afp surveillance guidelines pakistan

There are currently 60 sampling sites for environmental detection in 40 towns and districts of the country. Disclaimer. From 2018 to 2019, the number of WPV1 cases increased from 21 to 29 in Afghanistan (38% increase) and from 12 to 147 in Pakistan (1,125% increase). AFP surveillance performance indicators should be monitored at all levels Depth of analysis depends on the level at which it is being conducted. 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. The Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19: Molecular Diagnostic Testing, A 40-Year-Old Man With Persistent Febrile Neutropenia and Subsequent Rash, Management of Severe and Severe/Complicated, Norovirus and Other Viral Causes of Medically Attended Acute Gastroenteritis Across the Age Spectrum: Results from the MAAGE Study in the United States, About the Infectious Diseases Society of America, http://polioeradication.org/wp-content/uploads/2016/07/PEESP_EN_A4.pdf, http://www.euro.who.int/__data/assets/pdf_file/0003/79374/E88105.pdf, http://polioeradication.org/wp-content/uploads/2016/07/9.5_13IMB.pdf, Receive exclusive offers and updates from Oxford Academic, Lessons from Diagnostic Investigations of Patients with Poliomyelitis and Their Direct Contacts for the Present Surveillance of Acute Flaccid Paralysis, Lab Protocol Paper: Use of a High-throughput, Multiplex Reverse-transcription Quantitative Polymerase Chain Reaction Assay for Detection of Sabin Oral Polio Vaccine in Fecal Samples, Predictors of Virologically Confirmed Poliomyelitis in India, 1998–2000, Polio, AIDS, and Ebola: A Recurrent Ethical Dilemma. These activities includes testing stool samples of children suffering from acute flaccid paralysis (the clearest symptom the virus) and testing samples taken from sewage water across the country. Surveillance for wild poliovirus through reporting and laboratory testing of all cases of acute flaccid paralysis (AFP) among children under fifteen years of age. Hagan JE, Wassilak SG, Craig AS, et al. More importantly, cases are being reported faster by both VPVs and other sources, as the mean interval from paralysis onset to reporting of a case improved from 5.4 days in 2014 to 3.7 days in 2016 for VPVs and from 4.8 to 3.8 days for other sources. Lipid ratios representing SCD1, FADS1, and FADS2 activities as candidate biomarkers of early growth and adiposity. The patterns of reporting held in 2013, the first year of the polio outbreak, with public healthcare facilities again being the main reporting source for AFP cases. Any child under 15 years of age with AFP* or any person of any age with paralytic illness if polio is suspected Documents reviewed include program description documents outlining terms of reference for volunteers. In addition to poliomyelitis, AFP cases may have several other causes, including Guillain-Barré syndrome and transverse myelitis [6]. Along with the decline in case reporting, the national NPAFP rate decreased from 3.2 to 2.8 cases per 100000 persons aged <15 years when comparing case detection rates in 2011 to 2012 (Figure 1). ‘Adequate’ stool specimens are two stool specimens of sufficient quantity for laboratory analysis, collected at least 24 hours apart, within 14 days after the onset of paralysis, and arriving in the laboratory by reverse cold chain and with proper documentation. Objective: To evaluate acute flaccid paralysis (AFP) surveillance system in Khyber Pakhtunkhwa (KPK) – Pakistan.. Methods: This descriptive cross-sectional study was conducted at directorate general health services office KPK, Peshawar from 10th November – 31st December, 2012. In addition to AFP case counts and NPAFP rates, we evaluated the quality of surveillance activities undertaken by VPVs by examining 2 other key surveillance indicators: stool specimen adequacy rates and timeliness of reporting. If poliovirus is isolated in a stool sample, further tests are carried out to determine where the strain may have originated. Constraints due to insecurity coupled with bans on polio activities imposed by antigovernment elements have further hindered surveillance efforts in certain parts of the country. AFP case-reporting in areas in Somalia with access limitations, 2011–2016. Published by Oxford University Press for the Infectious Diseases Society of America 2018. These traditional reporting sources accounted for the bulk of AFP cases reported from these areas over the next 2 years, with VPVs responsible for only 3% of AFP cases reported from districts with access limitations in 2013. Abbreviations: AFP, acute flaccid paralysis; CI, confidence interval; SD, standard deviation; VPVs, Village Polio Volunteers. Of the 546 AFP cases reported in 2013, 194 (36%) were subsequently confirmed to be WPV cases. 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 … Mbaeyi C, Kamadjeu R, Mahamud A, Webeck J, Ehrhardt D, Mulugeta A. Cochi SL, Jafari HS, Armstrong GL, et al. To determine the contributions of VPVs to AFP case detection, we calculated overall case counts and proportions during 2011–2016, categorized by reporting source. 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. Even in regions that have been certified as polio free, such as Europe [10] and the Americas [11], AFP surveillance activities are undertaken as a way of maintaining certification standards [1, 7] and remaining vigilant in the event of reimportation of the virus as a result of migration from polio-infected areas [12–15]. Volunteers involved in the program, commonly referred to as VPVs, were recruited from local communities in nearly all districts of the country, with early priority given to districts designated as high risk based on predefined criteria. Surveillance is one of the main pillars of the Polio Eradication Programme. 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). Surveillance for cases of acute flaccid paralysis (AFP) is a key strategy adopted for the eradication of polio. Similarly, the mean duration to case notification decreased from 4.8 (95% CI, 4.32–5.21) days in 2014 to 3.8 (3.3–4.34) days in 2016 among all other reporting sources. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. This effect is even more pronounced when we limited our analysis to districts with security and access limitations, where VPVs have accounted for more than half of the AFP cases identified during 2015–2016. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. All authors: No reported conflicts of interest. In line with improvements in case detection, NPAFP rates rose considerably during the outbreak, increasing to 6.5 and 7.4 cases per 100000 persons aged <15 years during 2013 and 2014, respectively. In Pakistan, authorities have struggled to present a cohesive national strategy to control the coronavirus. The success of GPEI in drastically reducing the number of polio cases reported worldwide has been well documented [22–25]. 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. ; Centers for Disease Control and Prevention (CDC). As the morbidity:infection ratio of PV infection is very low, this fact contributes to the sensitivity of ENV which under optimal conditions can be better than that of the standard acute flaccid paralysis (AFP) surveillance. Currently, Pakistan has a well-functioning and sensitive AFP surveillance system at national, provincial, and district levels. The success of these programs in improving AFP case detection has been demonstrated in countries such as Niger and Tanzania [28, 29]. 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. Strengthening AFP surveillance systems is thus seen not just as essential to interrupting poliovirus circulation in areas with ongoing transmission but also for protecting the gains already achieved in places where the disease has been eliminated. Surveillance performance was assessed for the five 2019 priority countries in EMR (Afghanistan, Djibouti, Pakistan, Somalia, and Sudan) for 2018 and 2019 (Table 1). We did this to establish a statistical metric of performance of the surveillance system before and after the introduction of the VPV program. 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. The best available method to confirm the diagnosis of poliomyelitis is the isolation and identification of poliovirus from the stool. NPAFP rates decreased from levels during the outbreak to 4.8 and 5.3 cases per 100000 persons aged <15 years during 2015 and 2016, respectively, but remained significantly above preoutbreak reporting levels. The establishment of the VPV program to supplement existing structures in place for AFP surveillance has proved to be of vital importance in enhancing the country’s capacity to mount an effective response to outbreaks and maintain its polio-free status. AFP manifests clinically as a syndrome characterized by sudden onset of weakness or paralysis affecting a limb or limbs. None of the AFP cases reported during 2011–2012 were due to WPV infection, although 10 cases of circulating vaccine-derived poliovirus were reported during both years. Please check for further notifications by email. These samples are collected routinely by the Global Polio Eradication Initiative to detect transmission of wild-type poliovirus or VDPVs that rarely emerge as a result of reversion of the Sabin strains contained within the live-attenuated OPV. Each case of AFP acts as a signal to the polio surveillance system where polio is circulating and who it is likely to affect. VPVs accounted for only 2% of reported cases in 2013, having begun their activities in September of the same year. Identification of ≥2 nonpolio AFP (NPAFP) cases per 100000 persons aged <15 years is recommended by the World Health Organization (WHO) as a benchmark for surveillance activities in regions with active poliovirus transmission or places at significant risk of outbreaks [8, 9]. We stratified our results by year to decipher trends in timeliness of reporting when comparing AFP cases by reporting source. Delving into the detail: Greater episodic detail in narratives of a critical life event predicts an increase in adolescent depressive symptoms across one year. Potential conflicts of interest. Although the country’s existing AFP surveillance system has mostly achieved recommended benchmarks for case detection during the past decade, subnational gaps have persisted, as evidenced by the delays in detecting some polio cases during the aforementioned outbreaks. Progress towards poliomyelitis eradication: Pakistan, January 2016–September 2017 Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2017 17 November 2017, vol. We limited our analyses to districts with security and access limitations during the period under review. 9. Acknowledgments. 701–716) Environmental surveillance (ES) can detect circulating polioviruses from sewage without relying on clinical presentation. 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”. Acute Flaccid Paralysis (AFP) Surveillance of polio virus in Pakistan is a systematic collection, analysis and interpretation of data and the dissemination of information. 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. Although much of the improvement in case detection observed during the outbreak was the direct result of increased resources for response activities provided by GPEI, as recommended in the guidelines for outbreak response [27], the role of VPVs during and after the response cannot be overstated. However, within this comprehensive analysis, nine countries were highlighted as having child mortality rates that were decreasing at a lower-than-expected rate. Other reporting sources during this period included regular polio program staff, which accounted for 30% of reporting in 2012, and private healthcare providers, including traditional healers, which accounted for 21% of reporting in 2012. AFP surveillance in Pakistan collected data on 43,301 NPAFP cases between January 2003 and June 2016, with an average annual rate increasing from 4.3 to 11.4 NPAFP per 100,000 children under the age of 5 years from 2003 to 2016. The number of cases reported each year is used as an indicator of a country's ability to detect polio, even in countries where the disease no longer occurs. Surveillance for cases of acute flaccid paralysis (AFP) is a key strategy adopted by the Global Polio Eradication Initiative (GPEI) for the eradication of poliomyelitis [1–3]. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. In the years after program introduction, VPVs accounted for a high proportion of AFP cases reported in Somalia. Five additional WPV cases were confirmed in 2014, the last of which was identified by a VPV working in Hobyo district in the Northeast zone. Building trust at the grassroots level through community-based programs is beneficial on multiple levels because programs like the VPV program often evolve to encompass other disease surveillance and prevention activities. 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. In terms of reporting sources, public healthcare facilities, private healthcare providers, and regular polio program staff each reported 28% of the 32 AFP cases identified in districts with access limitations in 2011 (Figure 3). Pakistan’s polio crisis represents one of the last hurdles in a 23-year campaign run by the World Health Organization. Pakistan is one such co… Polio is reported through three systems: Acute Flaccid Paralysis (AFP) surveillance system, Disease Early Warning System (DEWS) and Health Management Information System (HMIS). Efforts are a bit better in Pakistan than in Afghanistan, where polio surveillance staff are now also conducting surveillance for Covid-19. Security & surveillance in Pakistan July 2015 www.privacyinternational.org. ES was initiated in Pakistan in 2009 at sites within Karachi and Lahore [].Sampling has since been expanded to many regions within Pakistan (Fig. The programme is able to identify where the polio virus is circulating through its highly sensitive surveillance activities. We also reviewed and analyzed AFP surveillance data for all cases reported in Somalia from January 2011 to November 2016. 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. Strengthening AFP surveillance systems is thus seen not just as essential to interrupting poliovirus circulation in areas with ongoing transmission but also for protecting the gains already achieved in places where the disease has been eliminated. In many areas, particularly those with access limitations, VPVs are actively involved in investigating the case with guidance from the district polio officer. AFP case-reporting sources in Somalia, 2011–2016. By 2014, however, VPVs were responsible for reporting approximately a quarter of all AFP cases, comparable to other major reporting sources, such as public healthcare facilities (24%) and regular polio program staff (29%). Although we could not determine from our data whether AFP cases identified by VPVs could have otherwise been detected by other reporting sources, our findings strongly suggest that much of the improvement in surveillance has been driven by the activities of VPVs. Given the increasing threat posed by insecurity to polio eradication efforts in places like Nigeria [30] and Afghanistan [9, 31], such programs will play an increasingly prominent role in bringing the goal of disease eradication within reach. For stool specimens taken from an AFP case to be considered adequate, 2 specimens need to be collected from the case-patient ≥24 hours apart and within 14 days of paralysis onset, and the specimens must arrive at the laboratory in good condition, that is, without leakage or desiccation and under cold conditions [9, 21]. By determining the exact genetic makeup of the virus, wild viruses can be compared to others and classified into genetic families which cluster in defined geographical areas. Of note, the last WPV case identified during the outbreak was reported by a VPV working in the Northeast zone of the country. 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. PESHAWAR: The health department has been diagnosing coronavirus patients quickly with the help of antigen detection rapid diagnostic test (Ag-RDT) as … 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. Among AFP cases with known reporting sources, VPVs accounted for 40% of the 279 cases reported in 2015, a high among reporting sources. Approximately 90% of AFP cases were notified within 7 days of paralysis of onset during 2011–2012. The detection of PV in some countries (e.g., Afghanistan, Nigeria, Pakistan, and Somalia) that is highly diverged from previously identified PV isolates indicates that WPV or VDPV transmission remained undetected by AFP surveillance even when AFP performance indicators were met at the state/provincial level . Current scenario of Polio 3. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. Notification speeds have since improved, with >80% of cases being reported within 7 days during 2014–2016. A crucial step in the investigation is the collection of 2 stool specimens from the case patients ≥24 hours apart. This is why a country like Somalia, with a recent history of polio outbreaks, has been prioritized by GPEI for AFP surveillance strengthening. They again accounted for the highest proportion of AFP cases reported in 2016 when compared with other reporting sources. Given the impact of the VPV program on improving AFP surveillance indicators in Somalia, similar community-based programs could play a crucial role in enhancing surveillance activities in countries with limited healthcare infrastructure. After the end of the outbreak, NPAFP rates have declined from levels during the outbreak, but they have remained significantly above preoutbreak levels. 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. Algiers (AFP) - 01/02/2021 - 16:37 Two Algerian soldiers killed in clash with jihadists: ministry. In Pakistan, AFP surveillance began in 1997, but was given focused attention in 2000. Intensified surveillance activities during the outbreak led to a 132% increase in the NPAFP rate in 2013. Despite these challenges, the country successfully interrupted indigenous transmission of wild poliovirus (WPV) in 2002 [17]. Once an AFP case is identified, VPVs immediately notify the district polio officer, and a case investigation is begun. To assess the impact of inaccessibility on case detection and the performance of VPVs, we performed additional analyses for case counts, proportions, and NPAFP rates. Kamso J, Mvika ES, Ota MO, Okeibunor J, Mkanda P, Mihigo R. Fekadu L, Okeibunor J, Nsubuga P, Kipela JM, Mkanda P, Mihigo R. Hussain SF, Boyle P, Patel P, Sullivan R. Kouadio K, Okeibunor J, Nsubuga P, Mihigo R, Mkanda P. Gumede N, Coulibaly SO, Yahaya AA, et al. Clinicians must follow all cases of AFP for a minimum of 60 days and correlate with virus intra-typing. Bannu due to its geographical location stands out to be one of highest risk areas for Poliomyelitis. Systems for AFP surveillance are particularly crucial in countries like Somalia, where the dilapidated healthcare infrastructure makes for increased vulnerability to polio outbreaks despite the elimination of indigenous WPV transmission. Vaccines are among the greatest success stories in public health. Overall reporting trends during 2014–2016 suggested more rapid identification of AFP cases over time by both VPVs and other reporting sources. 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 (. Categories of reporting sources included VPVs, public healthcare facilities, private healthcare providers, staff of the polio program (other than VPVs), and other sources within the community. The NPAFP rate for 2015 (the year after the outbreak) was 1.7 times that in 2012, the year before outbreak onset. However, despite the recession and eventual cessation of the outbreak in 2014, the NPAFP rate rose from levels in 2013, largely owing to the contributions of the newly introduced VPV program. The objectives of this study were to This project was funded and supported by the US Centers for Disease Control and Prevention. Before the 2013–2014 wild poliovirus outbreak, during which the VPV program was introduced, the number of AFP cases reported nationally declined from 172 cases in 2011 to 148 cases in 2012. Abbreviation: AFP, acute flaccid paralysis. The mean duration from paralysis onset to notification was the same (4.5 days) for AFP cases reported by both VPVs and other reporting sources during 2014–2016. Explore the difference between the single-chamber and dual-chamber microbial electrosynthesis for biogas production performance. Health worker awareness on AFP surveillance and active case search should be strengthened in all aspects … We then calculated the NPAFP rates per 100000 persons aged <15 years for each of the years under review. Only a small proportion (2%) of NPAFP cases reported during the outbreak were considered clinically compatible with polio after expert review. 1), focussing on major transportation hubs, and areas with either highly mobile populations or areas associated with suboptimal AFP surveillance or vaccination coverage. AFP case counts spiked during the polio outbreak, increasing to 546 and 420 cases during 2013 and 2014, respectively. 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. Acute flaccid paralysis (AFP) is defined as a sudden onset of paralysis/weakness in any part of the body of a child less than 15 years of age. This work is written by (a) US Government employee(s) and is in the public domain in the US. 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. ; EIS officer, Centers for Disease Control and Prevention. In the years before the VPV program was introduced (ie, 2011 and 2012), the majority of AFP cases were reported through public healthcare facilities, such as hospitals and maternal and child health centers. Birmingham ME, Linkins RW, Hull BP, Hull HF. Pogka V, Labropoulou S, Emmanouil M, et al. We compared the NPAFP rate in 2015, the year after the 2013–2014 polio outbreak, to the rate in 2012, the year before the outbreak, by calculating the incidence rate ratio using a Poisson regression model, adjusting for geopolitical zones. The VPV program has contributed significantly to improved surveillance for AFP cases in Somalia. All stool specimens collected from reported AFP cases are tested at the Regional Reference Laboratory (RRL) for polio eradication in Islamabad. A substantial increment was observed in detection rate. 1 Executive Summary The Pakistani government is engaged in a protracted conflict against armed militant groups within its borders and outside its borders, it is a key player in the global ‘war on terror’. Stool specimen adequacy rates have been consistently high, and AFP cases have been detected in a timelier manner since the program was introduced. The programme is able to identify where the polio virus is circulating through its highly sensitive surveillance activities. Duration from paralysis onset to notification, d, Copyright © 2021 Infectious Diseases Society of America. All AFP cases should have a full clinical and virological investigation with at least 80% of AFP cases having ‘adequate’ stool specimens collected. Most counties achieved targets for both key surveillance indicators. AFP Surveillance Dr. Sunil A. Tore M.B.B.S., D.P.H.,D.H.A., M.I.P.H.A. Pellegrinelli L, Bubba L, Primache V, et al. In 2014, however, VPVs accounted for just over a third (37%) of the 157 AFP cases identified in 41 districts with access limitations. Introduction: Polio has been eliminated from all countries except four, including Pakistan, where polio is still endemic. Environmental surveillance involves testing sewage or other environmental samples for the presence of poliovirus. 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