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

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.

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

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v34i2.9794 ◽

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

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Hospital discharges-based search of acute flaccid paralysis cases 2007–2016 in Italy and comparison with the National Surveillance System for monitoring the risk of polio reintroduction

BMC Public Health ◽

10.1186/s12889-019-7617-0 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Paola Stefanelli ◽

◽

Stefania Bellino ◽

Stefano Fiore ◽

Stefano Fontana ◽

...

Keyword(s):

Surveillance System ◽

Acute Flaccid Paralysis ◽

Polio Eradication ◽

Flaccid Paralysis ◽

National Surveillance ◽

Hospital Discharges ◽

Diagnostic Codes ◽

Northern Regions ◽

Afp Surveillance ◽

National Surveillance System

Abstract Background Acute flaccid paralysis (AFP) surveillance has been adopted globally as a key strategy for monitoring the progress of the polio eradication initiative. Hereby, to evaluate the completeness of the ascertainment of AFP cases in Italy, a hospital-discharges based search was carried out. Methods AFP cases occurring between 2007 and 2016 among children under 15 years of age were searched in the Italian Hospital Discharge Records (HDR) database using specific ICD-9-CM diagnostic codes. AFP cases identified between 2015 and 2016 were then compared with those notified to the National Surveillance System (NSS). Results Over a 10-year period, 4163 hospital discharges with diagnosis of AFP were reported in Italy. Among these, 956 (23.0%) were acute infective polyneuritis, 1803 (43.3%) myopathy, and 1408 (33.8%) encephalitis, myelitis and encephalomyelitis. During the study period, a decreasing trend was observed for all diagnoses and overall the annual incidence rate (IR) declined from 5.5 to 4.5 per 100,000 children. Comparing NSS with HDR data in 2015–2016, we found a remarkable underreporting, being AFP cases from NSS only 14% of those recorded in HDR. In particular, the acute infective polyneuritis cases reported to NSS accounted for 42.6% of those detected in HDR, while only 0.9% of myopathy cases and 13.1% of encephalitis/myelitis/encephalomyelitis cases have been notified to NSS. The highest AFP IRs per 100,000 children calculated on HDR data were identified in Liguria (17.4), Sicily (5.7), and Veneto (5.1) Regions; regarding the AFP notified to the NSS, 11 out of 21 Regions failed to reach the number of expected cases (based on 1/100,000 rate), and the highest discrepancies were observed in the Northern Regions. Overall, the national AFP rate was equal to 0.6, therefore did not reach the target value. Conclusions AFP surveillance data are the final measure of a country’s progress towards polio eradication. The historical data obtained by the HDR have been useful to assess the completeness of the notification data and to identify the Regions with a low AFP ascertainment rate in order to improve the national surveillance system.

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The critical role of acute flaccid paralysis surveillance in the Global Polio Eradication Initiative

International Health ◽

10.1093/inthealth/ihx016 ◽

2017 ◽

Vol 9 (3) ◽

pp. 156-163 ◽

Cited By ~ 10

Author(s):

Rudolf H. Tangermann ◽

Christine Lamoureux ◽

Graham Tallis ◽

Ajay Goel

Keyword(s):

Acute Flaccid Paralysis ◽

Critical Role ◽

Polio Eradication ◽

Flaccid Paralysis ◽

Acute Flaccid Paralysis Surveillance ◽

Global Polio Eradication Initiative

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Evaluation of Acute Flaccid Paralysis Surveillance System in Polio-Free Jordan, 2012

10.2196/preprints.10617.a ◽

2018 ◽

Author(s):

Fatima Zerriouh ◽

M Abdallat ◽

L Ghaffari ◽

I Iblan ◽

K Abusal ◽

...

Keyword(s):

Surveillance System ◽

Acute Flaccid Paralysis ◽

Flaccid Paralysis ◽

Acute Flaccid Paralysis Surveillance

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GUILLAIN BARRE SYNDROME;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.03.708 ◽

2013 ◽

Vol 20 (03) ◽

pp. 348-353

Author(s):

SOHAIL ASHRAF ◽

ARSHALOOZ J. RAHMAN

Keyword(s):

Mechanical Ventilation ◽

Clinical Features ◽

Acute Flaccid Paralysis ◽

Early Recognition ◽

Age Groups ◽

Rapid Onset ◽

Flaccid Paralysis ◽

Initial Symptom ◽

Age Group ◽

Main Factor

Background: Guillian Barre Syndrome is a polyradiculopathy characterized by symmetric ascending paralysis andareflexia. It affects all age groups and both sexes with an unpredictable outcome. Objectives: The aims of this study were to identify thevarious diseases presenting as Acute Flaccid Paralysis and notice clinical features and outcome of cases of Guillian Barre Syndrome.Materials and Methods: Retrospective analysis of 53 patients presenting as Acute Flaccid Paralysis was done. Clinical features andlaboratory investigations of 39 patients of Guillian Barre syndrome were reviewed. Results: Among all cases of Acute Flaccid Paralysis,Guillian Barre syndrome formed the bulk of the cases (73.6%).It was more common in females and in age group of 10 years or below. Inmajority of the cases, rapid onset of weakness was the initial symptom. Mortality was 100% in patients who had respiratory muscleinvolvement and who required mechanical ventilation. Conclusions: In our study the main factor causing death in a case of Guillian Barresyndrome was bulbar involvement requiring mechanical ventilation. Early recognition of the prognostic factors may lead to decreasedmortality in case of Guillian Barre syndrome.

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