Asthma morbidity in England and Wales appears to have increased in recent decades, despite advances in therapy, and this is widely attributed to increasing asthma prevalence. This increase has not, however, been fully reflected by mortality trends, and in children and young adults, there have been no clear changes. In adults aged Š45 yrs (in whom >85% of current asthma deaths are recorded), mean annual mortality doubled between the mid1970s and the early 1990s in both sexes [1,2]. The rate of change and the degree of annual fluctuation increased with age, and the apparent increase was most evident in those aged Š65 yrs.The cause of the marked increase in recorded asthma deaths in this age group is uncertain. If correct, it could reflect improved diagnostic recognition, an increase in asthma prevalence, an increase in disease severity or an adverse effect of medication. The 1979 and 1984 changes in international coding practice (International Classification of Diseases (ICD) 9, implementation of rule 3) artificially increased the mortality rate in those aged <45 yrs and >75 yrs, respectively, but this provides insufficient explanation for the observed trends [2][3][4].Alternatively, the increase may be largely artefactual. The accuracy of death certification is known to decline with advancing age, and there is concern that recent trends, especially in the elderly, may be attributable to diagnostic transfer [5,6]. An audit investigation in the period 1980-1989 in one district of the Northern Health Region of England suggested that the majority of certified "asthma deaths" had occurred in elderly smokers who had neither died from asthma nor suffered from it [7]. Other studies have suggested that asthma death certification for the whole population may overestimate the number of true asthma deaths by 13-47%, with the degree of inaccuracy in certification rising in the elderly to 39-80% [8][9][10].The recorded asthma mortality rates of 3.94 and 3.64 per 100,000 for the Northern Health Region (population 3.07 million) for the years 1991 and 1992, respectively, closely reflect the national figures for England and Wales of 3.67 and 3.48 (total population 51 million). Therefore, experience within the northern region as a whole is likely to be representative of the national picture. The aim of this study was, consequently, to estimate the magnitude of any inaccuracy in death certification for asthma within this region, and hence, to assess whether the apparent increase in asthma mortality in the elderly could have occurred, at least partly, as a result of diagnostic transfer. Methods SubjectsPermission was obtained from 13 of the 16 local Health Authorities for a review of death certificates for the years , 1991. D.W.E.C. Reid, V.J. Hendrick, T.C. Aitken, W.T. Berrill, S.C. Stenton, D.J. Hendrick. ©ERS Journals Ltd 1998. ABSTRACT: Asthma mortality appeared to increase two-fold in the UK from the mid-1970s to the early 1990s, but there is evidence of inaccuracy in asthma death certification and so a region-wide investigat...

Australia conducts surveillance for cases of acute flaccid paralysis (AFP) in children less than 15 years as recommended by the World Health Organization (WHO) as the main method to monitor its polio-free status. Cases of AFP in children are notified to the Australian Paediatric Surveillance Unit or the Paediatric Active Enhanced Disease Surveillance System and faecal specimens are referred for virological investigation to the National Enterovirus Reference Laboratory. In 2015, no cases of poliomyelitis were reported from clinical surveillance and Australia reported 1.2 non-polio AFP cases per 100,000 children, meeting the WHO performance criterion for a sensitive surveillance system. Two non-polio enteroviruses, enterovirus A71 and coxsackievirus B3, were identified from clinical specimens collected from AFP cases. Australia complements the clinical surveillance program with enterovirus and environmental surveillance for poliovirus. Two Sabin-like polioviruses were isolated from sewage collected in Melbourne in 2015, which would have been imported from a country that uses the oral polio vaccine. The global eradication of wild poliovirus type 2 was certified in 2015 and Sabin poliovirus type 2 will be withdrawn from oral polio vaccine in April 2016. Laboratory containment of all remaining wild and vaccine strains of poliovirus type 2 will occur in 2016 and the National Enterovirus Reference Laboratory was designated as a polio essential facility. Globally, in 2015, 74 cases of polio were reported, only in the two remaining countries endemic for wild poliovirus: Afghanistan and Pakistan. This is the lowest number reported since the global polio eradication program was initiated.

BackgroundAustralia uses acute flaccid paralysis (AFP) surveillance to monitor its polio-free status. The World Health Organization criterion for a sensitive AFP surveillance system is the annual detection of at least one non-polio AFP case per 100,000 children aged less than 15 years, a target Australia has not consistently achieved. Children exhibiting AFP are likely to be hospitalised and may be admitted to an intensive care unit. This provides a potential opportunity for active AFP surveillance.MethodsA data-linkage study for the period from 1 January 2005 to 31 December 2008 compared 165 non-polio AFP cases classified by the Polio Expert Panel with 880 acute neurological presentations potentially compatible with AFP documented in the Australian and New Zealand Paediatric Intensive Care (ANZPIC) Registry.ResultsForty-two (25%) AFP cases classified by the Polio Expert Panel were matched to case records in the ANZPIC Registry. Of these, nineteen (45%) cases were classified as Guillain-Barré syndrome on both registries. Ten additional Guillain-Barré syndrome cases recorded in the ANZPIC Registry were not notified to the national AFP surveillance system.ConclusionsThe identification of a further ten AFP cases supports inclusion of intensive care units in national AFP surveillance, particularly specialist paediatric intensive care units, to identify AFP cases that may not otherwise be reported to the national surveillance system.

Australia monitors its polio-free status by conducting surveillance for cases of acute flaccid paralysis (AFP) in children less than 15 years of age, as recommended by the World Health Organization (WHO). Cases of AFP in children are notified to the Australian Paediatric Surveillance Unit or the Paediatric Active Enhanced Disease Surveillance System, and faecal specimens are referred for virological investigation to the National Enterovirus Reference Laboratory. In 2022, no cases of poliomyelitis were reported from clinical surveillance and Australia reported 1.69 non-polio AFP cases per 100,000 children, thereby meeting the WHO’s performance criterion for a sensitive surveillance system. The non-polio enteroviruses coxsackievirus A2, coxsackievirus A6, coxsackievirus A10, echovirus 18, enterovirus A71 and enterovirus C96 were identified from clinical specimens collected from AFP cases. Australia also performs enterovirus and environmental surveillance to complement the clinical system focussed on children. In 2022, thirty cases of wild poliovirus were reported from three countries (Afghanistan, Mozambique and Pakistan); 24 countries also reported cases of poliomyelitis due to circulating vaccine-derived poliovirus.