Immunization Officer, Pune Municipal Corporation Date : 20.08.2010 2. US Centers for Disease Control and Prevention, Atlanta, Georgia, Correspondence: C. Mbaeyi, US Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS-A04, Atlanta, GA 30333 (. We then calculated the NPAFP rates per 100000 persons aged <15 years for each of the years under review. Lipid ratios representing SCD1, FADS1, and FADS2 activities as candidate biomarkers of early growth and adiposity. The NPAFP rates in areas with access limitations increased during the outbreak years to 5.4 and 7.1 in 2013 and 2014, respectively, and remained above preoutbreak levels in the succeeding years, with rates of 4.6 and 5.2 being reported in 2015 and 2016, respectively. This project was undertaken as part of the process of evaluating improvements in a public health surveillance system and was not considered to be human subjects research. Similarly, identification and reporting of an AFP case within 7 days of paralysis onset is an indicator of the timeliness of the surveillance system; hence, countries are required to identify and report ≥80% of AFP cases within 7 days of paralysis onset in order to meet the benchmark for timeliness [7]. In addition to poliomyelitis, AFP cases may have several other causes, including Guillain-Barré syndrome and transverse myelitis [6]. Surveillance systems for polio have been developed under guidance of the global polio eradication initiative.9 As for now, only four countries that are India, Nigeria, Pakistan and Afghanistan have endemic poliomyelitis, and within these countries the disease is confined to certain areas.10 Pakistan … Among AFP cases reported by VPVs, the mean duration from paralysis onset to notification improved from 5.4 (95% CI, 4.84–5.97) days in 2014 to 3.7 (3.32–4.14) days in 2016 (Table 1). To assess the impact of the VPV program on AFP surveillance, we determined case counts, case-reporting sources, and nonpolio AFP rates in the years before and after program introduction (ie, 2011–2016). Financial support. 9. AFP case counts spiked during the polio outbreak, increasing to 546 and 420 cases during 2013 and 2014, respectively. Your comment will be reviewed and published at the journal's discretion. Despite these challenges, the country successfully interrupted indigenous transmission of wild poliovirus (WPV) in 2002 [17]. All stool specimens collected from reported AFP cases are tested at the Regional Reference Laboratory (RRL) for polio eradication in Islamabad. This article focuses on the contributions of VPVs to strengthening poliovirus surveillance in Somalia by assessing the impact of their activities on key AFP surveillance indicators. In the long run, such a program could help ameliorate deficiencies in the country’s healthcare system for the prevention and control of other diseases of public health significance. Detection of poliovirus circulation is often predicated on the ability to identify AFP cases and test their stool specimens for poliovirus infection in a timely manner. Introduction: Polio has been eliminated from all countries except four, including Pakistan, where polio is still endemic. Of note, the last WPV case identified during the outbreak was reported by a VPV working in the Northeast zone of the country. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention. Security & surveillance in Pakistan July 2015 www.privacyinternational.org. Environmental surveillance (ES) can detect circulating polioviruses from sewage without relying on clinical presentation. Timeliness of reporting standards, pegged at ≤7 days from paralysis onset, declined steeply from 90% to 70% in 2013, mostly owing to intensified surveillance activities and late reporting of cases that were previously undetected by the surveillance system. Flanagan P, O’Lorcain P, Cotter S, et al. Bannu due to its geographical location stands out to be one of highest risk areas for Poliomyelitis. Acute flaccid paralysis (AFP) surveillance was introduced in Pakistan in 1995, and by 1998, staff in all provinces were trained in AFP surveillance and were sending monthly case reports to the Expanded Program on Immunization (EPI) office. During 2011–2016, there was significant variation in AFP case counts and the NPAPF rates in Somalia. Acute Flaccid Paralysis (AFP) Surveillance of polio virus in Pakistan is a systematic collection, analysis and interpretation of data and the dissemination of information. Stool specimen adequacy rates have been consistently high, and AFP cases have been detected in a timelier manner since the program was introduced. The best available method to confirm the diagnosis of poliomyelitis is the isolation and identification of poliovirus from the stool. Much of this success is predicated on the ability of countries to track and detect the emergence of new polio cases in places with active circulation of WPV based on surveillance for AFP cases. We stratified our results by year to decipher trends in timeliness of reporting when comparing AFP cases by reporting source. Oxford University Press is a department of the University of Oxford. The VPV program has contributed significantly to improved surveillance for AFP cases in Somalia. The Village Polio Volunteers (VPV) program was established in 2013 in a bid to strengthen polio eradication activities in Somalia, including AFP surveillance, given the country’s vulnerability to polio outbreaks. Introduction of the VPV program in the middle of the 2013–2014 polio outbreak in Somalia not only helped facilitate efforts to interrupt the outbreak, which ended in August 2014 [26], it has also ensured sustenance of a number of measures taken to strengthen AFP surveillance activities by the national polio program. Among AFP cases with known reporting sources, VPVs accounted for 40% of the 279 cases reported in 2015, a high among reporting sources. Tracking and reporting AFP cases is an effective method for detecting poliovirus circulation in a specified geographic area, since paralysis due to poliovirus infection can only be confirmed by testing stool specimens taken from AFP cases [7]. The VPV program, a community-based program, was established to enhance polio eradication activities in Somalia by strengthening surveillance and improving vaccination coverage in local communities. The subsequent occurrence of 2 large polio outbreaks during 2005–2007 [18] and 2013–2014 [19, 20] underscores the continued vulnerability of the country to reintroduction of WPV. To determine whether there were any differences in these key indicators by reporting source, we compared the adequacy of stool specimens and timeliness of reporting rates of AFP cases reported by VPVs with those reported by all other sources during 2014–2016, using χ2 tests. No significant difference was found when comparing the timeliness of AFP cases reported within 7 days by VPVs (86.0%) and those reported by other sources (84.8%) during 2014–2016. Abbreviation: AFP, acute flaccid paralysis. Background More than 99% of poliovirus infections are non-paralytic and therefore, not detected by acute flaccid paralysis (AFP) surveillance. In the near term, this improvement enhances the ability of the country’s polio program to detect and respond to new polio outbreaks, albeit limited by the reliance of AFP surveillance on the emergence of paralytic polio cases to determine the circulation of poliovirus in an area. Pakistan’s polio crisis represents one of the last hurdles in a 23-year campaign run by the World Health Organization. Polio is reported through three systems: Acute Flaccid Paralysis (AFP) surveillance system, Disease Early Warning System (DEWS) and Health Management Information System (HMIS). To determine the contributions of VPVs to AFP case detection, we calculated overall case counts and proportions during 2011–2016, categorized by reporting source. 8. The programme is able to identify where the polio virus is circulating through its highly sensitive surveillance activities. Each case of AFP acts as a signal to the polio surveillance system where polio is circulating and who it is likely to affect. For more information on surveillance activities, see the photo essay: “The journey of a stool sample: Understanding polio surveillance”, EPI Building, Block-D, Prime Minister's Health Complex, Chak Shahzad, 44000, Islamabad, Acute Flaccid Paralysis (AFP) Surveillance, Testing Stool Surveys From Healthy Children, “The journey of a stool sample: Understanding polio surveillance”. WHO recommends that ≥80% of stool specimens arriving in the laboratory must be adequate. Through case search methods, such as house-to-house and healthcare facility visits, VPVs identify incident AFP cases using an active surveillance model to support routine reporting from public facilities and private healthcare providers. Surveillance for cases of acute flaccid paralysis (AFP) is a key strategy adopted for the eradication of polio. The Global Polio Eradication Initiative (GPEI) has made tremendous gains in the last 28 years, with over 99% reduction in wild poliovirus (WPV) [1,2,3].Poliomyelitis is characterized by sudden weakness or floppy paralysis of any of the limbs, most especially in children [4,5,6,7,8].Acute flaccid paralysis (AFP) surveillance is the gold standard for poliomyelitis control and prevention. The programme conducts periodic stool surveys among children from high risk populations who may be carrying the poliovirus without any signs of paralysis, or wherein circulation has been difficult to detect through regular AFP surveillance. We limited our analyses to districts with security and access limitations during the period under review. Please check for further notifications by email. AFP Surveillance Dr. Sunil A. Tore M.B.B.S., D.P.H.,D.H.A., M.I.P.H.A. Cameroun WORLD - WILD POLIO VIRUS CASES - 2010 577 CASES IN 15 COUNTRIES Pakistan Afghanistan Countries Wild cases 2010 India 25 Afghanistan 12 Angola 16 Pakistan 31 Tajikistan 437 … VPVs accounted for only 2% of reported cases in 2013, having begun their activities in September of the same year. Just as GPEI manpower resources have played a crucial role in strengthening laboratory, disease surveillance, and outbreak response capacity in many countries in Africa [29, 35–37], VPV program assets could eventually transition into broader roles aimed at surveilling and preventing other vaccine-preventable and endemic diseases, such as measles and malaria. More than 500 VPVs are currently operational in all 4 geopolitical zones of Somalia (Central, Northeast, Northwest, and South). AFP case-reporting in areas in Somalia with access limitations, 2011–2016. Pakistan is one such co… Acknowledgments. Clinicians must follow all cases of AFP for a minimum of 60 days and correlate with virus intra-typing. We also compared the stool specimen adequacy rates and timeliness of cases reported by VPVs to those reported by other sources. Somalia has been embroiled in a protracted civil war since 1991 [16]. The country’s healthcare system has been severely weakened by political crisis, and, as a result, the delivery of immunization services lags considerably behind recommended global standards. No significant differences were observed in the adequacy of samples collected from cases reported by VPVs compared with those reported by other sources, including more experienced polio program staff. 2011 and 2012 ( Figure 2 ) the journal 's discretion for the first time the timeliness cases. Child mortality rates that were decreasing at a lower-than-expected rate clash with jihadists: ministry tested at journal. 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