Non-polio Acute Flaccid Paralysis Research Articles

Comment on Dhiman, R. et al. Correlation of Non-Polio Acute Flaccid Paralysis Rate with Pulse Polio Frequency in India. Int. J. Environ. Res. Public Health 2018, 15, 1755.

The authors of the published article 'Correlation between Non-Polio Acute Flaccid Paralysis Rates with Pulse Polio Frequency in India' [...].

Profile of polio-compatible cases in Nigeria, 2006\u20132016

BackgroundThe tremendous progress made by Nigeria towards polio eradication has recently suffered a setback with the isolation of circulating vaccine-derived poliovirus (cVDPV) type 2 from environmental samples and confirmation of four wild poliovirus (WPV) cases from acute flaccid paralysis (AFP) cases, with dates of onset of paralysis in July and August 2016. All these viruses were confirmed from the security-challenged northeastern state of Borno. Polio-compatible cases exist in Nigeria, and they indicate surveillance failure. Surveillance, therefore, has to be strengthened for the country to achieve certification. The objective of this paper is to highlight the epidemiological profile and magnitude of polio-compatible cases in Nigeria during the reporting period, as well as immunization and surveillance response activities conducted to close immunity and surveillance gaps.MethodsWe conducted a retrospective review of AFP surveillance performance and polio-compatible cases in Nigeria between 2006 and 2016 from the AFP database at the World Health Organization Country Office. We also reviewed and compared key epidemiological features of polio-compatible cases with those of wild poliovirus cases during the reporting period.ResultsThe non-polio AFP rate improved from 6.5 in 2006 to 19.5 in 2016. The corresponding figures for stool adequacy rates were 88 and 98%. The total number of polio-compatible cases reported during the reporting period was 888, with the highest number (194) of cases reported in 2006 and the least (24) in 2016. Clusters of polio-compatible cases were reported every year during the reporting period except in 2015. The highest number (65) of polio-compatible cases in clusters was reported in 2006. The key epidemiological features of polio-compatible and wild poliovirus cases were similar.ConclusionAFP surveillance performance has improved significantly during the reporting period. Surveillance gaps still existed as shown by the presence of orphan viruses and polio-compatible cases, and these gaps need to be identified and closed to achieve certification.

Acute flaccid paralysis (AFP) surveillance intensification for polio certification in Kaduna state, Nigeria: lessons learnt, 2015\u20132016

BackgroundNigeria has made remarkable progress in its current efforts to interrupt wild poliovirus transmission despite the re-emergence of wild poliovirus in 2016. The gains made in Nigeria have been achieved through concerted efforts by governments at all levels, traditional leaders, health workers, caregivers, and development partners. The efforts have involved an elaborate plan, coordination, and effective implementation of routine immunization services, supplemental immunization activities, and acute flaccid paralysis (AFP) surveillance.MethodsWe conducted the following activities to strengthen AFP surveillance in Kaduna state: a monetary reward for all AFP cases reported by health workers or community informants and verified as “true” AFP by a World Health Organization (WHO) cluster coordinator; training and sensitization of surveillance officers, clinicians, and community informants; recruitment of more personnel and expansion of the surveillance network; and the involvement of special populations (nomadic, hard-to-reach, and border communities) and caregivers in stool sample collection. The paired t test was used to evaluate the impact of the different initiatives implemented in Kaduna state to intensify AFP surveillance in 2016.ResultsThere was increased annualized non-polio AFP rate (ANPAFPR) in 21 out of 23 Local Government Areas (LGAs) of Kaduna state 6 months after implementation of different initiatives to intensify AFP surveillance. The AFP reported by the special population increased in 15 out of 23 LGAs. Statistical analyses of mean scores of ANPAFPR before and after the interventions using the paired t test revealed a significant difference in mean scores: mean = 19.7 (standard deviation (SD) = 16.1) per 100,000 < 15 years old in July–December 2015, compared with 38.0 (SD = 21.6) per 100,000 < 15 years old in January–June 2016 (p < 0.05). Likewise, analysis of silent wards using the paired t test showed a significant difference in mean scores: mean = 4.0 (SD = 2.1) in July–December 2015 compared with 2.4 (SD = 1.8) in January–June 2016 (p < 0.05).ConclusionThe different initiatives implemented in 23 LGAs of Kaduna state to intensify AFP surveillance may be responsible for the significant improvement in the AFP surveillance performance indicators in 2016.

Stopping circulatory vaccine-derived poliovirus in Kaduna state by scaling up special interventions in local government areas along rivers of interest- kamacha basin experience, 2013\u20132015

BackgroundThe Kamacha river is one of the five polio environmental surveillance sites in Kaduna State where 13 circulating vaccine-derived polioviruses (cVDPDs) were isolated between 2014 and 2015. Kamacha river accounted for 5 of all reported cVDPVs in Kaduna State between 2014 and 2015. Poor quality Supplemental Immunization Activities (SIAs) and low population immunity have been reported in the 10 LGAs with tributaries that flow into the river. We described the processes of implementing the various health interventions in these targeted LGAs along the Kamacha River and assessed the effectiveness of the interventions in stopping cVDPV in Kaduna, state, Nigeria.MethodsSpecial interventions that had been proven to be functional and effective in reaching unreached children with potent vaccines in the state were scaled up in these targeted 10 LGAs along the Kamacha River. These interventions included revision of house based microplans, scaling up of transit vaccination, scaling up of youth engagement, intensified supportive supervision, scaling up of Directly Observed Polio Vaccination (DOPV) and in-between rounds vaccination activities. We analyzed immunization plus days (IPDs) administrative tally sheet and monitoring data from 10 rounds before and 10 rounds after the special interventions.ResultsThe number of children immunized increased from 1,862,958 in December 2014 before the intervention to 1,922,940 in March 2016 after the intervention.Lot Quality Assurance Sampling (LQAS) results showed an increase in the proportion of LGAs accepted at coverage > 90% after the interventions, from 67% before intervention to 84% after intervention. The proportion of non-polio AFP children with > 4 doses of oral polio vaccine increased from 2 to 8% before to 93–98% after the interventions.. No new environmental cVDPV has been isolated since the introduction of the interventions in April 2015 until July 2016.ConclusionScaling up known working interventions in the 10 LGAs with tributaries that drain to Kamacha River environmental sample site may have contributed to improved immunity and interruption of cVDPV in Kaduna state. These interventions should be replicated in LGAs and states with persistent poliovirus isolation.

Strengthening the Acute Flaccid Paralysis (AFP) Surveillance Component of the Polio Eradication Initiative through Short Message Service (SMS) Reminders; Experience from Sokoto State, Nigeria 2014

Eradication of poliomyelitis remains a public health priority due to the paralytic effects of the virus on children and impact on global health system. However, existing gaps in surveillance can hinder eradication. Improved timeliness of identification and reporting of acute flaccid paralysis (AFP) cases with further confirmation of Wild Poliovirus (WPV) in stool samples, can help Nigeria achieve the performance indicators of non-polio AFP rate of ≥ 2/100,000 population aged < 15 years and ≥80% stool sample collection adequacy. To ascertain the awareness of AFP case definition and detection by health care workers and to evaluate the impact of SMS-based reporting on the AFP surveillance system the study was conducted from November 2013 to July 2014. In Sokoto state, 112 health facilities (focal sites) were operational and participated in this study. All AFP focal points for the 112 facilities were included in the study. In addition to AFP focal points, two clinicians per facility where possible, were included in the study. The study focused exclusively on reports from focal sites. The methodology was a one group pretest-posttest design conducted in 3 phases. 1) Pre-intervention Knowledge, Attitude and Practices (KAP) survey, 2) SMS implementation and 3) Post-intervention KAP. Results were analysed using the independent sample t-test to assess the increase in knowledge, attitudes, or practice scores pre- and post- training. The study showed improved knowledge gap of health care workers on AFP surveillance between pre and post intervention. It shows that this approach of improved surveillance will be effective in countries in hard to reach, access compromised or countries/place without sufficient surveillance staff.

Correlation between Non-Polio Acute Flaccid Paralysis Rates with Pulse Polio Frequency in India.

The last case of polio from India was reported in 2011. That year, the non-polio acute flaccid paralysis (NPAFP) rate in India was 13.35/100,000, where the expected rate is 1–2/100,000. A previous study of data from 2000 to 2010 has detailed the NPAFP rate in a state correlated with the pulse polio rounds conducted there, and the strongest correlation with the NPAFP rate was found when the number of doses from the previous 4 years were used. However, a simple association being found with regression analysis does not prove a causal relationship. After publication of those findings, as the threat of polio had lessened, the number of rounds of OPV administration was brought down. The present study has been done to look at data till the end of 2017, to see if the incidence of NPAFP declined with this reduction in polio immunization rounds. We used polio surveillance data acquired by the Government of India from 2000–2017. Correlation of the NAFP rate to the number of polio rounds in the state was examined, and the cumulative effect of polio doses administered in previous years was sought. NPAFP rate correlated with the OPV pulse polio rounds in that year (R = 0.46; p < 0.001), and the NPAFP rate started to decrease from 2012 when the number of pulse polio rounds had decreased. NPAFP rates in the states of Uttar Pradesh (UP) and Bihar were the highest in the country. Looking at the high-NPAFP states of UP and Bihar, we found that the correlation coefficient was strongest when doses used over 5 years was considered (R = 0.76; p < 0.001). The response to the reduction in OPV rounds (de-challenging) adds credence to the assumption that OPV was responsible for the change in the NPAFP rate. Now that India has been polio-free for over 6 years, we propose that we may be able to reduce NPAFP by further reducing pulse polio rounds.

In-Country Acute Flaccid Paralysis Surveillance Review, Nasarawa State, Nigeria, 2017

Objective: In August, 2017, we conducted a peer review evaluation of the reported high stool adequacy and Non-polio Acute Flaccid Paralysis (AFP) rates of the World Health Organisation (WHO) verified AFP cases, in order to estimate and establish concordance for both surveillance core indicators in Lafia and Nasarawa Egon LGAs in Nasarawa State.Introduction: Nigeria is the only polio endemic country in Africa. Four (4) WPV1 cases were confirmed in 2013 after two years of silence. Nigeria has a strong polio programme characterized by innovative and forward driven strategies, despite several challenges of which surveillance is one of the driving forces. Near perfect surveillance core indicators reported over the past twelve (12) months across certain states and Local Government Areas (LGAs) were issues of concern, given security challenges among others. In August, 2017, we conducted a peer review evaluation of the reported high stool adequacy and Non-polio Acute Flaccid Paralysis (AFP) rates of the World Health Organisation (WHO) verified AFP cases, in order to estimate and establish concordance for both surveillance core indicators in Lafia and Nasarawa Egon LGAs in Nasarawa State.Methods: The LGAs to be visited and AFP cases reported within ninety (90) days and verified to be true and adequate prior to peer review were selected. Any person with strong surveillance knowledge and skill, working in Nigeria with the government or partner agencies and involved in surveillance was identified as a peer reviewer, trained and deployed to the LGAs. Reviewers were not deployed to their geo-political zones where they work under routine conditions. Data was collected by visiting the residence of the respective AFP cases and eliciting responses, using a structured interviewer -administered peer review checklist. Data was collated, analysed using Microsoft Excel 2010 and interpreted accordingly. The causes of incoherence were identified and presented to the LGA Disease Surveillance and Notification Officers (DSNOs) and State authority. An improvement plan which would be monitored and evaluated was elaborated. The AFP surveillance data base for discordant AFP cases was updated with the data generated from the peer review.Results: Of the nineteen (19) AFP cases reviewed, 63.2% (12/19) were females. The mean Age of the total AFP case patients was 3 years (SD 3.4). In Lafia LGA, eight (8) AFP cases were verified and all were true AFP cases and adequate. In Nasarawa Egon LGA, eleven (11) cases were verified, 54.5% (6/11) were true AFP cases and 90.9% (10/11) were found to be adequate. The major causes of the gaps identified include mothers/caregivers dividing collected stool specimen sample to make for two (2) stool samples meant to be collected 24 hours apart for case investigation. This was due to failure on the part of the LGA DSNOs to either inform the mothers/caregivers or underscore the importance of appropriate stool collection. The inability of the surveillance focal officers to adequately identify/differentiate other disease conditions that mimic AFP and persistence of residual paralysis (in Non-polio AFP cases) in 5 (45.5%) cases were also identified in Nasarawa Egon LGA. This was as a result of the lack of referral to the next level for physiotherapy care.Conclusions: In Nasarawa Egon LGA, they were discordances in the reported AFP performance core indicators. They include inadequate stool sample, wrong classification of AFP cases and persistence of residual paralysis in Non-polio AFP cases. We therefore, recommend that the WHO State team should re-orient the LGA DSNOs on proper stool specimen collection for case investigation. Also, the LGA DSNOs should sensitize parents/caregivers on appropriate protocol of stool specimen collection and advise them on referral to the next level of care.

Strengthening Acute Flaccid Paralysis Surveillance Through the Village Polio Volunteers Program in Somalia.

Surveillance for cases of acute flaccid paralysis (AFP) is a key strategy adopted for the eradication of polio. 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. The Village Polio Volunteers (VPV) program was established in 2013 in a bid to strengthen polio eradication activities in Somalia, including AFP surveillance, given the country's vulnerability to polio outbreaks. To assess the impact of the VPV program on AFP surveillance, we determined case counts, case-reporting sources, and nonpolio AFP rates in the years before and after program introduction (ie, 2011-2016). We also compared the stool specimen adequacy rates and timeliness of cases reported by VPVs to those reported by other sources. In the years after program introduction, VPVs accounted for a high proportion of AFP cases reported in Somalia. 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. Further, from 2012 to 2015, the nonpolio AFP rate improved from 2.8 to 4.8 cases per 100000 persons aged <15 years. Stool specimen adequacy rates have been consistently high, and AFP cases have been detected in a timelier manner since the program was introduced. 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.

Iterative Excretion of Human Cosaviruses from Different Genotypes Associated with Combined Immunodeficiency Disorder

Background: Human cosaviruses (HCoSVs) are newly discovered enteric viruses in the Picornaviridae family. They have been described in non-polio acute flaccid paralysis, diarrheal patients, and healthy individuals. They remain rarely documented in immunodeficient patients. Objectives: This study reports iterative excretion of HCoSVs in a patient with major histocompatibility complex (MHC) class II combined immunodeficiency, a relatively common primary immunodeficiency in consanguineous settings. Methods: A total of 35 samples were collected from a patient followed for oral polio vaccine strains detection in stool samples during a 57-month period. Detection of HCoSVs in stools was performed by nested RT-PCR in the 5′ noncoding region. The genotype identification and screening for recombinant strains was performed by sequencing in the VP1 and 3D genomic regions followed by phylogenetic analysis. Results: The patient was infected with HCoSVs twice at a 3-year interval. The excreted viruses belonged to 2 different genotypes with 2 probable recombinant viruses. During HCoSV infections, the patient was also excreting Sabin-related polioviruses. Conclusions: This study describes excretion kinetics and genetic characteristics of HCoSVs in a patient with combined immunodeficiency due to MHC class II expression defect. The patient did not have concomitant symptoms related to the HCoSV infection.

Evaluation of acute flaccid paralysis surveillance system in Ekiti State, Nigeria, 2016

Introduction : poliomyelitis has been targeted for eradication and only three countries in the world, including Nigeria, still report cases. Highly sensitive surveillance for acute flaccid paralysis (AFP) is critical for the detection and eradication of Wild Polio virus (WPV). This study aimed to assess the capacity of the Ekiti State AFP surveillance system to promptly detect transmission of WPV. Methods : the Disease Surveillance and Notification officers (DSNOs) for the 16 Local Government Areas of Ekiti state were interviewed using a key informant interview guide. Case investigation (CIF) and AFP Surveillance System Weekly Health Facility Report forms for 2016 were reviewed using the CDC updated guidelines for evaluation of surveillance systems and the World Health Organization’s (WHO) guideline for evaluation of AFP surveillance system. Results : there were 326 reported cases of AFP but CIF were seen for only 248 (76.1%) cases. All stool samples were collected within 14 days of onset of paralysis, and 24 - 48 hours apart. All samples arrived at the WHO-accredited Polio laboratory in Ibadan within 72 hours of collection. Stool adequacy was 99.2%. Five (2.0%) samples were positive for Vaccine-derived Poliovirus. The Non-Polio Enterovirus isolation rate, a measure of the efficiency of the reverse cold chain was 8% (less than >10% target). Non-Polio Acute Flaccid Paralysis rate was 20.8/100,000. There was no isolation of WPV. All 16 DSNOs found the case definition for AFP simple to understand and the reporting system acceptable. Lack of transport was a difficulty faced by 10 (66.7%) of them. The system was solely funded by the WHO. Conclusion : Ekiti State AFP surveillance system in the year 2016 was sensitive, representative, acceptable and timely and the laboratory component performed well. However, the data quality was poor and the reverse cold chain was deficient. There is need to increase state and local governments’ financial commitment to the functioning of the system.

Distribution Pattern of the Non Polio Enterovirus (NPEV) Rate in Children with Acute Flaccid Paralysis Reported to the Surveillance System in Nigeria 2010-2015

Objective: This study focuses on the reverse cold chain system of stool sample management from cases reported to the AFP surveillance system between 2010 and 2015. Through the distribution of their NPEV isolation rates, we identify lapses in the reverse cold chain management and provide recommendations that should help improve the reverse cold chain system and the AFP surveillance system in general as Nigeria once again matches towards a polio free certification. Methods: A descriptive retrospective study was conducted using AFP surveillance data routinely collected between January 2010 and December 2015 by the Disease Surveillance and Notification Officers (DSNOs) in Nigeria and the WHO accredited Polio Laboratories. All AFP cases reported to the Disease Surveillance network during this period from all the states were included in the study. EPIINFO—veritable customized software was used to run queries on the access database and obtain the specific data sets required. Results: A total of 52,879 AFP cases were reported from 2010-2015, in which 7288 non-polio enteroviruses were isolated. NPEV isolation rate ranged from 10.8% in the southeast to 20.3% in the northeast with the states in the northern geopolitical zones having higher NPEV rates in comparison to the states in the southern geopolitical zones. The WHO Polio laboratory in Ibadan serves twenty-seven states in the country; the average non-polio AFP rate among states served by this laboratory is 11.7% from a total of 4012 AFP cases recorded. The WHO Polio laboratory in Maiduguri recorded 3276 with an average non-polio AFP rate of 19.2%. Conclusion: Though the country’s NPEV isolation rate remain slightly higher above the 10% recommended by WHO, steps should be taken to enhance the reverse cold-chain system particularly in the southern states. This would increase confidence in the AFP surveillance system in Nigeria as she proceeds once again towards complete polio eradication and meeting certification standards.

Vaccine-derived poliovirus surveillance in China during 2001\u20132013: the potential challenge for maintaining polio free status

BackgroundThe goal of polio eradication is to complete elimination and containment of all wild, vaccine-related and Sabin polioviruses. Vaccine-derived poliovirus (VDPV) surveillance in China from 2001–2013 is summarized in this report, which has important implications for the global polio eradication initiative.MethodsAcute flaccid paralysis (AFP) cases and their contacts with VDPVs isolated from fecal specimens were identified in our AFP surveillance system or by field investigation. Epidemiological and laboratory information for these children were analyzed and the reasons for the VDPV outbreak was explored.ResultsVDPVs were isolated from a total of 49 children in more than two-thirds of Chinese provinces from 2001–2013, including 15 VDPV cases, 15 non-polio AFP cases and 19 contacts of AFP cases or healthy subjects. A total of 3 circulating VDPVs (cVDPVs) outbreaks were reported in China, resulting in 6 cVDPVs cases who had not been vaccinated with oral attenuated poliomyelitis vaccine. Among the 4 immunodeficiency-associated VDPVs (iVDPVs) cases, the longest duration of virus excretion was about 20 months. In addition, one imported VDPV case from Myanmar was detected in Yunnan Province.ConclusionsUntil all wild, vaccine-related and Sabin polioviruses are eradicated in the world, high quality routine immunization and sensitive AFP surveillance should be maintained, focusing efforts on underserved populations in high risk areas.

Characterization of group B coxsackieviruses isolated from non-polio acute flaccid paralysis patients in Pakistan: vital assessment before polio eradication.

Pakistan is at the verge of polio eradication but isolation of non-polio enteroviruses (NPEVs) from acute flaccid paralysis (AFP) cases may result in serious or even fatal outcome. Many enteroviruses share similar symptoms and epidemiology as is the case with poliovirus and coxsackievirus (CV). The present study was designed to genetically characterize coxsackievirus B (CV-B) serotypes isolated from non-polio acute flaccid paralytic children, as well as to understand their probable role in paralysis. A total of 63 (20·1%) out of 313 stool samples during 2013 were found positive for NPEVs in rhabdomyosarcoma cells. Only 24 (38·0%) NPEVs were typed as CV-B by microneutralization assay and were further characterized by sequencing of the viral protein 1 (VP1) gene. Molecular phylogenetic analyses classified the study strains into six coxsackievirus B serotypes (coxsackievirus B1 to B6) with their respective prototype strains with evidence of epidemiological linkage and distinct clusters. Moreover, four major differences were found within the amino acid sequences of BC-loop in VP1 of CV-B strains. In conclusion, this study presented the molecular evolutionary genetic overview and distinct phylogenetic pattern of CV-B isolates from AFP cases in Pakistan, and explored the possible link between CV-B infections and AFP cases. Furthermore, our data reveal that these viruses might contribute to the incidence of paralysis in population and there is need of time to establish an enterovirus surveillance system for better understanding of epidemiological and virological characteristics of NPEV infections associated with AFP cases in the country.

Identification and molecular characterization of non-polio enteroviruses from children with acute flaccid paralysis in West Africa, 2013\u20132014

Besides polioviruses, non-polio enteroviruses (NPEVs) may also be associated with acute flaccid paralysis (AFP). Because poliomyelitis is on the verge of eradication, more attention should be paid to study NPEVs from non-polio AFP cases and their epidemic patterns. In West African countries the epidemiology of NPEVs remains largely unexplored. We investigated the genetic diversity, frequency, circulation patterns, and molecular epidemiology of NPEVs in seven West African countries by analyzing retrospectively a panel of 3195 stool samples from children with AFP collected through routine poliomyelitis surveillance activities between 2013 and 2014. VP1 sequencing and typing on 201 isolates revealed 39 NPEV types corresponding to EV-A (6.9%), EV-B (90.5%), EV-C (2%) and EV-D (0.5%) species. Echoviruses were isolated most frequently with 138 cases (68.6%), followed by coxsackievirus group B with 35 cases (17.4%). No single NPEV type was remarkably dominant. Interestingly, several rarely described types with limited detection worldwide were identified (EVA76, EVA119, EVB75, EVB77, EVB97, EVC99, CVA20, CVA21 and EVD94). This study demonstrates the extensive diversity and diverse circulation patterns of NPEVs from AFP surveillance and highlights the need to formulate effective long-term strategies to monitor NPEV circulations in West Africa.

Risk factors and short-term projections for serotype-1 poliomyelitis incidence in Pakistan: A spatiotemporal analysis.

BackgroundPakistan currently provides a substantial challenge to global polio eradication, having contributed to 73% of reported poliomyelitis in 2015 and 54% in 2016. A better understanding of the risk factors and movement patterns that contribute to poliovirus transmission across Pakistan would support evidence-based planning for mass vaccination campaigns.Methods and findingsWe fit mixed-effects logistic regression models to routine surveillance data recording the presence of poliomyelitis associated with wild-type 1 poliovirus in districts of Pakistan over 6-month intervals between 2010 to 2016. To accurately capture the force of infection (FOI) between districts, we compared 6 models of population movement (adjacency, gravity, radiation, radiation based on population density, radiation based on travel times, and mobile-phone based). We used the best-fitting model (based on the Akaike Information Criterion [AIC]) to produce 6-month forecasts of poliomyelitis incidence. The odds of observing poliomyelitis decreased with improved routine or supplementary (campaign) immunisation coverage (multivariable odds ratio [OR] = 0.75, 95% confidence interval [CI] 0.67–0.84; and OR = 0.75, 95% CI 0.66–0.85, respectively, for each 10% increase in coverage) and increased with a higher rate of reporting non-polio acute flaccid paralysis (AFP) (OR = 1.13, 95% CI 1.02–1.26 for a 1-unit increase in non-polio AFP per 100,000 persons aged <15 years). Estimated movement of poliovirus-infected individuals was associated with the incidence of poliomyelitis, with the radiation model of movement providing the best fit to the data. Six-month forecasts of poliomyelitis incidence by district for 2013–2016 showed good predictive ability (area under the curve range: 0.76–0.98). However, although the best-fitting movement model (radiation) was a significant determinant of poliomyelitis incidence, it did not improve the predictive ability of the multivariable model. Overall, in Pakistan the risk of polio cases was predicted to reduce between July–December 2016 and January–June 2017. The accuracy of the model may be limited by the small number of AFP cases in some districts.ConclusionsSpatiotemporal variation in immunization performance and population movement patterns are important determinants of historical poliomyelitis incidence in Pakistan; however, movement dynamics were less influential in predicting future cases, at a time when the polio map is shrinking. Results from the regression models we present are being used to help plan vaccination campaigns and transit vaccination strategies in Pakistan.

Adequacy of Acute Flaccid Paralysis (AFP) Surveillance Indicators for Iran in 2016

Eradication of polio as a largest public health innovation is led by the World Health Organization (WHO) in the world (1). The main strategies to reach this goal included improved routine immunization, adequate response to outbreaks and effective surveillance (2). Acute Flaccid Paralysis (AFP) surveillance has considered as a comprehensive program for polio eradication, by identification of areas of poliovirus transmission as well as cases of importation. Polio-free certification should be confirmed through surveillance (3). AFP surveillance has some indicators, where used to determine sufficient sensitivity of surveillance to detect poliovirus transmission in communities (4). Table.1 shows two cores of AFP surveillance performance indicators including non-polio AFP and stool adequacy rates for Iran in 2016 (5). In the year of 2016 recorded the 776 AFP cases (Non polio AFP rate: 4.2 per 100,000

Acute Flaccid Paralysis Surveillance system Evaluation, Oyo state, Nigeria; 2008-2014

ObjectiveWe evaluated the AFP surveillance system in Oyo State to assessits attributes and determine if it was meeting its set objectives.IntroductionIn September, 2015, Nigeria was delisted from the list of polioendemic countries globally. To be certified polio free, the countrymust attain and maintain certification standard Acute Flaccid Paralysis(AFP) surveillance for additional two-years. In Oyo State, no case ofWild Polio Virus (WPV) has been reported since February, 2009.MethodsWe used the Centre for Disease Control and Prevention updatedguidelines for evaluating public health surveillance system.We conducted a retrospective review of AFP surveillance databetween 1stJanuary, 2008 and 31stDecember, 2014. We conductedin-depth interviews with identified stakeholders. Semi-structuredquestionnaires were administered to Disease Surveillance andNotification Officers (DSNOs) and AFP focal persons. Univariateanalysis was performed by calculating frequencies, means andproportions using Microsoft Excel 2010.ResultsThe case definition of AFP and the tools for reporting are simple.Of the 897 AFP cases detected during the period under review(2008-2014), 20 (2.2%) were laboratory confirmed WPV. Thesensitivity of the system between 2008 and 2014 measured by theAnnualized Non-Polio AFP (NPAFP) rate was consistently abovethe target. of≥2/100,000 population(Mean=3.96, Standard deviation(SD): 0.48). The mean NPAFP rate for underperforming LGAs duringthe review period was 1.6, SD: 0.31. The mean Stool adequacy andTimeliness were 91.43% (SD: 18.3) and 91.3% (SD: 20.3) abovethe target of≥80% respectively. The mean Data quality was 90%(target is≥90; SD: 3.8). Positive Predictive Value (PVP) was 2%(2008 -2009), and 0% in 2010-2014.ConclusionsThe Oyo State AFP surveillance system is simple, flexible,sensitive and meeting its set objectives. However, PVP was low andthe system’s operating conditions are not stable. All the LGAs, at onepoint during the period under review did not meet the NPAFP andNPENT rates. We recommended that more logistic support shouldbe provided for non-performing LGAs to improve case reporting,investigation, and response. DSNOs should be re -sensitized onreverse cold chain, so as to improve the NPENT rate

Surveillance Systems to Track Progress Toward Polio Eradication - Worldwide, 2015-2016.

Global measures to eradicate polio began in 1988; as of 2014, four of six World Health Organization (WHO) regions have been certified polio-free. Within the two endemic regions (African and Eastern Mediterranean), Nigeria, Afghanistan, and Pakistan have never interrupted transmission of wild poliovirus (WPV) (1). The primary means of detecting poliovirus transmission is surveillance for acute flaccid paralysis (AFP) among children aged <15 years, combined with collection and testing of stool specimens from persons with AFP for detection of WPV and vaccine-derived polioviruses (VDPVs) (viruses that differ genetically from vaccine viruses and can emerge in areas with low vaccination coverage and cause paralysis) in WHO-accredited laboratories within the Global Polio Laboratory Network (2,3). AFP surveillance is supplemented by environmental surveillance for polioviruses in sewage from selected locations (4). Genomic sequencing of the VP1-coding region of isolated polioviruses enables mapping transmission by time and place, assessment of potential gaps in surveillance, and identification of the emergence of VDPVs. This report presents poliovirus surveillance data from 2015 and 2016, with particular focus on 20 countries in the African Region and six in the Eastern Mediterranean Region that reported WPV or circulating VDPVs (cVDPVs) during 2011-2016, as well as the three countries most affected by the 2014-2015 Ebola virus disease (Ebola) outbreak (Guinea, Liberia, and Sierra Leone). During 2016, 12 (60%) of the 20 African Region countries and all six of the Eastern Mediterranean Region countries met both surveillance quality indicators (nonpolio AFP rates of ≥2 per 100,000 persons aged <15 years per year and ≥80% of AFP cases with adequate stool specimens [stool adequacy]) at the national level; however, provincial-level variation was seen. To complete and certify polio eradication, surveillance gaps must be identified and surveillance activities, including supervision, monitoring, and specimen collection and handling, further strengthened.

Polio Eradication in Bangladesh: Evaluation of AFP Surveillance Indicators, 2011-2015

As per recommendation from WHO, Bangladesh began a comprehensive plan for AFP (Acute Flaccid Paralysis) and EPI (Expanded Program on Immunisation) disease surveillance from 1997. The country has been maintaining key performance indicators for AFP surveillance for the past ten years. Bangladesh has been declared polio free on 27th March 2014. The aim of this paper is to evaluate and describe results of AFP surveillance indicators for Bangladesh showing the progress made over time as well as identifying areas, which needs further improvements to maintain the polio free status. This retrospective study has been conducted using the surveillance data routinely collected from AFP cases on demographic characteristics and clinical & laboratory examination. Data of 7480 children less than 15 years old reported between January 2011 to December 2015 have been included in this study. Among all reported cases 59.22% cases were male children with a male: female ratio of 1.45:1. 54% of the reported AFP cases within the study period belong to 1-4 years of age. Among all reported cases, 56% have been diagnosed with Guillain-Barre Syndrome or GBS. Annual Non-Polio AFP rate has been successfully achieved nationally for each study year. Completeness and Timeliness of passive reporting from facilities have been satisfactory. 98% or more of all reported AFP cases within the study period has been investigated within 48 hours of notification. For over 95% of all reported AFP cases two stool samples were collected within 14 days of case reporting. 60 plus day follow up has been performed for at least 99% reported AFP cases within the study period. All epidemiological and laboratory surveillance indicators were successfully met for AFP surveillance. However it is important for Bangladesh to maintain long-term AFP case based surveillance along with introduction of Environmental surveillance due to the risk of poliovirus importation before global polio eradication.

Status of surveillance and routine immunization performances in Amhara Region, Ethiopia: findings from in-depth peer review

IntroductionTrend analyses of non-polio AFP and stool adequacy rates in Amhara Region showed optimal performance over the years. However, sub regional gaps continue to persist in certain zones where the reasons for low performance were not well documented. The objective of this study was to assess the performance of the disease surveillance and immunization system in Amhara Region, Ethiopia with emphasis on low performing woredas and zones.MethodsA descriptive cross-sectional study was conducted from July 2-10, 2015 to assess the structure, core and support surveillance functions in five zones and two town administrations that were purposively sampled based on differing performances, geographic location, and history of vaccine preventable disease outbreaks among others.ResultsOf the 82 sites reviewed, 71 (87%) have a designated surveillance focal person. Less than half 36(44%) of these focal persons have written terms of reference. Twenty-six (93%) of the health offices had a written surveillance work plan for the fiscal year. Only 17 (81%) of woreda health offices and town administrations had prioritized active surveillance sites into high, medium and low during the last 12 months. Only 4(17%) had independent active case search visits to these sites as per the priority. Seventy-eight (95%) and seventy-seven (94%) sites have a designated immunization focal person and updated EPI performance monitoring charts, respectively. There had been vaccine stock out in the 3 months before assessment in 28 (34%) of the sites.ConclusionThough there is an existence of well-organized surveillance network with adoption of the integrated disease surveillance and response, gaps exist in following the standard guidelines and operation procedures. Improvements needed in reporting site priority setting and regular visiting for active case search, outbreak investigation and management, vaccine supply and overall documentations.