A Theoretical Framework for Evaluating the Sensitivity of Surveillance for Detecting Wild Poliovirus: I. Factors Affecting Detection Sensitivity in a Person with Acute Flaccid Paralysis

Abstract Background Since 1988, the incidence of polio has reduced by more than 99 percent, worldwide, according to the WHO. Each year, more than 350,000 children were paralyzed, in more than 125 endemic countries. Today, only two countries are still having transmission of polio: Pakistan and Afghanistan. No wild poliovirus has been reported anywhere in Africa since 2016. A good and effective Acute Flaccid Paralysis (AFP) surveillance system is necessary to detect any suspected case of polio to interrupt the transmission of polio within any country. We evaluated the AFP surveillance system to identify gaps in its operations. Methods We used the updated CDC guidelines for evaluating public health surveillance systems and the WHO performance standards to assess the system. We also interviewed stakeholders using an adapted questionnaire, and a key informant interview. We also reviewed AFP surveillance data from 2013–2018. We summarized data using means, frequencies, and proportion. Results We interviewed a total of 49 respondents. Of these, 47 (98%) reported case definitions as being easy to use, and case investigation forms as being easy to fill, 46 (97%) reported data tools could easily accommodate changes, and all the surveillance officers understand the case definition of AFP. All respondents were willing to continue with the system. The non-polio AFP rate (24.6–55.2), stool adequacy (95-99.7%), timeliness, and completeness of reporting were found to be consistently above the WHO minimum standard. Conclusion The AFP surveillance system in Kebbi State was found to be useful, simple, flexible, acceptable, sensitive, representative, timely, and stable, though donor-driven. Absence of data on 60-day follow up and feedback from the laboratory was a major problem with the system.

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Evaluation of Acute Flaccid Paralysis (AFP) surveillance system, Kebbi State, Nigeria, 2013-2018

10.21203/rs.3.rs-23557/v3 ◽

2020 ◽

Author(s):

Hashim Abdulmumin Bala ◽

Yahaya Mohammed ◽

Nyampa Barau ◽

Lukman Surajudeen ◽

Polycarp Uche Ori

Keyword(s):

Surveillance System ◽

Acute Flaccid Paralysis ◽

Performance Standards ◽

Case Definition ◽

Flaccid Paralysis ◽

Suspected Case ◽

Surveillance Systems ◽

Case Definitions ◽

Wild Poliovirus ◽

Afp Surveillance

Abstract Background: Since 1988, the incidence of polio has reduced by more than 99 percent, worldwide, according to the WHO. Each year, more than 350,000 children were paralyzed, in more than 125 endemic countries. Today, only two countries are still having transmission of polio: Pakistan and Afghanistan. No wild poliovirus has been reported anywhere in Africa since 2016. A good and effective Acute Flaccid Paralysis (AFP) surveillance system is necessary to detect any suspected case of polio to interrupt the transmission of polio within any country. We evaluated the AFP surveillance system to identify gaps in its operations.Methods: We used the updated CDC guidelines for evaluating public health surveillance systems and the WHO performance standards to assess the system. We also interviewed stakeholders using an adapted questionnaire, and a key informant interview. We also reviewed AFP surveillance data from 2013-2018. We summarized data using means, frequencies, and proportion. Results: A total of 49 respondents were interviewed. Of these, 47 (98%) reported case definitions as being easy to use, and case investigation forms as being easy to fill, 46 (97%) reported data tools could easily accommodate changes, and all the surveillance officers understand the case definition of AFP. All respondents were willing to continue with the system. The non-polio AFP rate (24.6-55.2), stool adequacy (95-99.7%), timeliness, and completeness of reporting were found to be consistently above the WHO minimum standard.Conclusion: The AFP surveillance system in Kebbi State was found to be useful, simple, flexible, acceptable, sensitive, representative, timely, and stable, though donor-driven. The absence of data on 60-day follow up and feedback from the laboratory was a major problem with the system.

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Detection of Imported Wild Polioviruses and of Vaccine-Derived Polioviruses by Environmental Surveillance in Egypt

Applied and Environmental Microbiology ◽

10.1128/aem.00491-12 ◽

2012 ◽

Vol 78 (15) ◽

pp. 5406-5409 ◽

Cited By ~ 16

Author(s):

Soile Blomqvist ◽

Laila El Bassioni ◽

Eman M. El Maamoon Nasr ◽

Anja Paananen ◽

Svetlana Kaijalainen ◽

...

Keyword(s):

Acute Flaccid Paralysis ◽

Polio Eradication ◽

Flaccid Paralysis ◽

Environmental Surveillance ◽

Wild Type ◽

Wild Poliovirus ◽

Afp Surveillance

ABSTRACTSystematic environmental surveillance for poliovirus circulation has been conducted in Egypt since 2000. The surveillance has revealed three independent importations of wild-type poliovirus. In addition, several vaccine-derived polioviruses have been detected in various locations in Egypt. In addition to acute flaccid paralysis (AFP) surveillance, environmental surveillance can be used to monitor the wild poliovirus and vaccine-derived poliovirus circulation in populations in support of polio eradication initiatives.

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Protocol for the investigation of acute flaccid paralysis and suspected paralytic poliomyelitis

Paediatrics & Child Health ◽

10.1093/pch/2.6.409 ◽

1997 ◽

Vol 2 (6) ◽

pp. 409-412 ◽

Cited By ~ 1

Author(s):

Adwoa Bentsi-Enchill ◽

Keyword(s):

Acute Flaccid Paralysis ◽

Clinical Symptoms ◽

Incidental Finding ◽

Wild Strain ◽

Clinical Specimen ◽

Polio Eradication ◽

Flaccid Paralysis ◽

Paralytic Poliomyelitis ◽

Surveillance Program ◽

Wild Poliovirus

Abstract Despite the elimination of indigenous wild poliovirus in Canada, ongoing surveillance for poliomyelitis is important because of the risk of wild virus importation from endemic regions. Most recently, importation of wild poliovirus into Canada occurred in 1993 and 1996,inboth instances with no associated clinical illness. Since 1991, the active surveillance of acute flaccid paralysis (AFP) in children less than 15 years old has been carried out in Canada to monitor for suspected cases of paralytic poliomyelitis. AFP surveillance is currently implemented through the Canadian Paediatric Surveillance Program. All suspected cases of paralytic poliomyelitis reported to the Laboratory Centre for Disease Control are evaluated by the national Working Group on Polio Eradication. The proper laboratory and neurological investigation of all AFP cases younger than 15 years old and suspected cases of poliomyelitis of any age is essential for the rapid detection of paralytic poliomyelitis, the most important clinical specimen for laboratory investigation being a stool sample collected within two weeks after the onset of paralysis for viral studies. This paper provides guidelines for investigating all suspected cases of paralytic poliomyelitis, including AFP cases less than 15 years old. Guidelines are also provided for reporting confirmed or suspected cases of paralytic poliomyelitis as well as the incidental finding of wild strain poliovirus, with or without any clinical symptoms.

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Eradication of Wild Poliovirus from the Americas: Acute Flaccid Paralysis Surveillance, 1988-1995

The Journal of Infectious Diseases ◽

10.1093/infdis/175.supplement_1.s37 ◽

1997 ◽

Vol 175 (Supplement 1) ◽

pp. S37-S42 ◽

Cited By ~ 54

Author(s):

C. A. de Quadros ◽

B. S. Hersh ◽

J.-M. Olive ◽

J. K. Andrus ◽

C. M. da Silveira ◽

...

Keyword(s):

Acute Flaccid Paralysis ◽

Flaccid Paralysis ◽

Wild Poliovirus ◽

Acute Flaccid Paralysis Surveillance

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Laboratory-based Acute Flaccid Paralysis surveillance pre-polio free certification: Indonesia experience, 2003-2013

Health Science Journal of Indonesia ◽

10.22435/hsji.v10i1.1846 ◽

2019 ◽

Vol 10 (1) ◽

pp. 8-14

Author(s):

Nike Susanti ◽

Herna Herna

Keyword(s):

Acute Flaccid Paralysis ◽

Virus Transmission ◽

Flaccid Paralysis ◽

Microsoft Excel ◽

Wild Poliovirus ◽

Acute Flaccid Paralysis Surveillance ◽

Directorate General ◽

Good Laboratory ◽

Afp Surveillance

Latar belakang: Virus Polio Liar dapat menyebabkan kelumpuhan dan dapat dicegah dengan imunisasi. Untuk memonitor transmisi virus polio liar dilakukan surveilans Acute Flaccid Paralysis (AFP) dan investigasi laboratorium yang telah dimulai sejak tahun 1995 di Indonesia. Virus polio liar Indigenous terakhir ditemukan di Indonesia tahun 1995. Indonesia masih memiliki ancaman importasi virus polio liar dari negara endemis dan mutasi virus polio dari vaksin yang menyebakan kelumpuhan yang sama seperti virus polio liar. Artikel ini bertujuan untuk memberikan gambaran mengenai surveilans AFP berbasis laboratorium di Indonesia pada tahun 2003-2013 sehingga mengantarkan Indonesia sebagai negara bebas polio pada tahun 2014. Metode: Data yang dianalisis adalah data kasus AFP seluruh Indonesia periode tahun 2003-2013. Data didapat dari laboratorium jejaring laboratorium Polio di Jakarta, Bandung, Surabaya dan Sub Direktorat Surveilans, Direktorat Surveilans dan Karantina Kesehatan, Direktorat Jenderal Pencegahan dan Pengendalian Penyakit. Data di analisis menggunakan program Microsoft Excel. Hasil: Sebanyak 305 kasus AFP yang disebabkan oleh infeksi virus polio liar tipe 1 impor ditemukan pada tahun 2005 dan 2006. Terdapat 39 kasus AFP yang disebabkan cVDPV tipe 1 ditemukan di Pulau Madura pada tahun 2005. Virus polio liar tipe 1 hanya ditemukan di pulau Sumatera dan Jawa. Penyebaran Virus polio berhasil dihentikan pada tahun 2006 dan sudah tidak ditemukan lagi hingga tahun 2013. Kesimpulan: Surveilans AFP berbasis laboratorium yang baik berhasil memantau dan mendeteksi sirkulasi virus polio. Peningkatan kinerja surveillance AFP diperlukan untuk membuktikan terhentinya transmisi virus polio sehingga eradikasi polio secara global dapat diraih. Kata kunci: surveilans, laboratorium polio, Acute Flaccid Paralysis Abstract Background: Wild Poliovirus can cause flaccid paralysis and can be prevented by immunization. To monitor wild polio virus transmission, Acute Flaccid Paralysis (AFP) surveillance and laboratory investigations was initiated in 1995 in Indonesia. The last indigenous wild poliovirus found at 1995 in Indonesia. Indonesia still has the threat of imported wild polio viruses from endemic countries and poliovirus mutation from vaccine that can cause paralytic as well as wild poliovirus. The aim of this article is to describe the laboratory-based AFP surveillance in Indonesia from 2003-2013 so that it had led the Indonesia certified for polio free in 2014. Methods: Data analysis performed on AFP cases data from all provinces in Indonesia period of 2013-2014. Data were collected from polio laboratories network in Jakarta, Bandung, Surabaya and the Sub Directorate of Surveillance, Directorate of Surveillance and Health Quarantine, Directorate General of Disease Prevention and Control. Data were analyzed using Microsoft Excel program. Results: 305 paralysis cases were caused by imported type 1 wild poliovirus infection were found in 2005 and 2006. 39 paralysis cases caused by type 1 cVDPV infection were also found on Madura Island in 2005. Type 1 wild polioviruses only found on the Sumatra and Java island. The wild poliovirus transmission was stopped in 2006 and was no longer found until 2013. Conclusion: Good laboratory-based AFP surveillance has been successfully monitoring and detecting the circulation of the poliovirus. Improved AFP surveillance performance is needed to prove cessation of poliovirus transmission so that eradication of poliovirus can be achieved globally. Keywords: surveillance, polio laboratory, Acute Flaccid Paralysis

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Evaluation of Acute Flaccid Paralysis (AFP) surveillance system, Kebbi State, Nigeria, 2013-2018

10.21203/rs.3.rs-23557/v4 ◽

2020 ◽

Author(s):

Hashim Abdulmumin Bala ◽

Yahaya Mohammed ◽

Nyampa Barau ◽

Lukman Surajudeen ◽

Polycarp Uche Ori

Keyword(s):

Surveillance System ◽

Acute Flaccid Paralysis ◽

Performance Standards ◽

Case Definition ◽

Flaccid Paralysis ◽

Suspected Case ◽

Surveillance Systems ◽

Case Definitions ◽

Wild Poliovirus ◽

Afp Surveillance

Abstract Background: Since 1988, the incidence of polio has reduced by more than 99 percent, worldwide, according to the WHO. Each year, more than 350,000 children were paralyzed, in more than 125 endemic countries. Today, only two countries are still having transmission of polio: Pakistan and Afghanistan. No wild poliovirus has been reported anywhere in Africa since 2016. A good and effective Acute Flaccid Paralysis (AFP) surveillance system is necessary to detect any suspected case of polio to interrupt the transmission of polio within any country. We evaluated the AFP surveillance system to identify gaps in its operations.Methods: We used the updated CDC guidelines for evaluating public health surveillance systems and the WHO performance standards to assess the system. We also interviewed stakeholders using an adapted questionnaire, and a key informant interview. We also reviewed AFP surveillance data from 2013-2018. We summarized data using means, frequencies, and proportion. Results: A total of 49 respondents were interviewed. Of these, 47 (98%) reported case definitions as being easy to use, and case investigation forms as being easy to fill, 46 (97%) reported data tools could easily accommodate changes, and all the surveillance officers understand the case definition of AFP. All respondents were willing to continue with the system. The non-polio AFP rate (24.6-55.2), stool adequacy (95-99.7%), timeliness, and completeness of reporting were found to be consistently above the WHO minimum standard.Conclusion: The AFP surveillance system in Kebbi State was found to be useful, simple, flexible, acceptable, sensitive, representative, timely, and stable, though donor-driven. The absence of data on 60-day follow up and feedback from the laboratory was a major problem with the system.

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Type 1 wild poliovirus and putative enterovirus 109 in an outbreak of acute flaccid paralysis in Congo, October-November 2010

Eurosurveillance ◽

10.2807/ese.15.47.19723-en ◽

2010 ◽

Vol 15 (47) ◽

Cited By ~ 21

Author(s):

G Grard ◽

J F Drexler ◽

S Lekana-Douki ◽

M Caron ◽

A Lukashev ◽

...

Keyword(s):

Case Fatality Rate ◽

Acute Flaccid Paralysis ◽

Case Fatality ◽

Flaccid Paralysis ◽

Cumulative Number ◽

Fatality Rate ◽

Wild Type ◽

High Case Fatality Rate ◽

Wild Poliovirus

An outbreak of flaccid paralysis syndrome in adults is ongoing in Congo. Molecular analysis of faecal, throat and cerebrospinal samples identified wildtype 1 poliovirus and an additional enterovirus C strain related to enterovirus 109 as the cause. As of 22 November, the cumulative number of cases was 409, of which 169 (41.3%) were fatal. This is one of the largest wild type 1 poliovirus outbreaks ever described associated with an unusually high case fatality rate.

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Environmental Surveillance Complements Case-Based Surveillance of Acute Flaccid Paralysis in Polio Endgame Strategy 2019–2023

Applied and Environmental Microbiology ◽

10.1128/aem.00702-20 ◽

2020 ◽

Vol 86 (15) ◽

Cited By ~ 1

Author(s):

Peng Chen ◽

Yao Liu ◽

Haiyan Wang ◽

Guifang Liu ◽

Xiaojuan Lin ◽

...

Keyword(s):

Acute Flaccid Paralysis ◽

Polio Eradication ◽

Flaccid Paralysis ◽

World Health ◽

Paralytic Poliomyelitis ◽

Environmental Surveillance ◽

Wild Poliovirus ◽

The World ◽

Afp Surveillance ◽

Case Based

ABSTRACT The Polio Endgame Strategy 2019–2023 has been developed. However, more effective and efficient surveillance activities should be conducted with the preparedness of emergence for vaccine-derived poliovirus (VDPV) or wild poliovirus (WPV). We reviewed the impact of the case-based acute flaccid paralysis (AFP) surveillance (1991 to 2018) and environmental surveillance (2011 to 2018) in polio eradication in Shandong province of China. Clinical characteristics of AFP cases and enterovirus (EV) investigation of research samples were assessed. During the period, 10,224 AFP cases were investigated, and 352 sewage samples were collected. The nonpolio AFP rate sustained at over 2.0/100,000 since 1997. Of 10,224 cases, males and young children experienced a higher risk of severe diseases, and 68.5% suffered lower limb paralysis. We collected 1,707 EVs from AFP cases, including 763 polioviruses and 944 nonpolio enteroviruses (NPEVs). No WPV was isolated since 1992. The AFP surveillance showed high sensitivity in detecting 143 vaccine-associated paralytic poliomyelitis (VAPP) cases and 6 VDPVs. For environmental surveillance, 217 (61.6%) samples were positive for poliovirus, and altogether, 838 polioviruses and 2,988 NPEVs were isolated. No WPV was isolated in environmental surveillance, although one VDPV2 was identified. Phylogenetic analysis revealed environmental surveillance had the capacity to detect a large scope of NPEVs. The case-based AFP surveillance will be indispensable for detecting VAPP cases and VDPV circulation in countries using oral polio vaccine. Environmental surveillance is advantageous in identifying EV circulation and responding to ongoing circulating VDPV outbreaks and should be expanded to complement the AFP surveillance. IMPORTANCE Interrupting wild poliovirus transmission and stopping circulating vaccine-derived poliovirus (cVDPV) outbreaks have been proposed as two global goals by the World Health Organization in the Global Polio Eradication Initiative (GPEI). This analysis, based on the 28-year acute flaccid paralysis (AFP) surveillance and 8-year environmental surveillance, provides continued high-quality surveillance performance in achieving the GPEI and detecting the circulation of enterovirus. Given the ongoing cVDPV outbreaks in the world, we present the surveillance capacity of environmental surveillance in capturing enterovirus circulation. The final poliovirus (especially VDPV) elimination has become increasingly complex, and the case-based AFP surveillance alone will lead to difficulties in early detecting dynamics of poliovirus transmission and monitoring the extent of environmental circulation. This study goes beyond previous work to provide a detailed comprehensive evaluation of the enterovirus surveillance and can be used to formulate a set of implementation plan and performance indicators for environmental surveillance.

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