Surveillance Performance Indicators Research Articles

Progress in Access and Oral Polio Vaccine Coverage Among Children Aged

Warfare has long impeded vaccination programs in polio-endemic Afghanistan. We aimed to describe progress in access to children under 5, oral polio vaccine (OPV) coverage among children under 5 in nationwide polio campaigns, and polio surveillance performance indicators after the Islamic Republic of Afghanistan collapsed to Taliban forces in August 2021. Trends in the number of wild poliovirus type 1 (WPV1) and circulating vaccine-derived poliovirus type 2 (cVDPV2) cases and surveillance indicators from 2015 to 2023, and trends in the OPV coverage in the November 2020-June 2022 polio campaigns, were described. From 2015 to mid-July 2020, 74 of 126 (58.7%) WPV1 cases were reported from inaccessible areas. In November 2020, 34.1% of target children under 5 were inaccessible; in November 2021 (the first postchange polio campaign), all were accessible. From November 2020, under-5 OPV coverage of 69.9% rose steadily to 99.9% in the May 2022 campaign. The number of cVDPV cases fell from 308 (2020) to zero (2022). June 2022's house-to-house OPV coverage was 34.2% higher than non-house-to-house modalities. Nonpolio acute flaccid paralysis and stool adequacy rates rose from 18.5/100 000 and 92.6% in 2020 to 24.3/100 000 and 94.4% in 2022, respectively. Children's inaccessibility no longer vitiates polio eradication; polio surveillance systems are less likely to miss any poliovirus circulation.

Progress Toward Measles Elimination - African Region, 2017-2021.

Worldwide, measles remains a major cause of disease and death; the highest incidence is in the World Health Organization African Region (AFR). In 2011, the 46 AFR member states established a goal of regional measles elimination by 2020; this report describes progress during 2017-2021. Regional coverage with a first dose of measles-containing vaccine (MCV) decreased from 70% in 2017 to 68% in 2021, and the number of countries with ≥95% coverage decreased from six (13%) to two (4%). The number of countries providing a second MCV dose increased from 27 (57%) to 38 (81%), and second-dose coverage increased from 25% to 41%. Approximately 341 million persons were vaccinated in supplementary immunization activities, and an estimated 4.5 million deaths were averted by vaccination. However, the number of countries meeting measles surveillance performance indicators declined from 26 (62%) to nine (22%). Measles incidence increased from 69.2 per 1 million population in 2017 to 81.9 in 2021. The number of estimated annual measles cases and deaths increased 22% and 8%, respectively. By December 2021, no country in AFR had received verification of measles elimination. To achieve a renewed regional goal of measles elimination in at least 80% of countries by 2030, intensified efforts are needed to recover and surpass levels of surveillance performance and coverage with 2 MCV doses achieved before the COVID-19 pandemic.

Experience and findings from surveillance peer review in Nigeria, August 2017-May 2019.

acute flaccid paralysis (AFP) surveillance is the gold standard of the Global Polio Eradication Initiative (GPEI) for detecting cases of poliomyelitis and tracking poliovirus transmission. Nigeria's AFP surveillance performance indicators are among the highest in countries of the World Health Organization (WHO) African Region. The primary AFP surveillance performance indicators are the rate of non-polio AFP among children and the proportion of timely, adequate specimen collection. The surveillance working group of the National Emergency Operations Centre assessed the quality of AFP surveillance data in some reportedly high-performing states. we conducted a retrospective review of AFP surveillance performance indicators in Nigeria for 2010-2019. We also reviewed data in reports from four groups of surveillance peer reviews and validation visits (conducted by in-country GPEI partners) during August 2017-May 2019 in 16 states with high primary AFP surveillance indicators; the validation visits reviewed clinical information and the dates of specimen collection and onset of paralysis with caretakers. there were consistently increasing AFP surveillance primary performance indicators during 2010-2016, followed by declines during 2017-2019. From the data for 16 states with peer reviews conducted from August 2017-May 2019, overall concordance of reported and "true" (validated) AFP indicator data in peer review investigations was highly variable. True AFP concordance ranged from 58%-100%, and stool timeliness concordance ranged from 56%-95%. The most common clinical causes of reported AFP cases that were not true AFP were spastic paralysis, malaria, sickle cell disease, and malnutrition. All the states that participated in peer reviews developed surveillance improvement plans based on the gaps identified. Nigeria has highly sensitive AFP surveillance according to reported primary AFP performance indicators. The findings of peer reviews indicate that the AFP surveillance system needs to be strengthened and well-supervised to enhance data quality.

Evaluation of acute flaccid paralysis surveillance performance before and during the 2014-2015 Ebola virus disease outbreak in Guinea and Liberia.

the number of wild poliomyelitis cases, worldwide, dropped from 350,000 cases in 1988 to 33 in 2018. Acute flaccid paralysis (AFP) surveillance is a key strategy toward achieving global polio eradication. The 2014 Ebola virus disease (EVD) epidemic in West Africa infected over 28,000 people and had devastating effects on health systems in Guinea, Liberia, and Sierra Leone. We sought to assess the effects of the 2014 Ebola outbreak on AFP surveillance in Guinea and Liberia. a retrospective cross-sectional analysis was performed for Guinea and Liberia to evaluate EVD´s impact on World Health Organization (WHO) AFP surveillance performance indicators during 2012-2015. both Guinea and Liberia met the WHO target non-polio AFP incidence rate nationally, and generally sub-nationally, prior to the EVD outbreak; rates decreased substantially during the outbreak in seven of eight regions in Guinea and 11 of 15 counties in Liberia. Throughout the study period, both Guinea and Liberia attained appropriate overall targets nationally for "notification" and "stool adequacy" indicators, but each country experienced periods of poor regional/county-specific indicator performance. these findings mirrored the negative effect of the Ebola outbreak on polio elimination activities in both countries and highlights the need to reinforce this surveillance system during times of crisis.

Trends of key surveillance performance indicators of acute flaccid paralysis: a descriptive analysis, Uganda, 2015–2020

BackgroundPolio is disease caused by poliovirus which can in turn cause irreversible paralytic disease, presenting as Acute Flaccid Paralysis (AFP). A sensitive AFP surveillance system, in which all reported AFP cases are evaluated, first to determine if they are true AFP cases or not, is key for tracking polio eradication. True AFP cases are then later categorized as polio AFP or non-polio AFP (NPAFP) cases. Sensitivity is defined by meeting an annual NPAFP rate/100,000 population < 15 years of ≥ 4/100,000, and an annual stool adequacy (SA) rate of ≥ 80%. We describe Uganda’s AFP surveillance performance between 2015–2020, based on the WHO-recommended indicators, including; NPAFP and stool adequacy rate.MethodsWe performed a descriptive analysis of national AFP surveillance data, 2015–2020 obtained from ministry of health. We evaluated proportion of reported AFP cases that were true AFP, and changes in NPAFP and stool adequacy (SA) rate over the study period. We evaluated the trends in achieving the targeted NPAFP and SA rates from 2015–2020. We used QGIS to illustrate patterns in NPAFP and SA rates across districts and subregions.ResultsAmong 3,605 AFP cases reported and investigated countrywide from 2015–2020, 3,475 (96%) were true AFP cases. All the true AFP cases were non-polio related. District reporting was near-complete (97–100% each year). Overall, the mean NPAFP rate declined from 3.1/100,000 in 2015 to 2.1/100,000 in 2020. Less than 40% of districts met the NPAFP target rate in all years. The proportion of districts achieving the NPAFP target rate of ≥ 4/100,000 significantly declined from 35% in 2015 to 20% in 2020. The mean annual SA rate nationally was 88% from 2015–2020. Only 66% of districts achieved the SA target rate of ≥ 80% in the study period. The proportion of districts with SA rate ≥ 80% significantly increased from 68 to 80% between 2015 and 2020.ConclusionMost districts reported AFP cases. However, there was a decline in the NPAFP rate from 2015–2020 and few districts achieved the target rate. The suboptimal AFP surveillance system performance leaves the country at risk of missing ongoing poliovirus transmission. We recommend health worker training on active AFP searches, intensified supportive supervision, increase the number of environmental surveillance sentinel sites to boost AFP surveillance in the country, and periodic review meetings with districts to assess AFP surveillance performance.

Epidemiological description of and response to a large yellow fever outbreak in Edo state Nigeria, September 2018 - January 2019

BackgroundEdo State Surveillance Unit observed the emergence of a disease with “no clear-cut-diagnosis”, which affected peri-urban Local Government Areas (LGAs) from September 6 to November 1, 2018. On notification, the Nigeria Centre for Disease Control deployed a Rapid Response Team (RRT) to support outbreak investigation and response activities in the State. This study describes the epidemiology of and response to a large yellow fever (YF) outbreak in Edo State.MethodsA cross-sectional descriptive outbreak investigation of YF outbreak in Edo State. A suspected case of YF was defined as “Any person residing in Edo State with acute onset of fever and jaundice appearing within 14 days of onset of the first symptoms from September 2018 to January 2019”. Our response involved active case search in health facilities and communities, retrospective review of patients’ records, rapid risk assessment, entomological survey, rapid YF vaccination coverage assessment, blood sample collection, case management and risk communication. Descriptive data analysis using percentages, proportions, frequencies were made.ResultsA total of 209 suspected cases were line-listed. Sixty-seven (67) confirmed in 12 LGAs with 15 deaths [Case fatality rate (CFR 22.4%)]. Among confirmed cases, median age was 24.8, (range 64 (1-64) years; Fifty-one (76.1%) were males; and only 13 (19.4%) had a history of YF vaccination. Vaccination coverage survey involving 241 children revealed low YF vaccine uptake, with 44.6% providing routine immunisation cards for sighting. Risk of YF transmission was 71.4%. Presence of Aedes with high-larval indices (House Index ≥5% and/or Breteau Index ≥20) were established in all the seven locations visited. YF reactive mass vaccination campaign was implemented.ConclusionEdo State is one of the states in Nigeria with the highest burden of yellow fever. More males were affected among the confirmed. Major symptoms include fever, jaundice, weakness, and bleeding. Majority of surveillance performance indicators were above target. There is a high risk of transmission of the disease in the state. Low yellow fever vaccination coverage, and presence of yellow fever vectors (Ae.aegypti, Ae.albopictus and Ae.simpsoni) are responsible for cases in affected communities. Enhanced surveillance, improved laboratory sample management, reactive vaccination campaign, improved yellow fever case management and increased risk communication/awareness are very important mitigation strategies to be sustained in Edo state to prevent further spread and mortality from yellow fever.

The sensitivity of acute flaccid paralysis surveillance - the case of South Sudan: retrospective secondary analysis of AFP surveillance data 2014-2019.

IntroductionSouth Sudan has made quite impressive progress in interrupting wild poliovirus and maintaining a polio-free status since the last case was reported in 2009. South Sudan introduced different complementary strategies to enhance acute flaccid paralysis (AFP) surveillance. Hence, the objective of this study is to evaluate the sensitivity of the surveillance system using the WHO recommended surveillance standard and highlight the progress and challenges over the years.Methodswe conducted a retrospective, descriptive, quantitative study design and used the available secondary AFP surveillance database.Resultsthe overall non-polio AFP rate was 6.2/100,000 children under 15 years old in the study period. The stool adequacy was maintained well above the certification level of surveillance. The two main surveillance performance indicators were met at the national level throughout the study period. In contrast, only five out of ten states persistently attained and maintained the two main surveillance performance indicators throughout the study period, while in 2019 all states achieved except for Jonglei state. During the analysis period, no wild poliovirus was isolated except two circulating Vaccine Derived Poliovirus Type 2 (cVDPV2) cases in 2014 and one Immunodeficiency Vaccine Derived Poliovirus Type 2 (iVDPV2) case in 2015. However, on average, three cases were classified as polio compatible with each year of the study.ConclusionSouth Sudan met the two key surveillance performance indicators and had a sensitive AFP surveillance system during the period studied. We recommend intensifying surveillance activities in the former conflict-affected states and counties to maintain polio-free status.

Acute flaccid paralysis surveillance performance from 2011 to 2020 in Jonglei State, South Sudan: progress and challenges encountered.

IntroductionSouth Sudan reported the last indigenous wild poliovirus (WPV) in 2001 in Unity State, while the country was part of Sudan. In addition, the country reported an imported case of WPV in 2004-2005 and 2008-2009. The WPV circulation in the state was interrupted in 2009 and the last case was reported in Ayod county. The country continues to be at risk of importation of circulating vaccine-derived poliovirus type 2 (cVDPV2). In 2014 and 2020 the country experienced an outbreak of cVDPV2, in which Jonglei state was one of the affected states. Four out of 50 (8%) cVDPV2 cases in 2020 were reported from Jonglei State. The purpose of this study is to review surveillance performance indicators of Jonglei and compare them with the WHO surveillance performance standard and other country´s surveillance performances.Methodsretrospective secondary data analysis was conducted using the Jonglei state Acute Flaccid Paralysis (AFP) surveillance case-based database from 2011 to 2020. The reason for selecting Jonglei is because it is one of the poor performing states and is chronically hit by flood and internal conflicts. Data analyses were carried out using the Microsoft Excel (2016) program, where descriptive analysis frequencies, tables, and graphs were generated.Resultsthe study revealed that 346 AFP cases were reported in the counties of Jonglei state from 2011 through 2020. Out of 11 counties, 11 (100%) of them have reported suspected AFP cases. Children under five years accounted for 275 (79%) of all cases. The male gender accounted for 175 (51%) of all cases. A total of 249 (72%) had received three or more doses of Oral Polio Vaccine (OPV). Non-Polio Acute Flaccid Paralysis (NPAFP) rate varies from 1.2 in 2014 to 4.4 cases per 100,000 children under 15 years in 2018. The stool adequacy ranges from 58% in 2020 to 100% in 2011.Conclusionthe performance of Jonglei´s AFP surveillance system did not meet the WHO recommended target for both major AFP surveillance indicators (non-polio AFP rate and stool adequacy) during the study period.

Polio eradication in a chronic conflict setting lessons from the Republic of South Sudan, 2010-2020.

Introductionin 1988 the World Health Assembly set an ambitious target to eradicate Wild Polio Virus (WPV) by 2000, following the successful eradication of the smallpox virus in 1980. South Sudan and the entire African region were certified WPV free on August 25, 2020. South Sudan has maintained its WPV free status since 2010, and this paper reviewed the country’s progress, outlined lessons learned, and describes the remaining challenges in polio eradication.Methodssecondary data analysis was conducted using the Ministry of Health and WHO polio surveillance datasets, routine immunisation coverage, polio campaign data, and surveys from 2010 to 2020. Relevant technical documents and reports on polio immunisation and surveillance were also reviewed. Data analysis was conducted using EPI Info 7 software.Resultsadministrative routine immunisation coverage for bivalent Oral Polio Vaccine (OPV) 3rd dose declined from 77% in 2010 to 56% in 2020. In contrast, the administrative and post-campaign evaluation coverage recorded for the nationwide supplemental polio campaigns since 2011 was consistently above 85%; however, campaigns declined in number from four in 2011 to zero in 2020. Overall, 76% of notified cases of Acute Flaccid Paralysis (AFP) received three or more doses of the oral polio vaccine. The Annualized Non-AFP rate ranged between 4.0 to 5.4 per 100,000 under 15 years populations, and stool adequacy ranged from 83% to 94%.ConclusionSouth Sudan’s polio-free status documentation was accepted by the ARCC in 2020, thereby enabling the African Region to be certified WPV free on August 25, 2020. However, there are concerns as the country continues to report low routine immunisation coverage and a reduction in the number of polio campaigns conducted each year. It is recommended that the country conduct high-quality nationwide supplemental polio campaigns yearly to achieve and maintain the required herd immunity. It invests in its routine immunisation program while ensuring optimal AFP surveillance performance indicators.

Surveillance to Track Progress Toward Polio Eradication - Worldwide, 2020-2021.

Since the Global Polio Eradication Initiative (GPEI) was established in 1988, the number of reported poliomyelitis cases worldwide has declined by approximately 99.99%. By the end of 2021, wild poliovirus (WPV) remained endemic in only two countries (Pakistan and Afghanistan). However, a WPV type 1 (WPV1) case with paralysis onset in 2021, was reported by Malawi a year after the World Health Organization (WHO) African Region (AFR) was certified as WPV-free and circulating vaccine-derived poliovirus (cVDPV) cases were reported from 31 countries during 2020-2021 (1,2). cVDPVs are oral poliovirus vaccine-derived viruses that can emerge after prolonged circulation in populations with low immunity and cause paralysis. The primary means of detecting poliovirus transmission is through surveillance for acute flaccid paralysis (AFP) among persons aged <15 years, with confirmation through stool specimen testing by WHO-accredited laboratories, supplemented by systematic sampling of sewage and testing for the presence of poliovirus (environmental surveillance). The COVID-19 pandemic caused disruptions in polio vaccination and surveillance activities across WHO regions in 2020; during January-September 2020, the number of reported cases of AFP declined and the interval between stool collection and receipt by laboratories increased compared with the same period in 2019 (3). This report summarizes surveillance performance indicators for 2020 and 2021 in 43 priority countries* and updates previous reports (4). In 2021, a total of 32 (74%) priority countries† met two key surveillance performance indicator targets nationally, an improvement from 2020 when only 23 (53%) met both targets; however, substantial national and subnational gaps persist. High-performing poliovirus surveillance is critical to tracking poliovirus transmission. Frequent monitoring of surveillance indicators could help identify gaps, guide improvements, and enhance the overall sensitivity and timelines of poliovirus detection to successfully achieve polio eradication.

Innovations in the Implementation of Polio Surveillance Enhancement Plan in Oyo State, Nigeria: Key Benefits, Lessons Learned, Challenges and Opportunities

Background: Nigeria attained the milestone of being certified wild poliovirus free in the year 2020. However, a drop in the key performance indicators of polio surveillance system was across various Local Government Areas (LGAs) in Oyo State. This drop highlighted the need for an innovative way of enhancing polio surveillance in Oyo State. Methods: This study was conducted in four phases and each phase utilized a cross-sectional study design and purposive sampling technique to select eligible LGAs and participants. LGAs that met at least two of the set-out criteria (had not reported at least a case of Acute Flaccid Paralysis (AFP) 12 months preceding the survey, with decline in AFP case detection rate, had not met AFP key indicators, are densely populated, and has an international border) were selected. A concurrent mixed method of data collection was utilized, and quantitative data were collected with a semi-structured questionnaire administered using Computer Assisted Personal Interviews (CAPI) during community active case search, health facility retroactive case search (HFRACS). Qualitative data collection was done through Focus Group Discussion (FGD). Surveillance intensification activities were conducted over eight weeks period. Data were analyzed using Microsoft Excel Software; summarization was done using frequencies and percentages while presentation was done using charts and spot maps. Results: A total of 1277, 49, 259 and 632 settlements, households and health facilities respectively were visited across 24 (73%) LGAs in Oyo State. Of the 150 suspected AFP cases identified, 45 (30%) were rejected cases, 33 (22%) were missed cases and 72 (48%) were true AFP cases. Non-Polio AFP Rate (NP-AFP rate) increased from 2.7 to 6.9 (P < 0.0001) after the surveillance intensification, also, the Non-Polio Enterovirus (NPENT) isolation was increased by 40% (16% to 23%). At the end of the intensification activities, all LGAs in Oyo State had met the WHO recommended Non-Polio Acute Flaccid Paralysis (NP-AFP) rate of ≥3/100,000 population. Conclusions: Innovative strategies implemented in AFP surveillance across Oyo State have resulted in improvement in AFP surveillance performance indicators in the State. There is therefore the need for dynamic and innovative ways of conducting AFP surveillance to prevent poliomyelitis epidemics and to ensure maintenance of Nigeria polio free certification status.

Evaluation of acute flaccid paralysis surveillance indicators in Sokoto state, Nigeria, 2012\u20132019: a secondary data analysis

BackgroundNigeria, the last endemic country in the WHO African Region, was certified free of Wild Polio Virus (WPV) in 2020. However, due to low immunity in some communities in Sokoto, outbreaks of the circulating Vaccine Derived Polio Virus (cVDPV) occur. The aim of this study is to evaluate the Acute Flaccid Paralysis (AFP) surveillance indicators in Sokoto state, Nigeria.MethodsThis retrospective study was an analysis of routinely collected AFP surveillance data between 2012 and 2019 by the Sokoto state surveillance network. We assessed the Sokoto state AFP surveillance system using the AFP surveillance performance indicators. We performed all analyses using Microsoft Excel 2019.ResultsCumulatively, 3001 Acute Flaccid Paralysis (AFP) cases were reported over the evaluation period, out of which 1692 (56.4%) were males, and 2478 (82.4%) were below five years. More than half, 1773 (59.1%), had a fever at the beginning of the disease, and 1911 (63.7%) had asymmetric paralysis. The non-polio AFP rate (9.1 to 23.5% per 100,000 children < 15 years old) and stool adequacy rate (92.5 to 100%) indicate high sensitivity. The proportion of cases that had stool samples collected early, timely transported to the laboratory and arrived at the laboratory in optimal condition were all above the World Health Organization (WHO) minimum standard of 80%. There was inadequate profile documentation of some suspected cases.ConclusionsSokoto State has exceeded the WHO minimum standards in most of the AFP surveillance indicators. The performance of the system is sufficient enough to detect any reintroduction of WPV into the state. However, there is a need for improvement in data quality.

Surveillance to Track Progress Toward Polio Eradication - Worldwide, 2019-2020.

When the Global Polio Eradication Initiative (GPEI) was established in 1988, an estimated 350,000 poliomyelitis cases were reported worldwide. In 2020, 140 wild poliovirus (WPV) cases were confirmed, representing a 99.99% reduction since 1988. WPV type 1 transmission remains endemic in only two countries (Pakistan and Afghanistan), but outbreaks of circulating vaccine-derived poliovirus (cVDPV) occurred in 33 countries during 2019-2020 (1,2). Poliovirus transmission is detected primarily through syndromic surveillance for acute flaccid paralysis (AFP) among children aged <15 years, with confirmation by laboratory testing of stool specimens. Environmental surveillance supplements AFP surveillance and plays an increasingly important role in detecting poliovirus transmission. Within 2 weeks of COVID-19 being declared a global pandemic (3), GPEI recommended continuing surveillance activities with caution and paused all polio supplementary immunization activities (4). This report summarizes surveillance performance indicators for 2019 and 2020 in 42 priority countries at high risk for poliovirus transmission and updates previous reports (5). In 2020, 48% of priority countries* in the African Region, 90% in the Eastern Mediterranean Region, and 40% in other regions met AFP surveillance performance indicators nationally. The number of priority countries rose from 40 in 2019 to 42 in 2020.† Analysis of 2019-2020 AFP surveillance data from 42 countries at high risk for poliovirus transmission indicates that national and subnational nonpolio AFP rates and stool specimen adequacy declined in many priority countries, particularly in the African Region, suggesting a decline in surveillance sensitivity and quality. The findings in this report can be used to guide improvements to restore a sensitive surveillance system that can track poliovirus transmission and provide evidence of interruption of transmission.

Polio Data Quality Improvement in the African Region.

The polio Eradication Initiative (PEI) is one of the most important public health interventions in Africa. Quality data is necessary to monitor activities and key performance indicators and access year by year progress made. This process has been possible with a solid polio health information system that has been consolidated over the years.This study describes the whole process to have data for decision making. The main components are the data flow, the role of the different levels, data capture and tools, standards and codes, the data cleaning process, the integration of data from various sources, the introduction of innovative technologies, feedback and information products and capacity building. The results show the improvement in the timeliness of reporting data to the next level, the availability of quality data for analysis to monitor key surveillance performance indicators, the output of the data cleaning exercise pointing out data quality gaps, the integration of data from various sources to produce meaningful outputs and feedback for information dissemination.From the review of the process, it is observed an improvement in the quality of polio data resulting from a well-defined information system with standardized tools and Standard Operating Procedures (SOPs) and the introduction of innovative technologies. However, there is room for improvement; for example, multiple data entries from the field to the surveillance unit and the laboratory. Innovative technologies are implemented for the time being in areas hard to reach due to the high cost of the investment.A strong information system has been put in place from the community level to the global level with a link between surveillance, laboratory and immunization coverage data. To maintain standards in Polio Information system, there is need for continuous training of the staff on areas of surveillance, information systems, data analysis and information sharing. The use of innovative technologies on web-based system and mobile devices with validation rules and information check will avoid multiple entries.

The Epidemiology of Rubella in Lesotho before the Introduction of a Rubella Containing Vaccine: A Review of Measles Case-based Surveillance, 2012-2016

Aim: The aim of the study was to determine the burden and epidemiology of rubella infection in Lesotho before the introduction of a rubella-containing vaccine. It was also to assess the performance of the measles case-based surveillance system in Lesotho.&#x0D; Study Design: Retrospective cross-sectional descriptive study.&#x0D; Place and Duration of Study: The study was done in Lesotho from February to March 2019 based on the 2012 to 2016 data.&#x0D; Methods: There was a review of the measles case-based surveillance data with a total of 1587 suspected cases reported during the study period. Samples were collected from suspected measles cases and tested for measles. Those samples that tested negative for measles were subsequently tested for rubella IgM at the National Reference Laboratory. The serum samples were analysed for rubella IgM using commercial enzyme-linked immunosorbent assay (ELISA) kits SERION and EUROIMMUN.&#x0D; Results: There were 2 measles IgM and 748 rubella IgM positive cases confirmed. The rubella IgM positive cases accounted for 48% of the samples tested for rubella infection. There were also several rubella outbreaks during the study period. The Lesotho surveillance system met the two principal surveillance performance indicators for each year during the period of the study.&#x0D; Conclusion: This study showed that there was high level of rubella sero-positivity with several outbreaks of rubella infections during the study period. Rubella infection was predominantly seen in those aged between 5 and &lt;13 years of age. This justified the introduction of a rubella containing vaccine in Lesotho in 2017. Although the two principal surveillance performance indicators (non-measles febrile rash illness rates and the percentage of districts that reported at least one case of measles with blood specimen per year) were met during the period under review, there were districts that performed poorly. This study revealed the need for strengthening of rubella-containing vaccine component of routine immunization to lower the impact of rubella infection in Lesotho. A detailed district level review to identify and address the causes of poor performance in some districts is recommended. There is also a need to identify the current challenges and evaluate the impact of the recently introduced rubella-containing vaccine on rubella infection in Lesotho.

The impact of the COVID-19 pandemic on measles surveillance in the World Health Organisation African Region, 2020.

Introductionfollowing the declaration of the COVID-19 pandemic, many countries imposed restrictions on public gatherings, health workers were repurposed for COVID-19 response, and public demand for preventive health services declined due to fear of getting COVID-19 in health care settings. These factors led to the disruption in health service delivery, including childhood immunization, in the first months of the pandemic. Measles surveillance supported with laboratory confirmation, is implemented in the African Region as part of the strategies towards attaining measles elimination. World Health Organisation developed guidelines to assist countries to continue to safely provide essential health services including immunization and the surveillance of vaccine preventable diseases during the pandemic.Methodswe analysed the measles case-based surveillance and laboratory databases for the years 2014 to 2020, to determine the impact of the COVID-19 pandemic on measles surveillance, comparing the performance in 2020 against the preceding years.Resultsthe weekly reporting of suspected measles cases declined starting in April 2020. Twelve countries had more than 50% decline in both the number of reported cases as well as in the number of specimens collected in 2020, as compared to the mean for the years 2014-2018. In 2020, only 30% of the specimens from suspected measles cases arrived at the national laboratory within 3 days of collection. At Regional level, 86% of the districts reported suspected measles cases in 2020, while the non-measles febrile rash illness rate was 2.1 per 100,000 population, which was the lowest rate documented since 2014. Only 11 countries met the targets for the two principal surveillance performance indicators in 2020 as compared to an average of 21 countries in the years 2014-2019.Conclusionthe overall quality of measles surveillance has declined during the COVID pandemic in many countries. Countries should implement immediate and proactive measures to revitalise active surveillance for measles and monitor the quality of surveillance. We recommend that countries consider implementing specimen collection and testing methods that can facilitate timely confirmation of suspected measles cases in remote communities and areas with transportation challenges.

Acute flaccid paralysis surveillance system evaluation-Enugu state, Nigeria 2015–2018

Background: Nigeria is one of the three polio-endemic countries worldwide. Wild polio virus was reported last in Nigeria by August 2016 although pockets of circulating vaccine derived viruses’ infection and vaccine associated paralytic polio still occur. As part of the polio endgame strategy Nigeria targets to achieve and sustain optimum surveillance performance indicators in all States by December 2018. We evaluated the acute flaccid paralysis (AFP) surveillance system in Enugu State to assess if the target for these indicators are being met. Methods and materials: We used an adapted US CDC Updated Guidelines for Evaluating Public Health Surveillance Systems. We reviewed of AFP surveillance data collected 2015–2018. We conducted key informant interviews and focus group discussion with purposively selected stakeholders. We collected data from 30 randomly selected AFP Surveillance officers in the state using an adapted questionnaire and recorded frequencies and proportions of key indicators. Results: One compatible poliovirus case was identified in 2015 among the 1211 AFP cases recorded. The case definition of AFP and tools for reporting are simple. The system is mainly funded by foreign partners although the main challenge is sustainability. The system is unstable as there are few trained staff who are regularly assigned other duties or transferred to other departments other than AFP surveillance. The system is flexible, and accepted by all stakeholders. The sensitivity of the system measured by the annualized Non-Polio AFP (NPAFP) rate is 15.1 ± 2.7 (target of ≥2/100,000 population). The mean data quality was 94%, SD: 2.8 (target ≥90). Mean stool adequacy and timeliness of reporting were 83.9 ± 14.3% and 91.0 ± 8.6% respectively both having target of ≥80%. Case investigations done in ≤48 h: Mean 89 ± 7.4, non-polio enterovirus isolation rate: Mean 39.5 ± 19.4, target >10% and 60 days follow up Mean 85.2 SD (17.0). Conclusion: Enugu State AFP surveillance is meeting most of its target although stability of the system is suboptimal. We recommended that Enugu state government train a pool of health officers on AFP surveillance and reduce staff mobility. Enugu state government should also plan to have a budget line for surveillance of AFP, and take ownership of the surveillance structure.

Assessment of acute flaccid paralysis surveillance performance in East and Southern African countries 2012 - 2019.

Introduction:polio eradication initiatives started in 1988, this is almost the past 32 years following the WHA resolution 41.8 of eradicating polio by the year 2000. As of 2019, only 3 countries remained to be polio endemic globally, Afghanistan, Pakistan and Nigeria. The east and southern sub-region countries had shown progressive achievement towards polio eradication and to start with the African regional certification. The availability of sensitive AFP surveillance performance is among important strategies in the achievement of polio eradication. We, therefore, decided to conduct this assessment of AFP performance from 2012 to 2019 in the ESA sub-region have evidence documentation and support the certification process of the WHO AFRO region.Methods:we reviewed all reported acute flaccid paralysis (AFP) cases from 19 countries in the ESA sub region with the date of onset of paralysis from 1 January 2012 to 31 December 2019. The data were run to descriptive analysis based on the personal characteristics and AFP surveillance performance indicators parameters.Results:a total of 46,014 AFP cases were reported from 19 countries in the ESA countries who were paralyzed from 1 January 2012 to 31 December 2019. The most affected age group was children aged 0 to 3 years old where 19,740 children with acute paralysis were reported representing 42.9% of the total reported AFP for the period. The overall assessment of the non-polio AFP rate, there is an increase from a rate of 2.7 in 2012 to 3.5 in 2019 per 100,000 population aged less than 15 years, reflects a significant change with a p-value of 0.040 (95% C.I. ranges from 0.035 to 1.564). Furthermore, the percentage of stool adequacy raised from 86.4% in 2012 to 88.5% in 2019, with an observed 2.1% difference and no significant change over the 8 years.Conclusion:we observed an overall increase in the sensitivity of the AFP surveillance performance for the ESA sub-region countries from 2012 to 2019 using the national performance indicators. The COVID-19 pandemic paused an operational challenge for AFP surveillance performances from 2020. A further subnational surveillance performance analysis is suggested.

Acute flaccid paralysis in North East Delta, Egypt: A retrospective analysis of prospectively collected surveillance data

BackgroundEffective acute flaccid paralysis (AFP) surveillance is crucial in countries approaching the final phase of polio eradication. Thus this study was conducted to highlight the epidemiological pattern of AFP as a surveillance tool for polio in Egypt. MethodsA record-based descriptive study was conducted to include all AFP cases (599) reported in the last 9 years starting from January 2009 to December 2017 in Dakahlia, North East of Delta, Egypt. ResultsThe overall non-polio AFP rate in less than 15 years old children was 2.99/100,000 during the study period. The majority of cases (98%) were notified within 7 days from onset of the disease, and investigated within 48 h of reporting. The commonest diagnoses were encephalitis (21.3%), myositis (20.2%), neuropathies (19.2%) and Guillain–Barre syndrome (17.8%) with no recorded cases diagnosed as poliomyelitis. The mean annual vaccination coverage rate was 96.1 ± 1.6. ConclusionsAFP surveillance system in Dakahlia, Egypt was effective in meeting the WHO surveillance performance indicators ensuring polio-free status and absence of wild polio virus transmission over the last 9 years in this locality. High routine immunization coverage, maintenance and improvement of current levels of surveillance performance are required for optimum surveillance.

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.