicsurveillance utilizing these guidelines focusing on PID The VPV program has contributed significantly to improved surveillance for AFP cases in Somalia. The detection of PV in some countries (e.g., Afghanistan, Nigeria, Pakistan, and Somalia) that is highly diverged from previously identified PV isolates indicates that WPV or VDPV transmission remained undetected by AFP surveillance even when AFP performance indicators were met at the state/provincial level . Any child under 15 years of age with AFP* or any person of any age with paralytic illness if polio is suspected AFP case-reporting in areas in Somalia with access limitations, 2011–2016. This effect is even more pronounced when we limited our analysis to districts with security and access limitations, where VPVs have accounted for more than half of the AFP cases identified during 2015–2016. These activities includes testing stool samples of children suffering from acute flaccid paralysis (the clearest symptom the virus) and testing samples taken from sewage water across the country. Abbreviations: AFP, acute flaccid paralysis; WPV, wild poliovirus. However, despite the recession and eventual cessation of the outbreak in 2014, the NPAFP rate rose from levels in 2013, largely owing to the contributions of the newly introduced VPV program. To determine the contributions of VPVs to AFP case detection, we calculated overall case counts and proportions during 2011–2016, categorized by reporting source. Your comment will be reviewed and published at the journal's discretion. There are currently 60 sampling sites for environmental detection in 40 towns and districts of the country. All AFP cases should have a full clinical and virological investigation with at least 80% of AFP cases having ‘adequate’ stool specimens collected. We computed the mean number days from paralysis onset to case reporting and 95% confidence intervals (CIs). This is why a country like Somalia, with a recent history of polio outbreaks, has been prioritized by GPEI for AFP surveillance strengthening. This article focuses on the contributions of VPVs to strengthening poliovirus surveillance in Somalia by assessing the impact of their activities on key AFP surveillance indicators. Dr Hamzullah khan, Dr Sarfaraz Khan Afridi, Dr Obaid ul Islam, World Health Organization Pakistan. The Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19: Molecular Diagnostic Testing, A 40-Year-Old Man With Persistent Febrile Neutropenia and Subsequent Rash, Management of Severe and Severe/Complicated, Norovirus and Other Viral Causes of Medically Attended Acute Gastroenteritis Across the Age Spectrum: Results from the MAAGE Study in the United States, About the Infectious Diseases Society of America, http://polioeradication.org/wp-content/uploads/2016/07/PEESP_EN_A4.pdf, http://www.euro.who.int/__data/assets/pdf_file/0003/79374/E88105.pdf, http://polioeradication.org/wp-content/uploads/2016/07/9.5_13IMB.pdf, Receive exclusive offers and updates from Oxford Academic, Lessons from Diagnostic Investigations of Patients with Poliomyelitis and Their Direct Contacts for the Present Surveillance of Acute Flaccid Paralysis, Lab Protocol Paper: Use of a High-throughput, Multiplex Reverse-transcription Quantitative Polymerase Chain Reaction Assay for Detection of Sabin Oral Polio Vaccine in Fecal Samples, Predictors of Virologically Confirmed Poliomyelitis in India, 1998–2000, Polio, AIDS, and Ebola: A Recurrent Ethical Dilemma. Introduction: Polio has been eliminated from all countries except four, including Pakistan, where polio is still endemic. The establishment of the VPV program to supplement existing structures in place for AFP surveillance has proved to be of vital importance in enhancing the country’s capacity to mount an effective response to outbreaks and maintain its polio-free status. Despite these challenges, the country successfully interrupted indigenous transmission of wild poliovirus (WPV) in 2002 [17]. This work is written by (a) US Government employee(s) and is in the public domain in the US. 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