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

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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Detection of non-polio and polio enteroviruses in Acute Flaccid Paralysis surveillance in Turkey

Acta Microbiologica et Immunologica Hungarica ◽

10.1556/030.2021.01353 ◽

2021 ◽

Author(s):

Gulay Korukluoglu ◽

Umit Ozdemirer ◽

Fatma Bayrakdar ◽

Zehra Unal ◽

Yasemin Cosgun ◽

...

Keyword(s):

Acute Flaccid Paralysis ◽

Flaccid Paralysis ◽

Sequencing Analysis ◽

National Data ◽

Polio Virus ◽

Vaccination Rates ◽

Acute Flaccid Paralysis Surveillance ◽

Polio Vaccination ◽

Afp Surveillance ◽

Comprehensive Study

AbstractPoliomyelitis was a disease feared worldwide, striking suddenly and paralysing mainly children for life. Monitoring of suspected cases of poliomyelitis is carried out with Acute Flaccid Paralysis (AFP) surveillance in Turkey. This study examines national data of AFP surveillance and the epidemiology of enteroviruses (EV) in Turkey from 2000 to 2019 and gives an overview of the detected serotypes of EVs. A total of 13,640 samples collected from patients with 5216 AFP pre-diagnosed cases (2 samples from each patient) and 3,208 contacts, during a 20-year period (2000–2019) were investigated. All isolated polioviruses were tested for their wild or vaccine origin according to the WHO recommended protocol by PCR and sequencing analysis were performed. Enterovirus positivity was detected in a total of 915 cases, which were identified as 204 Sabin-like polio virus (SLPV) and 711 non-polio enterovirus (NPEV). Of the 204 SLPV, 141 (69.1%) AFP were detected in patients and 63 (30.9%) were detected in samples taken from their contacts. Of the 711 NPEVs, 516 (72.5%) were from AFP cases and 195 (27.5%) were detected in samples taken from their contacts. It is concluded that the reason for the higher detection rate of NPEV in samples from AFP pre-diagnosed cases is attributed to the polio vaccination rates reaching 97% between 2008 and 2019 in Turkey. The most frequently detected NPEV serotypes were Coxackie A24, B3, and Echo 30. This retrospective study is the first comprehensive study in Turkey to evaluate the results of the AFP surveillance in the last 20 years.

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Enterovirus D68 Subclade B3 Circulation in Senegal, 2016: Detection from Influenza-like Illness and Acute Flaccid Paralysis Surveillance

Scientific Reports ◽

10.1038/s41598-019-50470-z ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Amary Fall ◽

Ndack Ndiaye ◽

Mamadou Malado Jallow ◽

Mamadou Aliou Barry ◽

Cheikh Saad Bou Touré ◽

...

Keyword(s):

Active Surveillance ◽

Acute Flaccid Paralysis ◽

Flaccid Paralysis ◽

Influenza Like Illness ◽

Acute Flaccid Paralysis Surveillance ◽

Afp Surveillance ◽

Enterovirus D68 ◽

Low Levels ◽

Respiratory Specimens ◽

Children Under 5

Abstract Following the 2014 outbreak, active surveillance of the EV-D68 has been implemented in many countries worldwide. Despite subsequent EV-D68 outbreaks (2014 and 2016) reported in many areas, EV-D68 circulation remains largely unexplored in Africa except in Senegal, where low levels of EV-D68 circulation were first noted during the 2014 outbreak. Here we investigate subsequent epidemiology of EV-D68 in Senegal from June to September 2016 by screening respiratory specimens from ILI and stool from AFP surveillance. EV-D68 was detected in 7.4% (44/596) of patients; 40 with ILI and 4 with AFP. EV-D68 detection was significantly more common in children under 5 years (56.8%, p = 0.016). All EV-D68 strains detected belonged to the newly defined subclade B3. This study provides the first evidence of EV-D68 B3 subclade circulation in Africa from patients with ILI and AFP during a 2016 outbreak in Senegal. Enhanced surveillance of EV-D68 is needed to better understand the epidemiology of EV-D68 in Africa.

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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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ACUTE FLACCID PARALYSIS SURVEILLANCE SYSTEM: CURRENT STATUS IN AZAD JAMMU & KASHMIR- 2018

Pakistan Journal of Public Health ◽

10.32413/pjph.v9i2.316 ◽

2019 ◽

Vol 9 (2) ◽

pp. 54-56

Author(s):

Syed Nadeem-ur-Rehman ◽

Uzma Hafeez ◽

Mumtaz Ahmad Khan ◽

Masood Ahmad Bukhari

Keyword(s):

Surveillance System ◽

Disease Surveillance ◽

Acute Flaccid Paralysis ◽

Case Definition ◽

Flaccid Paralysis ◽

Current Status ◽

Adjacent Area ◽

Surveillance Systems ◽

Acute Flaccid Paralysis Surveillance ◽

Afp Surveillance

Background: The State of Azad Jammu & Kashmir (AJ&K) is polio free since October 2000.The objectives of our study is to review of existing Acute Flaccid Paralysis Surveillance System in Azad Jammu &Kashmir, identify the strong & weak points of the existing system and suggest course of action for efficient performance of the existing system. Methods: This qualitative & quantitative evaluation was conducted at Provincial Disease Surveillance &Response Unit (PDSRU) Muzaffarabad Azad Jammu & Kashmir during March -April 2019. The database of AFP cases during 2018 was reviewed and relevant stakeholder's interviews were conducted consulting guidelines formulated by the Centre for Disease Control & prevention(CDC) in 2001 for Evaluating Public Health Surveillance Systems. Results: In 2018, a total of 265 AFP cases were registered. The mean age was 65 months (range 01 - 180 months). 59 % (n=157) were male children. 58% of cases were under 05 year's age. Standardized case definition and data format with simple information flow was found. System was flexible enough to incorporate measles and neonatal tetanus cases since 2009. Data quality was excellent (100% zero and monthly reports). A close coordination was observed amongst all relevant stakeholders. Sensitivity was 200%. No polio case was identified and therefore, PPV was zero. Majority of cases were reported by public sector (93%).Sufficient financial as well as skilled human resources were available and hence system found stable. Timeliness of reporting found 90%. Conclusion: The performance of AFP surveillance system in AJ&K is up to the mark. However, there is constant threat of reintroduction of polio virus from adjacent area of Punjab & Khyber Pakhtunkhwa provinces. Highly vigilant AFP surveillance system with capacity of rapid response is the solution. Furthermore, it is vital to sustain the AFP Surveillance till the goal of global polio eradication is achieved.

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Evaluation of Acute Flaccid Paralysis Surveillance indicators in Sokoto State, Nigeria, 2012-2019: A secondary data analysis

10.21203/rs.3.rs-117324/v1 ◽

2020 ◽

Author(s):

Ismail Abdullateef Raji ◽

Auwal Abubakar Usman ◽

Abdulrahman Ahmad ◽

Saheed Gidado ◽

Abdulhakeem Abayomi Olorukooba ◽

...

Keyword(s):

Acute Flaccid Paralysis ◽

Secondary Data ◽

High Sensitivity ◽

Flaccid Paralysis ◽

World Health ◽

Surveillance Network ◽

Polio Virus ◽

Acute Flaccid Paralysis Surveillance ◽

Afp Surveillance ◽

Health Organization

Abstract Background: Nigeria and indeed, entire Africa has been certified free of Wild Polio Virus (WPV) in 2020. However, the continent is still at risk of importation of WPV, especially in states like Sokoto in Nigeria, which has an international border. Furthermore, due to low immunity in some communities in Sokoto, outbreaks of the circulating Vaccine Derived Polio Virus (cVDPV) occur. Therefore, this paper evaluates the Acute Flaccid Paralysis (AFP) surveillance indicators in Sokoto state, Nigeria. Methods: This 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.Results: Cumulatively, 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%) 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.Conclusions: Sokoto 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.

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Retrospective Analysis of Six Years of Acute Flaccid Paralysis Surveillance and Polio Vaccine Coverage Reported by Italy, Serbia, Bosnia and Herzegovina, Montenegro, Bulgaria, Kosovo, Albania, North Macedonia, Malta, and Greece

Vaccines ◽

10.3390/vaccines10010044 ◽

2021 ◽

Vol 10 (1) ◽

pp. 44

Author(s):

Stefano Fontana ◽

Gabriele Buttinelli ◽

Stefano Fiore ◽

Concetta Amato ◽

Marco Pataracchia ◽

...

Keyword(s):

Acute Flaccid Paralysis ◽

Vaccine Coverage ◽

Laboratory Data ◽

Vaccine Uptake ◽

Flaccid Paralysis ◽

Data Management System ◽

Reference Laboratory ◽

Polio Vaccine ◽

Acute Flaccid Paralysis Surveillance ◽

Afp Surveillance

Here we analyzed six years of acute flaccid paralysis (AFP) surveillance, from 2015 to 2020, of 10 countries linked to the WHO Regional Reference Laboratory, at the Istituto Superiore di Sanità, Italy. The analysis also comprises the polio vaccine coverage available (2015–2019) and enterovirus (EV) identification and typing data. Centralized Information System for Infectious Diseases and Laboratory Data Management System databases were used to obtain data on AFP indicators and laboratory performance and countries’ vaccine coverage from 2015 to 2019. EV isolation, identification, and typing were performed by each country according to WHO protocols. Overall, a general AFP underreporting was observed. Non-Polio Enterovirus (NPEV) typing showed a high heterogeneity: over the years, several genotypes of coxsackievirus and echovirus have been identified. The polio vaccine coverage, for the data available, differs among countries. This evaluation allows for the collection, for the first time, of data from the countries of the Balkan area regarding AFP surveillance and polio vaccine coverage. The need, for some countries, to enhance the surveillance systems and to promote the polio vaccine uptake, in order to maintain the polio-free status, is evident.

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

10.21203/rs.3.rs-23557/v1 ◽

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 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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