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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. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. 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. The objective of this study was to determine frequency of AFP and their aetiologies in District of Bannu during time period of four years from 2007 to 2011. Pakistan’s polio crisis represents one of the last hurdles in a 23-year campaign run by the World Health Organization. Pogka V, Labropoulou S, Emmanouil M, et al. More than 500 VPVs are currently operational in all 4 geopolitical zones of Somalia (Central, Northeast, Northwest, and South). 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. Once collected, VPVs work closely with the district polio officer to ensure that the specimens are transported in a timely manner to the regional polio laboratory in Nairobi, Kenya, where testing is conducted. 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. Introduction: Polio has been eliminated from all countries except four, including Pakistan, where polio is still endemic. Surveillance is one of the main pillars of the Polio Eradication Programme. 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]. To determine the contributions of VPVs to AFP case detection, we calculated overall case counts and proportions during 2011–2016, categorized by reporting source. AFP surveillance, or finding and reporting children with acute flaccid paralysis (AFP), is fundamental in detecting polio cases. WHO recommends that ≥80% of stool specimens arriving in the laboratory must be adequate. Abbreviation: AFP, acute flaccid paralysis. 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. Stool samples were collected during acute flaccid paralysis (AFP) surveillance in Pakistan between October 2019 and February 2020. Only a small proportion (2%) of NPAFP cases reported during the outbreak were considered clinically compatible with polio after expert review. 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. ‘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. Algiers (AFP) - 01/02/2021 - 16:37 Two Algerian soldiers killed in clash with jihadists: ministry. 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 (. From 2011 to 2012, rates of case reporting in these areas decreased from 3.2 to 2.6 cases per 100000 persons aged <15 years in 2012. 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. 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. We limited our analyses to districts with security and access limitations during the period under review. 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]. Most counties achieved targets for both key surveillance indicators. Despite these challenges, the country successfully interrupted indigenous transmission of wild poliovirus (WPV) in 2002 [17]. Overall reporting trends during 2014–2016 suggested more rapid identification of AFP cases over time by both VPVs and other reporting sources. 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. 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. Efforts are a bit better in Pakistan than in Afghanistan, where polio surveillance staff are now also conducting surveillance for Covid-19. AFP case-reporting sources in Somalia, 2011–2016. VPVs accounted for only 2% of reported cases in 2013, having begun their activities in September of the same year. This process helps determine the most appropriate immunization strategies to prevent further spread of the poliovirus. 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. Vaccines are among the greatest success stories in public health. Disclaimer. The programme is able to identify where the polio virus is circulating through its highly sensitive surveillance activities. 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. Hagan JE, Wassilak SG, Craig AS, et al. Surveillance is one of the main pillars of the Polio Eradication Programme. AFP case counts by type and nonpolio AFP (NPAF) rates in Somalia, 2011–2016. Once an AFP case is identified, VPVs immediately notify the district polio officer, and a case investigation is begun. Of the 546 AFP cases reported in 2013, 194 (36%) were subsequently confirmed to be WPV cases. 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. Dr Hamzullah khan, Dr Sarfaraz Khan Afridi, Dr Obaid ul Islam, World Health Organization Pakistan. 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. 8. Such facilities accounted for 43% and 33% of case reporting in 2011 and 2012 (Figure 2). 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 . During 2011–2016, there was significant variation in AFP case counts and the NPAPF rates in Somalia. Please check for further notifications by email. 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. Notification speeds have since improved, with >80% of cases being reported within 7 days during 2014–2016. We acknowledge the contributions of the national polio program staff and the Village Polio Volunteers in Somalia to the success of this project. Community-based surveillance programs, such as the VPV program, encourage a paradigm shift from passive reporting to active detection of diseases of public health significance. 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. Each of the VPVs assigned to a district works closely with the district polio officer to actively search for and report AFP cases, in addition to other polio eradication activities, such as community sensitization ahead of vaccination campaigns. ; EIS officer, Centers for Disease Control and Prevention. If the cause is poliomyelitis, this may result in permanent disability, and outcomes could sometimes be fatal [4, 5]. Abbreviations: AFP, acute flaccid paralysis; CI, confidence interval; SD, standard deviation; VPVs, Village Polio Volunteers. Oxford University Press is a department of the University of Oxford. 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. Surveillance performance was assessed for the five 2019 priority countries in EMR (Afghanistan, Djibouti, Pakistan, Somalia, and Sudan) for 2018 and 2019 (Table 1). 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. There are currently 60 sampling sites for environmental detection in 40 towns and districts of the country. However, within this comprehensive analysis, nine countries were highlighted as having child mortality rates that were decreasing at a lower-than-expected rate. 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 … Thank you for submitting a comment on this article. 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’. Immunization Officer, Pune Municipal Corporation Date : 20.08.2010 2. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Kenya’s AFP surveillance system surpassed the WHO recommended minimum targets for both non-polio AFP rate and stool adequacy during the period studied. In addition to AFP surveillance, environmental surveillance helps enhance the sensitivity of surveillance for polioviruses. 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. Documents reviewed include program description documents outlining terms of reference for volunteers. This is why a country like Somalia, with a recent history of polio outbreaks, has been prioritized by GPEI for AFP surveillance strengthening. 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. 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. Search for other works by this author on: World Health Organization Liaison Office for Somalia, Nairobi, Kenya, Global Polio Eradication Initiative (GPEI), Polio eradication and endgame strategic plan 2013–2018, Poliomyelitis surveillance: the compass for eradication, Progress toward global interruption of wild poliovirus transmission, 2010–2013, and tackling the challenges to complete eradication, From emergence to eradication: the epidemiology of poliomyelitis deconstructed, An epidemiological analysis of acute flaccid paralysis in Khuzestan Province, southwest Iran, from 2006 to 2010, Differential diagnosis of acute flaccid paralysis and its role in poliomyelitis surveillance, Recommended standards for surveillance of selected vaccine preventable diseases: vaccines and biologicals, Progress toward polio eradication—worldwide, 2015-2016, Progress toward poliomyelitis eradication—Afghanistan, January 2014–August 2015, Certification of poliomyelitis eradication. Stool specimen adequacy rates have been consistently high, and AFP cases have been detected in a timelier manner since the program was introduced. 7. A substantial increment was observed in detection rate. Paris (AFP) - 01/02/2021 - 14:44 Bitcoin passes $30,000 for the first time. Statistical analyses were performed using SAS software (version 9.3; SAS Institute), and statistical significance was defined as P < .05. 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. In the years after program introduction, VPVs accounted for a high proportion of AFP cases reported in Somalia. The NPAFP rate for 2015 (the year after the outbreak) was 1.7 times that in 2012, the year before outbreak onset. 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. Lipid ratios representing SCD1, FADS1, and FADS2 activities as candidate biomarkers of early growth and adiposity. Currently, Pakistan has a well-functioning and sensitive AFP surveillance system at national, provincial, and district levels. Abstract: Objectives: To determine the status of the AFP surveillance system at Mohmand agency FATA in a sense to improve the sensitivity of the system in 2012. ; Centers for Disease Control and Prevention (CDC). 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]. 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. 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). Mbaeyi C, Kamadjeu R, Mahamud A, Webeck J, Ehrhardt D, Mulugeta A. Cochi SL, Jafari HS, Armstrong GL, et al. Chukwuma Mbaeyi, Abdinoor Mohamed, Brian Ogola Owino, Kumlachew F Mengistu, Derek Ehrhardt, Eltayeb Ahmed Elsayed, Strengthening Acute Flaccid Paralysis Surveillance Through the Village Polio Volunteers Program in Somalia, Clinical Infectious Diseases, Volume 67, Issue 6, 15 September 2018, Pages 941–946, https://doi.org/10.1093/cid/ciy180. 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. 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. They again accounted for the highest proportion of AFP cases reported in 2016 when compared with other reporting sources. 9. Vol 9, Pan American Health Organization, 20 August, Acute flaccid paralysis laboratorial surveillance in a polio-free country: Brazil, 2005–2014, Reporting of acute flaccid paralysis in children under 15 years of age: improving surveillance, January 2009–December 2014, Surveillance of poliomyelitis in Northern Italy: results of acute flaccid paralysis surveillance and environmental surveillance, 2012–2015, Laboratory surveillance of polio and other enteroviruses in high-risk populations and environmental samples, Aid in a city at war: the case of Mogadishu, Somalia, Progress toward polio eradication—Somalia, 1998–2013, Polio outbreak investigation and response in Somalia, 2013, Effectiveness of oral polio vaccination against paralytic poliomyelitis: a matched case-control study in Somalia, Progress toward poliomyelitis eradication—Pakistan, January 2015–September 2016, The eradication of polio—progress and challenges, EIS officer, Centers for Disease Control and Prevention, Progress toward polio eradication—worldwide, 2013-2014, The global polio eradication initiative: lessons learned and prospects for success, Centers for Disease Control and Prevention (CDC), Progress toward polio eradication—worldwide, 2014-2015, Responding to a poliovirus outbreak: standard operating procedures for a new polio outbreak in a polio-free country, The value of community participation in disease surveillance: a case study from Niger, The contribution of the polio eradication initiative to narrowing the gaps in the health workforce in the African Region, Polio eradication efforts in regions of geopolitical strife: the Boko Haram threat to efforts in sub-Saharan Africa, Progress toward poliomyelitis eradication—Afghanistan, January 2015–August 2016, Reaching the unreached with polio vaccine and other child survival interventions through partnership with military in Angola, Eradicating polio in Pakistan: an analysis of the challenges and solutions to this security and health issue, Public health surveillance and knowing about health in the context of growing sources of health data, Polio infrastructure strengthened disease outbreak preparedness and response in the WHO African Region, Polio Eradication Initiative: contribution to improved communicable diseases surveillance in WHO African Region, Polio Eradication Initiative (PEI) contribution in strengthening public health laboratories systems in the African Region. Each case of AFP acts as a signal to the polio surveillance system where polio is circulating and who it is likely to affect. 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. These NPAFP rates were derived from AFP cases from which neither wild nor vaccine-derived polioviruses were isolated. 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. We also reviewed and analyzed AFP surveillance data for all cases reported in Somalia from January 2011 to November 2016. 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. Over the past couple of years, the number of sites for environmental surveillance has increased, making it the largest environmental surveillance network in the world. Financial support. 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. 1), focussing on major transportation hubs, and areas with either highly mobile populations or areas associated with suboptimal AFP surveillance or vaccination coverage. Environmental surveillance (ES) can detect circulating polioviruses from sewage without relying on clinical presentation. 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