scholarly journals Clinico-Epidemiological Study of Acute Flaccid Paralysis at a Tertiary Centre

2014 ◽  
Vol 34 (2) ◽  
pp. 104-110
Author(s):  
Shipra Chaudhary ◽  
Nisha Keshary Bhatta ◽  
Basudha Khanal ◽  
Rabin Bhandari ◽  
Rupa Rajbhandari Singh
Keyword(s):  
Respiratory Failure ◽  
Acute Flaccid Paralysis ◽  
Autonomic Failure ◽  
Polio Eradication ◽  
Case Definition ◽  
Flaccid Paralysis ◽  
Eastern Region ◽  
Tertiary Centre ◽  
Significant Difference ◽  
Afp Surveillance

Objectives: To study the clinico-epidemiological profile of different causes of Acute Flaccid Paralysis (AFP) including Acute Encephalitis Syndrome (AES) and their associated co-morbidities. Methodology: A prospective hospital-based study was carried out including all cases fulfilling AFP case definition. History, clinical examination, necessary investigations were performed and required treatment given. Regular follow-ups were done and final classification made alongwith AFP surveillance team. Results: Out of 43 children included in the study, 18 expired and 25 completed follow-up. Final classification showed 53.5% AES, 9.3% Guillain Barre Syndrome (GBS), 9.3% dyselectrolytemia, 9.3%, peripheral neuritis, 7% Non-Polio Entero Virus (NPEV) and 11.6% others. Fever, altered sensorium and convulsions were present in 79.1%, 65.1% and 58.1% respectively. Eighty-four percent had asymmetrical paralysis with quadriparesis in 72%. Cerebrospinal fluid was abnormal in 34.9%. Japanese encephalitis serology was positive in 4.7%.  The mean GCS was 9.53±4.27 with a significant difference between survivors and non-survivors (p=0.02). Almost half (52.2%) required ICU care, of which 14 expired (p=0.005). Seventeen children needed mechanical ventilation, of which 13 died (p<0.001). Requirement of inotropes and complications like respiratory failure and autonomic failure were significantly related to death. Conclusion: AES, being one of the commonest causes of AFP, should be included in AFP surveillance. Poor GCS, requirement of inotropes, complications like respiratory failure and autonomic failure are related with poor prognosis. This study also helped in national surveillance of AFP cases in the eastern region and the target to achieve polio eradication in our country.doi: http://dx.doi.org/10.3126/jnps.v34i2.9794J Nepal Paediatr Soc 2014;34(2):104-110 

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

2018 ◽  
Vol 23 (47) ◽  
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.

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

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.

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

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.

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

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.

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

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.

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

2012 ◽  
Vol 78 (15) ◽  
pp. 5406-5409 ◽  
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.

scholarly journals Two-Source Capture-Recapture Method to Estimate the Incidence of Acute Flaccid Paralysis in the Marches Region (Italy)

2020 ◽  
Vol 17 (24) ◽  
pp. 9400
Author(s):  
Pamela Barbadoro ◽  
Aurora Luciani ◽  
Matteo Ciotti ◽  
Marcello D’Errico ◽  
Keyword(s):  
Surveillance System ◽  
Acute Flaccid Paralysis ◽  
Critical Role ◽  
Age Groups ◽  
Polio Eradication ◽  
Flaccid Paralysis ◽  
Incidence Estimate ◽  
Common Diagnosis ◽  
Significant Difference ◽  
Capture Recapture

A combination of high infant immunization coverage and surveillance of acute flaccid paralysis (AFP) cases, plays a critical role in polio eradication. This study aimed to estimate the incidence of AFP, to evaluate the completeness of AFP ascertainment during the years, age groups and gender, and to define the main associated diagnosis among children aged under 15 in the Marches region of Italy. Analysis was performed on data from the active AFP surveillance system and the hospital discharge records in the 2006–2014 period. The two-source capture-recapture method was applied. After cross-validation, 30 AFP compatible conditions as defined by the WHO were identified, with an incidence estimate of 1.91 cases of AFP per 100,000 children under 15 years (95% CI = 1.4–2.6/100,000). Guillain–Barrè syndrome was the most common diagnosis. A significant difference (p < 0.05) has been registered in the estimated probability of case ascertainment in females. The reasons for the lower reporting of cases in females are unknown. Specific research and the implementation of a more sensitive surveillance system are essential in verifying potential inequalities and to succeed in the polio eradication initiative.

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

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Maureen Anyanwu
Keyword(s):  
Surveillance System ◽  
Disease Surveillance ◽  
Acute Flaccid Paralysis ◽  
Case Definition ◽  
Operating Conditions ◽  
Flaccid Paralysis ◽  
Cold Chain ◽  
Acute Flaccid Paralysis Surveillance ◽  
Afp Surveillance ◽  
The Mean

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

scholarly journals Cases of Acute Flaccid Paralysis Associated with Coxsackievirus A2: Findings of a 20-Year Surveillance in the Russian Federation

2022 ◽  
Vol 10 (1) ◽  
pp. 112
Author(s):  
Olga E. Ivanova ◽  
Armen K. Shakaryan ◽  
Nadezhda S. Morozova ◽  
Yulia A. Vakulenko ◽  
Tatyana P. Eremeeva ◽  
...  
Keyword(s):  
Acute Flaccid Paralysis ◽  
Laboratory Data ◽  
Foot And Mouth Disease ◽  
Polio Eradication ◽  
Vaccination Schedule ◽  
Flaccid Paralysis ◽  
Global Polio Eradication Initiative ◽  
Afp Surveillance ◽  
Stool Samples ◽  
The Russian Federation

Surveillance for acute flaccid paralysis syndrome (AFP) in children under 15 is the backbone of the Global Polio Eradication Initiative. Laboratory examination of stool samples from AFP cases allows the detection of, along with polioviruses, a variety of non-polio enteroviruses (NPEV). The etiological significance of these viruses in the occurrence of AFP cases has been definitively established only for enteroviruses A71 and D68. Enterovirus Coxsackie A2 (CVA2) is most often associated with vesicular pharyngitis and hand, foot and mouth disease. Among 7280 AFP cases registered in Russia over 20 years (2001–2020), CVA2 was isolated only from five cases. However, these included three children aged 3 to 4 years, without overt immune deficiency, immunized with 4–5 doses of poliovirus vaccine in accordance with the National Vaccination Schedule. The disease resulted in persistent residual paralysis. Clinical and laboratory data corresponded to poliomyelitis developing during poliovirus infection. These findings are compatible with CVA2 being the cause of AFP. Molecular analysis of CVA2 from these patients and a number of AFP cases in other countries did not reveal association with a specific phylogenetic group, suggesting that virus genetics is unlikely to explain the pathogenic profile. The overall results highlight the value of AFP surveillance not just for polio control but for studies of uncommon AFP agents.

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