Abstract
BackgroundThe poliovirus has been targeted for eradication since 1988. Kenya reported its last case of indigenous Wild Poliovirus (WPV) in 1984 but suffered from an outbreak of circulating Vaccine-derived Poliovirus type 2 (cVDPV2) in 2018. We aimed to describe Kenya’s polio surveillance performance 2016–2018 using WHO recommended polio surveillance standards.MethodsRetrospective secondary data analysis was conducted using Kenyan AFP surveillance case-based database from 2016 to 2018. Analyses were carried out using Epi-Info statistical software (version 7) and mapping was done using Quantum Geographic Information System (GIS) (version 3.4.1).ResultsKenya reported 1706 cases of AFP from 2016 to 2018. None of the cases were confirmed as poliomyelitis. However, 23 (1.35%) were classified as polio compatible. Children under 5 years accounted for 1085 (63.6%) cases, 937 (55.0%) cases were boys, and 1503 (88.1%) cases had received three or more doses of Oral Polio Vaccine (OPV). AFP detection rate substantially increased over the years; however, the prolonged health workers strike in 2017 negatively affected key surveillance activities. The mean Non-Polio (NP-AFP) rate during the study period was 2.87/ 100,000 children under 15 years, and two adequate specimens were collected for 1512 (88.6%) AFP cases. Cumulatively, 31 (66.0%) counties surpassed target for both WHO recommended AFP quality indicators.ConclusionsThe performance of Kenya’s AFP surveillance system surpassed the minimum WHO recommended targets for both non-polio AFP rate and stool adequacy during the period studied. In order to strengthen the country’s polio free status, health worker’s awareness on AFP surveillance and active case search should be strengthened in least performing counties to improve case detection. Similar analyses should be done at the sub-county level to uncover underperformance that might have been hidden by county level analysis.
Highlights
The poliovirus has been targeted for eradication since 1988
None of the detected cases was classified as poliomyelitis, but the National Polio Expert Committee (NPEC) classified 23 (1.35%) Acute Flaccid Paralysis (AFP) cases as polio compatible according to the World health Organization (WHO) virological classification flowchart [28] (Fig. 2)
This highlights that there is a potential for Poliovirus importation in Kenya especially from polio outbreak neighboring countries thereby justifying the need for strengthening AFP surveillance [7, 30]
Summary
The poliovirus has been targeted for eradication since 1988. There are three serotypes of the Wild Poliovirus (WPV); type 1, 2 and 3 – types 2 and 3 have been eradicated. The Poliovirus is transmitted from person to person primarily through contaminated fecal matter entering the oral route [1, 3]. It can be transmitted in rare cases through saliva [3, 4]. Human beings are the only known reservoir for the poliovirus [5]. The Poliovirus replicates in the intestine of its human host and spreads to the central nervous system [3, 6]
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