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

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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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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Preponderance of Enterovirus Species C in RD-L20B cell culture negative stool samples from children diagnosed with Acute Flaccid Paralysis in Nigeria

10.1101/116004 ◽

2017 ◽

Author(s):

J.A. Adeniji ◽

A.O. Oragwa ◽

U.E. George ◽

U.I. Ibok ◽

T.O.C. Faleye ◽

...

Keyword(s):

Cell Culture ◽

Acute Flaccid Paralysis ◽

Direct Detection ◽

Rna Extraction ◽

Clinical Specimen ◽

Flaccid Paralysis ◽

Surveillance Program ◽

Two Samples ◽

Afp Surveillance ◽

Stool Samples

AbstractsRecently, a reverse transcriptase seminested polymerase chain reaction (RT-snPCR) assay was recommended by the WHO for direct detection of enteroviruses from clinical specimen. In this study, we use the assay and its modification to screen acute flaccid paralysis (AFP) samples previously confirmed negative for enteroviruses by the RD-L20B algorithm.Thirty paired stool suspensions collected in 2015 as part of the national AFP surveillance program in different states of Nigeria were analyzed in this study. The samples were previously confirmed negative for enteroviruses by the polio laboratory in accordance with the WHO recommended RD-L20B cell culture based algorithm. Two samples previously confirmed to contain enteroviruses were included as positive controls. All samples were subjected to RNA extraction, and the RT-snPCR assay and its modifications. All amplicons were sequenced and enteroviruses identified using the enterovirus genotyping tool.Overall, amplicons were recovered from the two controls and 50% (15/30) of samples screened. Fourteen were successfully typed of which, 7.1% (1/14), 21.4% (3/14), 64.3% (9/14) and 7.1% (1/14) were EV-A, EV-B, EV-C and a mixture of EV-B and C (EV-C99 and E25), respectively. The two controls were identified as EV-C99 and CV-A1, both EV-Cs. The PV-2 detected had VP1 ILE143. Hence, a vaccine strain.The results of this study showed that about 50% of enterovirus infections (including some Sabin PV2s) are being missed by the RD-L20B cell culture based algorithm. This highlights the value of the RT-snPCR assay and its modifications. The circulation and preponderance of EV-Cs in Nigeria was also confirmed.

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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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Protecting investments in polio eradication: the past, present and future of surveillance for acute flaccid paralysis

Epidemiology and Infection ◽

10.1017/s0950268804002638 ◽

2004 ◽

Vol 132 (5) ◽

pp. 779-780 ◽

Cited By ~ 3

Author(s):

D. L. HEYMANN ◽

E. M. DE GOURVILLE ◽

R. B. AYLWARD

Keyword(s):

Acute Flaccid Paralysis ◽

Oral Polio Vaccine ◽

Policy Decision ◽

Polio Eradication ◽

Global Policy ◽

Wild Poliovirus ◽

The Road ◽

Polio Vaccine ◽

The Past ◽

Consultation Group

In September 2003 a WHO consultation group on vaccine-derived polioviruses (VDPV) concluded that in order to prevent future generations of paralytic polio after interruption of transmission of wild poliovirus, the use of trivalent oral polio vaccine (OPV) must be stopped [1]. Another important global policy decision along the road to polio eradication thus became possible – cessation of OPV use at some time after eradication. The question now is not whether OPV must be stopped, but rather when.

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Vaccine associated paralytic poliomyelitis cases from children presenting with acute flaccid paralysis in Uganda

Journal of Medical Virology ◽

10.1002/jmv.24285 ◽

2015 ◽

Vol 87 (12) ◽

pp. 2163-2167 ◽

Cited By ~ 1

Author(s):

Mary B. Nanteza ◽

Annet Kisakye ◽

Martin O. Ota ◽

Nicksy Gumede ◽

Josephine Bwogi ◽

...

Keyword(s):

Acute Flaccid Paralysis ◽

Flaccid Paralysis ◽

Paralytic Poliomyelitis

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Acute Flaccid Paralysis surveillance in Polio Eradication and Beyond: Learning from Bangladesh

10.21203/rs.3.rs-680893/v1 ◽

2021 ◽

Author(s):

Humayra Binte Anwar ◽

Yameen Mazumder ◽

Sanjana Nujhat ◽

Bushra Zarin Islam ◽

Anna Kalbarczyk ◽

...

Keyword(s):

Surveillance System ◽

Disease Surveillance ◽

Technical Assistance ◽

Acute Flaccid Paralysis ◽

Grey Literature ◽

Polio Eradication ◽

Flaccid Paralysis ◽

Depth Information ◽

Acute Flaccid Paralysis Surveillance ◽

Afp Surveillance

Abstract IntroductionGlobal Polio Eradication Initiative, GPEI led by the World Health Organization (WHO), helped to develop standard acute flaccid paralysis surveillance (AFP) system worldwide, including Bangladesh, which comprises infrastructure, knowledge, expertise, funding, technical assistance, and trained personnel. AFP surveillance can complement any disease surveillance systems, and many countries are now utilizing these polio surveillance assets for monitoring other vaccine-preventable diseases. This paper outlines how AFP surveillance has evolved in Bangladesh over time, its success and challenging factors, and its potential to accomplish other health goals.MethodologyThis mixed-method study includes a grey literature review, a survey for quantitative and qualitative information on barriers and facilitators, and Key Informant Interviews (KIIs) to gather relevant in-depth information on AFP surveillance in Bangladesh. Grey literature was collected online and paper documentation from different stakeholders. Online and in-person surveys were conducted in six divisions of Bangladesh, including Dhaka, Rajshahi, Rangpur, Chittagong, Sylhet, and Khulna, to map tacit knowledge ideas, approaches, and experiences. KIIs were conducted at global, national, and sub-national levels. Data were then combined on focused emerging themes, including history, challenges, and successes of the AFP surveillance system in Bangladesh.ResultsAFP surveillance in Bangladesh was first introduced in 1990 at the district and Upazila level major hospitals. High population growth, low performance, hard-to-reach areas, and groups of people residing in risky zones were major challenges to implementing this surveillance system. Surveillance was gradually enriched by establishing certification standards and community-based AFP surveillance and improved Surveillance Immunization Medical Officer (SIMO) network activities, laboratory activities, and proper monitoring and evaluation. In Bangladesh, a national disease surveillance system and a laboratory are now being used for multiple diseases, including polio, measles, Japanese Encephalitis, Neonatal Tetanus etc.ConclusionIn Bangladesh, it is evident that the AFP surveillance system is supporting the health system more broadly by building knowledge, experience, and assets and forming a strong platform for other health programs. In addition, its strengths can be leveraged for combating new and emerging diseases like COVID-19. However, the sustainability of the AFP surveillance in Bangladesh still needs collaborative support from partners, mainly technical assistance.

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Vaccineassociated paralytic poliomyelitis and acute flaccid paralysis on some territories of Russia during 20 years

Journal Infectology ◽

10.22625/2072-6732-2019-11-3-102-109 ◽

2019 ◽

Vol 11 (3) ◽

pp. 102-109

Author(s):

N. I. Romanenkova ◽

N. R. Rozaeva ◽

M. A. Bichurina ◽

O. I. Kanaeva ◽

I. G. Chkhyndzheriya

Keyword(s):

Acute Flaccid Paralysis ◽

Flaccid Paralysis ◽

Paralytic Poliomyelitis ◽

Nucleotide Substitutions ◽

Isolation And Identification ◽

Aim Analysis ◽

Genome Region ◽

Poliomyelitis Vaccine ◽

Medical Recommendations ◽

Type 3

Aim: Analysis of the morbidity of vaccine-associated paralytic poliomyelitis and acute flaccid paralysis and the results of virological investigation of the patients on 14 territories of the Russian Federation in 1998-2017. Materials and methods: We investigated nearly 3000 stool samples from paralytic patients and contact persons. Isolation and identification of polioviruses were performed according to WHO recommendations with the help of cell lines RD and L20B. We conducted the sequencing of the genome fragments VP3-VP1, VP1-2A and full sequencing of genome region VP1 of 45 poliovirus strains. Results: From 1998 till 2017 1257 cases of acute flaccid paralysis were registered on 14 territories of Russia, 15 cases of which (1,2%) were classified as vaccine-associated paralytic poliomyelitis. From these patients 9 children were non vaccinated and 6 children received from one to four doses of oral poliomyelitis vaccine. The percentage of the detection of polioviruses from the patients and contact persons in different years was not equal and constituted from 3, 4±0,89% to 9, 5±0,79%. All in all from the patients with acute flaccid paralysis and contact persons we isolated 191 polioviruses, 60 of them belonged to type 1, 55 polioviruses were identified as types 2 and 76 as type 3. Some cases of vaccine-associated paralytic poliomyelitis are described in the article; polioviruses were isolated from all these patients. The sequencing of the genome fragments of 45 poliovirus strains showed that the majority of them had the nucleotide substitutions including neurovirulent substitutions. Conclusion: In order to prevent the risk of the appearance of vaccine-associated paralytic poliomyelitis it is necessary to maintain the high quality of surveillance of poliomyelitis and acute flaccid paralysis, to ensure the 95% coverage of children with poliomyelitis vaccine, to minimize the cases of groundless delays of vaccination according to medical recommendations and parents’ refusals to vaccinate children against poliomyelitis and to respect strictly the National calendar of vaccination.

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Acute flaccid paralysis (AFP) surveillance: challenges and opportunities from 18 years’ experience, Spain, 1998 to 2015

Eurosurveillance ◽

10.2807/1560-7917.es.2018.23.47.1700423 ◽

2018 ◽

Vol 23 (47) ◽

Cited By ~ 5

Author(s):

Josefa Masa-Calles ◽

Nuria Torner ◽

Noemí López-Perea ◽

María de Viarce Torres de Mier ◽

Beatriz Fernández-Martínez ◽

...

Keyword(s):

Acute Flaccid Paralysis ◽

Polio Eradication ◽

Case Definition ◽

Flaccid Paralysis ◽

Notification Rate ◽

Surveillance Network ◽

Challenges And Opportunities ◽

Afp Surveillance ◽

The Mean ◽

Annual Proportion

Acute flaccid paralysis (AFP) surveillance is key for global polio eradication. It allows detecting poliovirus (PV) reintroductions from endemic countries. This study describes AFP surveillance in Spain from 1998 to 2015. During this time, 678 AFP cases were reported to the Spanish National Surveillance Network. The mean notification rate was 0.58 AFP cases/100,000 population under 15 years old (range: 0.45/100,000–0.78/100,000). Two periods (P) are described: P1 (1998–2006) with the AFP notification rate ranging from 0.66/100,000 to 0.78/100,000, peaking in 2001 (0.84/100,000); and P2 (2007–2015) when the AFP rate ranged from 0.43/100,000 to 0.57/100,000, with the lowest rate in 2009 (0.31/100,000). No poliomyelitis cases were caused by wild PV infections, although two Sabin-like PVs and one imported vaccine-derived PV-2 were detected. Overall, 23 (3.4%) cases met the hot case definition. Most cases were clinically diagnosed with Guillain–Barré syndrome (76.9%; 504/655). The adequate stool collection rate ranged from 33.3% (7/21) to 72.5% (29/40). The annual proportion of AFP cases with non-polio enterovirus findings varied widely across the study period. AFP surveillance with laboratory testing for non-polio enteroviruses must be maintained and enhanced both to monitor polio eradication and to establish sensitive surveillance for prompt detection of other enteroviruses causing serious symptoms.

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Controlling polio outbreak due to imported wild poliovirus in Indonesia: A success story

Paediatrica Indonesiana ◽

10.14238/pi49.4.2009.234-43 ◽

2009 ◽

Vol 49 (4) ◽

pp. 234 ◽

Cited By ~ 1

Author(s):

Sumarmo Poorwo Soedarmo ◽

Sidik Utoro

Keyword(s):

Acute Flaccid Paralysis ◽

Polio Eradication ◽

Outbreak Response ◽

Success Story ◽

Wild Poliovirus ◽

First Case ◽

Supplementary Immunization Activities ◽

Stool Samples ◽

Outbreak Response Immunization

Background As a WHO member state, Indonesia is committed toGlobal Polio Eradication. The last indigenous polio case was found in 1995. However, we faced a big challenge with the occurrence of polio outbreak, beginning with a polio case caused by imported wild poliovirus (WPV) type 1 in Sukabumi in 2005. The virus was originated from Sudan and imported to Indonesia through Saudi Arabia. The outbreak ended with totally 305 cases throughout the country. The last one occurred on 20 February 2006 in Aceh Tenggara District, Nanggroe Aceh Darussalam Province. In addition and separated from the WPV type 1 outbreak, in August 2005, four Acute Flaccid Paralysis (AFP) cases with type 1 Vaccine Derived Poliovirus (VDPV) in stool samples were identified in Madura, East Java Province. The first case was on 9 June 2005 and ended with 45 cases in Madura and another case in Probolinggo District, East Jawa.Objective To report a success of controlling outbreak of importedWPV in Indonesia.Methods Outbreak Response Immunization (ORI) and mopup immunization were conducted immediately. To completelystop the transmission, three rounds of National ImmunizationDays (NIDs) were conducted in 2005 (August, September, andNovember). Some more Supplementary Immunization Activities(SIAs) were conducted in 2006 (mop up in January, NIDs inFebruary and early April, mop ups in June and August 2006).For the VDPV outbreak, ORI of 18,880 children in 83 villagestook place during the first week of August, beside three roundsofNIDs in 2005.Results All activities resulted in satisfactorily coverage, whereeach round always exceeded 95%.Conclusions Those activities were conducted successfully andproven to be effective to stop the outbreak. Then again, Indonesia can be a polio free country in the coming years.

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