Potential for the Australian and New Zealand paediatric intensive care registry to enhance acute flaccid paralysis surveillance in Australia: a data-linkage study

Linda K Hobday,Janet Alexander,Bruce R Thorley,Michelle Cretikos,Peter D Massey,David N Durrheim,Thomas Aitken,Anthony Slater

doi:10.1186/1471-2334-13-384

Abstract

BackgroundAustralia uses acute flaccid paralysis (AFP) surveillance to monitor its polio-free status. The World Health Organization criterion for a sensitive AFP surveillance system is the annual detection of at least one non-polio AFP case per 100,000 children aged less than 15 years, a target Australia has not consistently achieved. Children exhibiting AFP are likely to be hospitalised and may be admitted to an intensive care unit. This provides a potential opportunity for active AFP surveillance.MethodsA data-linkage study for the period from 1 January 2005 to 31 December 2008 compared 165 non-polio AFP cases classified by the Polio Expert Panel with 880 acute neurological presentations potentially compatible with AFP documented in the Australian and New Zealand Paediatric Intensive Care (ANZPIC) Registry.ResultsForty-two (25%) AFP cases classified by the Polio Expert Panel were matched to case records in the ANZPIC Registry. Of these, nineteen (45%) cases were classified as Guillain-Barré syndrome on both registries. Ten additional Guillain-Barré syndrome cases recorded in the ANZPIC Registry were not notified to the national AFP surveillance system.ConclusionsThe identification of a further ten AFP cases supports inclusion of intensive care units in national AFP surveillance, particularly specialist paediatric intensive care units, to identify AFP cases that may not otherwise be reported to the national surveillance system.

Highlights

Australia uses acute flaccid paralysis (AFP) surveillance to monitor its polio-free status
This study investigated whether AFP cases were likely to be admitted to an intensive care unit (ICU) or paediatric intensive care units (PICUs) and whether there were cases recorded in the ANZPIC Registry that had not been notified to the national AFP surveillance system
Use of the data linkage methods we describe to periodically audit reporting and stool collection rates for AFP cases admitted to specialist PICUs may serve to maintain awareness and thereby improve Australia’s performance in meeting the WHO surveillance targets

Summary

Introduction

Australia uses acute flaccid paralysis (AFP) surveillance to monitor its polio-free status. The World Health Organization criterion for a sensitive AFP surveillance system is the annual detection of at least one nonpolio AFP case per 100,000 children aged less than 15 years, a target Australia has not consistently achieved. Children exhibiting AFP are likely to be hospitalised and may be admitted to an intensive care unit. This provides a potential opportunity for active AFP surveillance. To maintain WHO certification as polio-free, Australia is expected to: 1) detect at least one case of non-polio AFP for every 100,000 children less than 15 years of age annually; 2) collect two faecal specimens greater than 24 hours apart and within 14 days of the onset of paralysis, from at least 80% of AFP cases; and. It is imperative to exclude poliovirus as the causative agent of the paralysis

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Conclusion