Materiały źródłowe

• #1 Surveillance of acute flaccid paralysis – Canada.ca

  https://www.canada.ca/en/public-health/services/surveillance/acute-flaccid-paralysis.html

  Acute flaccid paralysis (AFP) is defined as the sudden onset of muscle weakness or paralysis. In Canada, we conduct surveillance of AFP in children less than 15 years old. […] Surveillance of acute flaccid paralysis (AFP) in Canada is a collaborative effort between the Public Health Agency of Canada and the Canadian Paediatric Society, through the Canadian Acute Flaccid Paralysis Surveillance System (CAFPSS). The surveillance system monitors for all forms of AFP. […] As AFP is a characteristic of polio, the purpose of national AFP surveillance is to ensure prompt, appropriate investigation of AFP cases to rule out the possibility of poliovirus infection. Canada was declared polio-free in 1994 however, active monitoring for possible cases is crucial to ensuring the safety of all Canadians.

• #2 WHO EMRO | Surveillance | About eradication | Polio Eradication

  https://www.emro.who.int/polio-eradication/about-eradication/surveillance.html

  Quality surveillance is foundational to the polio eradication initiative. Surveillance both detects the presence of poliovirus and informs the programmes actions typically, whether to launch a vaccination campaign in response to disease detection, and if so, what sort of campaign. […] As the world moves closer to polio eradication, surveillance becomes ever more important: the final determination to certify the Eastern Mediterranean Region free of wild poliovirus will rest on the basis of surveillance data. […] Accordingly, in the Region, the worlds last with transmission of wild poliovirus, the programme directs a significant amount of funding and expertise into the establishment, maintenance and improvement of polio surveillance networks. […] Polio surveillance is the practice of exhaustively searching for poliovirus in its only known reservoir humans. This happens two ways: through surveillance for acute flaccid paralysis (AFP), the primary symptom of poliomyelitis infection, and through surveillance of sewage outflow, to search for virus that has been shed in the stool of infected people. […] AFP surveillance is known as the gold standard of polio surveillance, but environmental surveillance has an increasingly important role in the Region. For both practices, there are a set of clear surveillance indicators that must be met.

• #3

  https://www.cdc.gov/Mmwr/preview/mmwrhtml/mm5347a5.htm

  Any disease eradication initiative relies on sensitive and timely surveillance. Such surveillance is especially challenging for polio eradication, because only one of every 200 poliovirus infections results in clinically apparent paralytic disease. To ensure that paralytic polio cases will be detected if they occur, countries conduct surveillance for all AFP by using a standard case definition. All cases identified are tested to determine whether paralysis is caused by poliovirus infection. The quality of AFP surveillance is measured by using a standard definition for sensitivity and completeness, as follows: A rate of one or more nonpolio AFP cases per 100,000 population aged 15 years with timely collection of specimens indicates that surveillance is sensitive enough to detect polio and allows comparison of AFP reporting completeness among and within countries.

• #4 Understanding Paralysis: Prevalence, Causes, and Advances in Rehabilitation – Myolyn

  https://myolyn.com/incidence-and-prevalence-of-paralysis-myolyn/

  Paralysis affects millions of Americans and its effects are a significant public health concern. According to the 2013 U.S. Paralysis Prevalence and Health Disparities Survey, approximately 5.4 million people or about 1 in every 50 live with some form of paralysis. […] After stroke, patients may present with full or partial paralysis. Current research suggests that 35% of survivors with initial paralysis in the leg will not regain meaningful function, and 20-25% will not be able to return to walking without full assistance. […] SCIs are typically categorized as complete or incomplete an incomplete SCI means that there is some sensory or motor function below the level of injury, while a complete SCI indicates a complete loss of motor and sensory function below the level of injury. Estimates indicate that 46.8% of spinal cord injuries are categorized as incomplete tetraplegia, 20.1% are complete paraplegia, 19.7% are incomplete paraplegia, and 12.8% are complete tetraplegia. […] Complete paralysis in people with MS is rare, but it is estimated that about a third of people will develop some form of paralysis. More commonly, around 70% of people with MS experience significant and widespread muscle weakness (categorized as partial paralysis or paresis).

• #5

  https://www.cdc.gov/Mmwr/preview/mmwrhtml/mm5347a5.htm

  Since the 1988 World Health Assembly resolution to eradicate poliomyelitis, the number of countries where polio is endemic has decreased from 125 in 1988 to six at the end of 2003. As part of the eradication strategy, a global surveillance system was established to 1) identify acute flaccid paralysis (AFP) cases in children aged 15 years and 2) deploy a network of accredited laboratories to perform virologic testing of stool specimens to determine whether the paralysis resulted from poliovirus infection. This report describes the status of global AFP surveillance, including its expansion or use as a model in 131 (66%) of 198 countries for the reporting of measles and other vaccine-preventable diseases. As poliomyelitis is eradicated, AFP surveillance systems in these and other countries might be further expanded and adapted to improve the detection of and response to other diseases.

• #6 Surveillance – GPEI

  https://polioeradication.org/what-we-do/

  Polio surveillance underpins the entire polio eradication initiative. Without surveillance, it would be impossible to pinpoint where and how poliovirus is still circulating. Polio surveillance identifies new cases and detects any circulation of poliovirus. […] Nationwide AFP (acute flaccid paralysis) surveillance is the gold standard for detecting cases of poliomyelitis. […] Environmental surveillance involves testing sewage or other environmental samples for the presence of poliovirus. Environmental surveillance often confirms wild poliovirus infections in the absence of cases of paralysis. […] The number of AFP cases reported each year is used as an indicator of a countrys ability to detect polio even in countries where the disease no longer occurs. A countrys surveillance system needs to be sensitive enough to detect at least one case of AFP for every 100 000 children under 15 even in the absence of polio.

• #7

  https://www.cdc.gov/Mmwr/preview/mmwrhtml/mm5347a5.htm

  Any disease eradication initiative relies on sensitive and timely surveillance. Such surveillance is especially challenging for polio eradication, because only one of every 200 poliovirus infections results in clinically apparent paralytic disease. To ensure that paralytic polio cases will be detected if they occur, countries conduct surveillance for all AFP by using a standard case definition. All cases identified are tested to determine whether paralysis is caused by poliovirus infection. The quality of AFP surveillance is measured by using a standard definition for sensitivity and completeness, as follows: A rate of one or more nonpolio AFP cases per 100,000 population aged 15 years with timely collection of specimens indicates that surveillance is sensitive enough to detect polio and allows comparison of AFP reporting completeness among and within countries.

• #8 Surveillance Indicators – GPEI

  https://www.archive.polioeradication.org/polio-today/polio-now/surveillance-indicators/

  Nationwide AFP (acute flaccid paralysis) surveillance is the gold standard for detecting cases of poliomyelitis. […] Environmental surveillance involves testing sewage or other environmental samples for the presence of poliovirus. Environmental surveillance often confirms wild poliovirus infections in the absence of cases of paralysis. […] At least one case of non-polio AFP should be detected annually per 100 000 population aged less than 15 years. In endemic regions, to ensure even higher sensitivity, this rate should be two per 100 000. […] All AFP case specimens must be processed in a WHO-accredited laboratory within the Global Polio Laboratory Network (GPLN).

• #9 Evaluation of the Acute flaccid paralysis surveillance indicators in Zambia from 2015–2021: a retrospective analysis | BMC Public Health | Full Text

  https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-023-17141-1

  This paper therefore evaluates the seven-year (20152021) performance of the AFP surveillance system in Zambia and identifies areas that require improvement for action to maintain a polio-free Zambia. […] The WHO established minimum performance indicators that are used to assess and maintain the quality of AFP surveillance system. […] The findings indicated that, the average annualised non-polio AFP rate over the seven years was 4.40 per 100,000 population of15 years of age with 6.4 in 2015 and 4.1 in 2021, which are far above the WHO recommended value of 2.0 per 100,000 population of15 years of age. […] This highlights the sensitivity of the surveillance system and likelihood of detecting a poliovirus in the country if it is reintroduced. […] These gaps could result in a missed opportunity to detect ongoing poliovirus transmission in those districts and highlights the need to continue to support and strengthen AFP surveillance at all levels.

• #10 Evaluation of acute flaccid paralysis surveillance indicators in Sokoto state, Nigeria, 2012–2019: a secondary data analysis | BMC Public Health | Full Text

  https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11238-1

  The funding of the AFP surveillance System in Sokoto State is by the federal government, Sokoto state government, and LGAs with robust technical and financial support by development partners notably, WHO and Centers for Disease Control and Prevention (CDC) / Africa Field Epidemiology Network (AFENET). […] We evaluated the AFP performance using the WHO indicators for assessing the AFP surveillance system. […] The non-polio AFP rate and the stool adequacy rate are used as the standard for assessing the quality of AFP surveillance. These two indicators can be combined into a single indicator of AFP surveillance quality, the surveillance index, which can be used to compare progress over time and or geographic differences. […] The AFP Surveillance system in Sokoto State has performed well over the past eight years by exceeding most of the minimum WHO targets both at the state and LGA levels. The system is sensitive enough to detect any outbreak of wild or circulating polio virus.

• #11 Community-Based Surveillance of Acute Flaccid Paralysis: A Review on Detection and Reporting Strategy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11842678/

  Surveillance is the cornerstone for eliminating polio, halting the virus’s spread, and identifying its transmission. Polio surveillance tasks encompass thorough inspections of each residence, monitoring any changes in health trends, overseeing illness prevention initiatives, and managing reactions to outbreaks. There are two different kinds of polio surveillance: Environmental surveillance (ES) and acute flaccid paralysis (AFP). […] The AFP surveillance process includes both health facility and community-based approach to identify and monitor poliovirus (PV) circulation. […] Community-based surveillance (CBS), on the other hand, leverages community volunteers (CVs) and local leaders to identify AFP cases through active case screening. This process involves detecting, reporting, investigating, and initiating response actions, ensuring that even hard-to-reach communities are effectively monitored and addressed.

• #12 WHO EMRO | Surveillance | About eradication | Polio Eradication

  https://www.emro.who.int/polio-eradication/about-eradication/surveillance.html

  Quality surveillance is foundational to the polio eradication initiative. Surveillance both detects the presence of poliovirus and informs the programmes actions typically, whether to launch a vaccination campaign in response to disease detection, and if so, what sort of campaign. […] As the world moves closer to polio eradication, surveillance becomes ever more important: the final determination to certify the Eastern Mediterranean Region free of wild poliovirus will rest on the basis of surveillance data. […] Accordingly, in the Region, the worlds last with transmission of wild poliovirus, the programme directs a significant amount of funding and expertise into the establishment, maintenance and improvement of polio surveillance networks. […] Polio surveillance is the practice of exhaustively searching for poliovirus in its only known reservoir humans. This happens two ways: through surveillance for acute flaccid paralysis (AFP), the primary symptom of poliomyelitis infection, and through surveillance of sewage outflow, to search for virus that has been shed in the stool of infected people. […] AFP surveillance is known as the gold standard of polio surveillance, but environmental surveillance has an increasingly important role in the Region. For both practices, there are a set of clear surveillance indicators that must be met.

• #13 WHO EMRO | Surveillance | About eradication | Polio Eradication

  https://www.emro.who.int/polio-eradication/about-eradication/surveillance.html

  The polio programme relies on a vast network of health care workers, traditional healers, pharmacists and community leaders around the Region to look for, and report, any case of AFP in their community. […] The main sign or symptom of poliomyelitis, the disease caused by poliovirus, is acute flaccid paralysis (AFP). This is mainly seen in children below 15 years of age. […] Accordingly, the goal of AFP surveillance is to detect, report and investigate all AFP cases so that poliomyelitis can be ruled out as the cause of the paralysis. […] Environmental surveillance involves testing sewage runoff for the presence of poliovirus. Because the majority of cases of poliomyelitis are asymptomatic, but all infected people shed virus in their stool, environmental surveillance has the benefit of allowing us to detect the presence of polio in an area before any case of paralysis appears. […] In places that are polio-free, regular environmental surveillance allows us to detect any new emergence or international spread of polioviruses a significant threat until polio is eradicated.

• #14 Surveillance of acute flaccid paralysis – Canada.ca

  https://www.canada.ca/en/public-health/services/surveillance/acute-flaccid-paralysis.html

  AFP remains a rare, but serious condition. More than 150 countries have reported cases of non-polio AFP to the World Health Organization in 2017. For the same year, over 100 000 cases have been reported worldwide in children less than 15 years of age for an annual rate of approximately five cases per 100 000 population. […] In the Region of the Americas, 22 countries conduct AFP surveillance. In 2017, the rate of AFP in the Americas was about one case per 100 000 population in children less than 15 years old.

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

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6341937/

  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.

• #16 Evaluation of the Acute flaccid paralysis surveillance indicators in Zambia from 2015–2021: a retrospective analysis | BMC Public Health | Full Text

  https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-023-17141-1

  The resurgence of poliovirus infection in previously polio free regions and countries calls for renewed commitment to the global polio eradication efforts including strengthening of Acute Flaccid Paralysis (AFP) surveillance systems. […] This study describes a seven-year AFP surveillance, assesses the surveillance indicators, and highlights areas for improvement. […] The AFP surveillance indicators performance was assessed using the World Health Organisations recommended minimum AFP surveillance indicators performance. […] The non-polio AFP rate ranges from 3.4 to 6.4 per 100,000 children15 years old and stool adequacy ranging from 70.9% to 90.2% indicating sensitive surveillance with late detection of cases. […] The percentage of cases with early stool collection, timely transportation was above the World Health Organisation (WHO) minimum of 80% but with declining proportion of stools arriving in the laboratory in optimal condition.

• #17 Study of acute flaccid paralysis surveillance system in Kerman (Iran) for one decade | Russian Open Medical Journal

  https://www.romj.org/2014-0104

  The incidence of AFP 1.6/100000 at any age, and 1 per 100,000 in children under 15 years old, the GBS was the most common diagnosis, 0.8 per 100,000. […] In our study the incidence of AFP is 2.016 per 100,000 populations for one year. […] The overall incidence of GBS was between 1.1/100,000/year and 1.8/100,000/year in Europe and North America. […] The rate GBS in our study is 0.96 per 100000 in children 15 years old or smaller. […] Other causes of AFP are include; stroke, synovitis, myelitis, seizures, cerebral palsy, viral infections, tumors, cerebellitis and Non-polio AFP. […] In this study the rate of incidence in cities with low mean temperature higher than in cities with high mean temperature. […] In this study we find an increase incidence of GBS at 1387 (2008-2009), but we cant find any factor about it. […] The incidence rate of GBS is more in spring season. […] In sum, GBS, synovitis and Electrolite disturbances were the most common diagnoses. There was no proven case of poliomyelitis.

• #18 Insights and Implications from the Analysis of Acute Flaccid Paralysis Surveillance Data in Ethiopia by Gashaw Demlew, Mesfin Tefera, Kokeb Dese, Hundessa Daba, Efrem Wakjira, Dessalew Yohannes, Ketema Lemma, Hamdia Murad, Elbetel Taye Zewde, Bontu Habta

  https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4901340

  Background: Ethiopia halted the spread of indigenous wild polioviruses in 2001 but faced renewed outbreaks in 2013 and 2020, highlighting the need for robust polio surveillance. Surveillance for acute flaccid paralysis (AFP) is essential for detecting poliovirus transmission. Key components for effective AFP surveillance include detection speed, quality improvement, and integration with other health programs. […] This retrospective descriptive study analyzed Ethiopia’s AFP surveillance system from 2017 to 2022 using national polio surveillance data. Key indicators, such as the non-polio AFP rate, stool specimen adequacy, and timeliness of case investigation and specimen collection, were evaluated at national and sub-national levels. […] Key indicators showed improvements, with the non-polio AFP rate increasing from 2.6 to 3.2 per 100,000 children under 15, and stool adequacy rates rising from 83.4% in 2017 to 90% by 2020. National-level AFP surveillance performance indicators were consistently met, but significant variations were observed at the sub-national level, particularly in pastoralist and conflict-affected regions.

• #19

  https://www.cdc.gov/Mmwr/preview/mmwrhtml/mm5347a5.htm

  Since the 1988 World Health Assembly resolution to eradicate poliomyelitis, the number of countries where polio is endemic has decreased from 125 in 1988 to six at the end of 2003. As part of the eradication strategy, a global surveillance system was established to 1) identify acute flaccid paralysis (AFP) cases in children aged 15 years and 2) deploy a network of accredited laboratories to perform virologic testing of stool specimens to determine whether the paralysis resulted from poliovirus infection. This report describes the status of global AFP surveillance, including its expansion or use as a model in 131 (66%) of 198 countries for the reporting of measles and other vaccine-preventable diseases. As poliomyelitis is eradicated, AFP surveillance systems in these and other countries might be further expanded and adapted to improve the detection of and response to other diseases.

• #20 Study of acute flaccid paralysis surveillance system in Kerman (Iran) for one decade | Russian Open Medical Journal

  https://www.romj.org/2014-0104

  During the past decade, polio eradication has stalled globally. Acute flaccid paralysis (AFP) surveillance is a key strategy for monitoring the progress of polio eradication. […] In Iran there is a unit in charge of polio eradication activities. […] AFP surveillance is a key strategy for monitoring the progress of polio eradication and is a sensitive instrument for detecting potential poliomyelitis cases and poliovirus infection. […] The most important and most common is Guillain Barre syndrome, since the disappearance of polio in 2000 in Bangladesh, a high incidence of acute flaccid weakness in Bangladeshi children (3.25 cases per 100,000) is still present but is now related mostly to GBS. […] Guillain-Barre syndrome is an important cause of AFP among children, but rarely, cases in infants have been reported.

• #21 Community-Based Surveillance of Acute Flaccid Paralysis: A Review on Detection and Reporting Strategy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11842678/

  Polio is a highly contagious viral disease that primarily affects children under 15, often leading to permanent paralysis, known as acute flaccid paralysis (AFP). AFP surveillance is essential for the eradication of polio, with community-based surveillance (CBS) playing a pivotal role in detecting and reporting cases. CBS improves the timeliness and accuracy of AFP detection, but challenges such as underreporting, delays, and low community awareness persist. […] Strategies involving use of mobile applications, awareness campaigns, and improvements in healthcare infrastructure were implemented to improve CBS of AFP. […] The review revealed that CBS has significantly advanced the global fight against polio by increasing community awareness, enabling earlier detection, and improving the reporting of AFP cases. However, issues such as security concerns, delayed reporting, low levels of community awareness, and underutilization of technology persist. This review recommends strengthening organizational structures, improving healthcare access, raising community awareness, and using technology for more efficient AFP surveillance.

• #22 Community-Based Surveillance of Acute Flaccid Paralysis: A Review on Detection and Reporting Strategy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11842678/

  Surveillance is the cornerstone for eliminating polio, halting the virus’s spread, and identifying its transmission. Polio surveillance tasks encompass thorough inspections of each residence, monitoring any changes in health trends, overseeing illness prevention initiatives, and managing reactions to outbreaks. There are two different kinds of polio surveillance: Environmental surveillance (ES) and acute flaccid paralysis (AFP). […] The AFP surveillance process includes both health facility and community-based approach to identify and monitor poliovirus (PV) circulation. […] Community-based surveillance (CBS), on the other hand, leverages community volunteers (CVs) and local leaders to identify AFP cases through active case screening. This process involves detecting, reporting, investigating, and initiating response actions, ensuring that even hard-to-reach communities are effectively monitored and addressed.

• #23

  https://link.springer.com/article/10.1007/s44197-025-00349-2

  The establishment process begins with raising awareness to find and identify a potential volunteer from the community members. […] The CBS system has a structure for flow of information. […] The purpose of CBS is to guarantee that disease cases that are within the community are not missed so that the officials monitoring disease surveillance system get information early and provide rapid response. […] The implementation of CBS for AFP has led to the growth and utilization of the community, greatly enhancing public health efforts and ensuring that no cases are left undetected or unnoticed. […] CBS strategy increased number of reporting AFP case, particularly in remote and underserved area where health facilities are limited. […] Improvements brought in some countries discussed as follows.

• #24 Community-Based Surveillance of Acute Flaccid Paralysis: A Review on Detection and Reporting Strategy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11842678/

  AFP surveillance has a well-established structure from national level down to the community. […] Despite its effectiveness, AFP surveillance efforts encounter numerous challenges. Factors such as inadequate healthcare infrastructure, limited-service accessibility, deficient transportation and communication, geographic inaccessibility, high population mobility, spread of emergency infectious disease, security concerns, cultural and language barriers, and low community awareness contribute to underreporting and delayed detection of AFP. […] To address these challenges, initiatives have been undertaken, including the improvement of healthcare infrastructure, heightened community awareness, and the deployment of mobile clinics and community health workers. […] The establishment process begins with raising awareness to find and identify a potential volunteer from the community members.

• #25 WHO EMRO | Surveillance | About eradication | Polio Eradication

  https://www.emro.who.int/polio-eradication/about-eradication/surveillance.html

  Between 2020 and 2021, the polio programme expanded its environmental surveillance network in the Region, particularly in Afghanistan, Egypt, Somalia and Sudan. […] The Eastern Mediterranean Region Polio Laboratory Network was established in 1991 by WHO and national governments. Its key role is to provide virological information that can be used to target resources on eradicating and, in the case of importations, containing the spread of wild polioviruses. […] Although surveillance systems across the Region were impacted by the COVID-19 pandemic, regional surveillance have continued to function through the pandemic and have done so in line with special guidelines set by the GPEI to ensure the safety of workers. […] Whats more, the polio surveillance network, in both the field and the laboratory, has supported the pandemic response in setting up surveillance for reporting and detection of COVID-19 cases, contact tracing, laboratory testing and data management.

• #26 iProceedings – Evaluation of the Acute Flaccid Paralysis Surveillance System From 2016 to 2020: A Retrospective Study

  https://www.iproc.org/2022/1/e36484/

  Background: Acute flaccid paralysis surveillance played a major role in the global eradication of polio. The World Health Organization adopted this method to monitor the progress toward poliomyelitis eradication. The Expanded Program of Immunization in Jordan has routinely collected acute flaccid paralysis data since 1999, which then attained a polio-free certification. Yet, because of wars in neighboring countries such as Syria and Iraq, there is a risk of polio outbreaks occurring. […] Objective: This study aims to evaluate the acute flaccid paralysis surveillance system in Jordan from 2016 to 2020 and identify areas for improvement. […] Results: A total of 483 cases of nonpolio acute flaccid paralysis were reported. Most of them (n=478, 99%) were younger than 15 years, and among those, 55.6% were younger than 5 years, and 58% were male. At the national level, the surveillance achieved all the World Health Organization indicators throughout the evaluating period, except for two indicators: the proportion of stool specimens from which nonpolio enterovirus was isolated in 2016 and 2017, and the nonpolio acute flaccid paralysis detection rate per 100,000 of the population younger than 15 years in 2020. At a subnational level (governorates level), the proportion of stool specimens from which nonpolio enterovirus was isolated, as an indicator, was not achieved most of the time. This was frequently observed in each of all evaluation years of 2016 to 2020. Moreover, most indicators were not achieved at the governorate level in 2020.

• #27 iProceedings – Evaluation of the Acute Flaccid Paralysis Surveillance System From 2016 to 2020: A Retrospective Study

  https://www.iproc.org/2022/1/e36484/

  Conclusions: There are some gaps that need improvement in the acute flaccid paralysis surveillance system in Jordan, especially at the governorate level. The lower performance during 2020 could have been caused by the COVID-19 crisis and the lockdown during the pandemic. Similar challenges are possible in the future and proper preparation is required.

• #28 Evaluation of acute flaccid paralysis surveillance performance before and during the 2014-2015 Ebola virus disease outbreak in Guinea and Liberia

  https://www.panafrican-med-journal.com/content/article/45/190/full/

  To evaluate the impact of the EVD outbreak on AFP surveillance performance in Guinea and Liberia, standard WHO AFP surveillance performance indicators were analyzed for the years immediately before and during the EVD outbreak. […] AFP surveillance is one of the key strategies for polio eradication and the primary means of detecting poliovirus transmission. […] Both Guinea and Liberia saw reductions in their overall national NP-AFP rates during the Ebola period compared with the previous two years pre-Ebola. […] The EVD outbreak negatively affected AFP surveillance performance in both Guinea and Liberia, particularly sub-nationally. During crises in the health-care system, AFP surveillance systems must be reinforced to ensure that they continue to function.

• #29

  https://www.cdc.gov/Mmwr/preview/mmwrhtml/mm5347a5.htm

  As of the end of 2003, a total of 196 of 214 countries and territories operated AFP surveillance systems and reported data weekly to WHO. For many developed countries, the AFP surveillance system is integrated into existing disease surveillance systems. […] A WHO region is certified polio-free after a period of 3 years without isolation of wild poliovirus from an AFP case, in the presence of high-quality AFP surveillance. Three of the six WHO regions have been certified as polio-free. […] Globally, more than two thirds of countries with AFP surveillance have used that infrastructure, or applied it as a model, for measles surveillance. […] In polio-free countries in the African, Southeast Asian, and Eastern Mediterranean regions, polio-funded SMOs have conducted measles surveillance activities.

• #30

  https://www.cdc.gov/Mmwr/preview/mmwrhtml/mm5347a5.htm

  With expansion of AFP surveillance programs, in certain countries, SMOs now search for cases of NT and other diseases in addition to cases of AFP when they visit health centers and hospitals. […] In certain countries of the Africa Region, AFP surveillance provides a functional infrastructure, trained personnel, and other resources used to implement Integrated Disease Surveillance and Response (IDSR), a strategy adopted in 1998 by the Regional Committee of the WHO Regional Office for the Africa Region to strengthen all infectious disease surveillance activities, especially at the district level. […] Expansion of AFP surveillance systems has increased the responsibilities of SMOs in dozens of countries. […] Adoption of the global polio eradication goal in 1988 required implementation of AFP surveillance in all countries and territories, including areas affected by conflict and other obstacles. As the AFP surveillance system matured, countries and regions began to use this system to conduct surveillance for other diseases. At present, two thirds of countries with AFP systems have adapted their systems for surveillance of measles and other vaccine-preventable diseases. […] In resource-poor countries and areas of conflict, the AFP surveillance system often is the only method for early detection of diseases that are prone to epidemics.

• #31

  https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5347a5.htm

  In resource-poor countries and areas of conflict, the AFP surveillance system often is the only method for early detection of diseases that are prone to epidemics. External technical and funding support for AFP surveillance is provided by the international polio partnership. […] To date, diseases that have been successfully monitored by systems modeled after AFP and measles surveillance systems share common traits: well-defined case of syndromic presentation, relative ease of specimen collection for laboratory confirmation, strong international commitment and funding for control/elimination, and continued focus on using surveillance data for targeted control activities.

• #32 Thirty Years of Experience of Acute Flaccid Paralysis Surveillance for Polio — China, 1993–2022

  https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.065

  Detecting poliovirus infections proves to be highly challenging due to their asymptomatic nature and infectious potential, highlighting the crucial importance of effective detection methods in the context of polio eradication efforts. In many countries, including China, the primary approach for identifying polio outbreaks has been through acute flaccid paralysis (AFP) surveillance. […] Data on all AFP cases identified since 1993 and national-level AFP surveillance system quality indicators aligned with the World Health Organization (WHO) standards were collected for analysis. […] Between 1993 and 2022, a total of 150,779 AFP cases were identified and reported. […] AFP surveillance has been instrumental in China’s accomplishment of maintaining a polio-free status. […] The ongoing adherence to key performance indicators, ensuring sensitivity and prompt specimen collection, demonstrates that AFP surveillance is proficient in detecting poliovirus in China.

• #33 Thirty Years of Experience of Acute Flaccid Paralysis Surveillance for Polio — China, 1993–2022

  https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.065

  The evaluation of AFP surveillance quality relies on two key performance indicators: the NPAFP detection rate and the percentage of AFP cases with adequate stool specimens. […] Our research reveals a swift and sustained enhancement in surveillance indicators. […] The significance of AFP surveillance remains paramount, even post global polio eradication.

• #34

  https://www.cdc.gov/Mmwr/preview/mmwrhtml/mm5347a5.htm

  Since the 1988 World Health Assembly resolution to eradicate poliomyelitis, the number of countries where polio is endemic has decreased from 125 in 1988 to six at the end of 2003. As part of the eradication strategy, a global surveillance system was established to 1) identify acute flaccid paralysis (AFP) cases in children aged 15 years and 2) deploy a network of accredited laboratories to perform virologic testing of stool specimens to determine whether the paralysis resulted from poliovirus infection. This report describes the status of global AFP surveillance, including its expansion or use as a model in 131 (66%) of 198 countries for the reporting of measles and other vaccine-preventable diseases. As poliomyelitis is eradicated, AFP surveillance systems in these and other countries might be further expanded and adapted to improve the detection of and response to other diseases.

• #35 Insights and Implications from the Analysis of Acute Flaccid Paralysis Surveillance Data in Ethiopia by Gashaw Demlew, Mesfin Tefera, Kokeb Dese, Hundessa Daba, Efrem Wakjira, Dessalew Yohannes, Ketema Lemma, Hamdia Murad, Elbetel Taye Zewde, Bontu Habta

  https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4901340

  Despite positive trends, the emergence of vaccine-derived poliovirus cases since 2021 is concerning. To address this, the study recommends reinforcing non-polio AFP detection and stool adequacy rates, implementing targeted interventions in pastoralist and conflict-affected areas, and leveraging advanced technologies like real-time data collection and artificial intelligence. These measures are crucial for maintaining Ethiopia’s progress in wild poliovirus eradication and tackling the threat of vaccine-derived poliovirus, ensuring continued success in the global polio eradication campaign.

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

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6341937/

  The objective of this study is to report and evaluate the results of 18 years (1998-2015) of the surveillance programme for AFP in Spain in terms of incidence, epidemiological and laboratory investigations, clinical diagnosis, as well as utility and quality of surveillance. […] In Spain, AFP surveillance is the main component of poliovirus surveillance, along with supplementary EV laboratory surveillance. Environmental surveillance is not established nationwide. Laboratory techniques and protocols that should be maintained or could be developed in the event of PV importation or an outbreak are assessed annually by a pilot environmental study in an urban area. The results are reported yearly to the RCC. […] The National Certification Committee (NCC) for polio eradication was established in Spain in 1998 as a component of the National Plan of Actions Aimed at the Achievement of the Certificate of Polio Eradication (NPCPE). An annual update on polio eradication activities is prepared by the NCC and submitted to the RCC. The report contains a statement presenting the evidence-based rationale for the absence of poliovirus circulation in the country.

• #37 Surveillance – GPEI

  https://polioeradication.org/what-we-do/

  Polio surveillance underpins the entire polio eradication initiative. Without surveillance, it would be impossible to pinpoint where and how poliovirus is still circulating. Polio surveillance identifies new cases and detects any circulation of poliovirus. […] Nationwide AFP (acute flaccid paralysis) surveillance is the gold standard for detecting cases of poliomyelitis. […] Environmental surveillance involves testing sewage or other environmental samples for the presence of poliovirus. Environmental surveillance often confirms wild poliovirus infections in the absence of cases of paralysis. […] The number of AFP cases reported each year is used as an indicator of a countrys ability to detect polio even in countries where the disease no longer occurs. A countrys surveillance system needs to be sensitive enough to detect at least one case of AFP for every 100 000 children under 15 even in the absence of polio.

• #38 Community-Based Surveillance of Acute Flaccid Paralysis: A Review on Detection and Reporting Strategy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11842678/

  The CBS system has a structure for flow of information. […] The purpose of CBS is to guarantee that disease cases that are within the community are not missed so that the officials monitoring disease surveillance system get information early and provide rapid response. […] The implementation of CBS for AFP has led to the growth and utilization of the community, greatly enhancing public health efforts and ensuring that no cases are left undetected or unnoticed. […] The CBS strategy increased number of reporting AFP case, particularly in remote and underserved area where health facilities are limited. […] With CBS being implemented across the world, outbreak control measures have improved and the world is now one step closer to being polio-free. […] The tools further facilitate surveillance activities via remote supervision with real-time data exchange to improve the provision of intervention and feedback to CVs.

• #39

  https://link.springer.com/article/10.1007/s44197-025-00349-2

  The CBS effort is further improved by involving stakeholders from various sectors, including academia, business, NGOs, community leaders, civil society, and other pertinent parties in a cooperative and coordinated effort to advance surveillance techniques and ensure adequate readiness for responding to outbreaks. […] The progress of CBS for AFP has been thoroughly reviewed, showcasing its vital role in advancing poliovirus eradication efforts. […] CBS enhances community knowledge, enabling early detection and timely reporting of suspected AFP cases.

• #40 WHO EMRO | Surveillance | About eradication | Polio Eradication

  https://www.emro.who.int/polio-eradication/about-eradication/surveillance.html

  Quality surveillance is foundational to the polio eradication initiative. Surveillance both detects the presence of poliovirus and informs the programmes actions typically, whether to launch a vaccination campaign in response to disease detection, and if so, what sort of campaign. […] As the world moves closer to polio eradication, surveillance becomes ever more important: the final determination to certify the Eastern Mediterranean Region free of wild poliovirus will rest on the basis of surveillance data. […] Accordingly, in the Region, the worlds last with transmission of wild poliovirus, the programme directs a significant amount of funding and expertise into the establishment, maintenance and improvement of polio surveillance networks. […] Polio surveillance is the practice of exhaustively searching for poliovirus in its only known reservoir humans. This happens two ways: through surveillance for acute flaccid paralysis (AFP), the primary symptom of poliomyelitis infection, and through surveillance of sewage outflow, to search for virus that has been shed in the stool of infected people. […] AFP surveillance is known as the gold standard of polio surveillance, but environmental surveillance has an increasingly important role in the Region. For both practices, there are a set of clear surveillance indicators that must be met.

• #41

  https://www.cdc.gov/Mmwr/preview/mmwrhtml/mm5347a5.htm

  With expansion of AFP surveillance programs, in certain countries, SMOs now search for cases of NT and other diseases in addition to cases of AFP when they visit health centers and hospitals. […] In certain countries of the Africa Region, AFP surveillance provides a functional infrastructure, trained personnel, and other resources used to implement Integrated Disease Surveillance and Response (IDSR), a strategy adopted in 1998 by the Regional Committee of the WHO Regional Office for the Africa Region to strengthen all infectious disease surveillance activities, especially at the district level. […] Expansion of AFP surveillance systems has increased the responsibilities of SMOs in dozens of countries. […] Adoption of the global polio eradication goal in 1988 required implementation of AFP surveillance in all countries and territories, including areas affected by conflict and other obstacles. As the AFP surveillance system matured, countries and regions began to use this system to conduct surveillance for other diseases. At present, two thirds of countries with AFP systems have adapted their systems for surveillance of measles and other vaccine-preventable diseases. […] In resource-poor countries and areas of conflict, the AFP surveillance system often is the only method for early detection of diseases that are prone to epidemics.

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