Acute flaccid paralysis (AFP) surveillance intensification for polio certification in Kaduna state, Nigeria: lessons learnt, 2015–2016

Abstract

BackgroundNigeria has made remarkable progress in its current efforts to interrupt wild poliovirus transmission despite the re-emergence of wild poliovirus in 2016. The gains made in Nigeria have been achieved through concerted efforts by governments at all levels, traditional leaders, health workers, caregivers, and development partners. The efforts have involved an elaborate plan, coordination, and effective implementation of routine immunization services, supplemental immunization activities, and acute flaccid paralysis (AFP) surveillance.MethodsWe conducted the following activities to strengthen AFP surveillance in Kaduna state: a monetary reward for all AFP cases reported by health workers or community informants and verified as “true” AFP by a World Health Organization (WHO) cluster coordinator; training and sensitization of surveillance officers, clinicians, and community informants; recruitment of more personnel and expansion of the surveillance network; and the involvement of special populations (nomadic, hard-to-reach, and border communities) and caregivers in stool sample collection. The paired t test was used to evaluate the impact of the different initiatives implemented in Kaduna state to intensify AFP surveillance in 2016.ResultsThere was increased annualized non-polio AFP rate (ANPAFPR) in 21 out of 23 Local Government Areas (LGAs) of Kaduna state 6 months after implementation of different initiatives to intensify AFP surveillance. The AFP reported by the special population increased in 15 out of 23 LGAs. Statistical analyses of mean scores of ANPAFPR before and after the interventions using the paired t test revealed a significant difference in mean scores: mean = 19.7 (standard deviation (SD) = 16.1) per 100,000 < 15 years old in July–December 2015, compared with 38.0 (SD = 21.6) per 100,000 < 15 years old in January–June 2016 (p < 0.05). Likewise, analysis of silent wards using the paired t test showed a significant difference in mean scores: mean = 4.0 (SD = 2.1) in July–December 2015 compared with 2.4 (SD = 1.8) in January–June 2016 (p < 0.05).ConclusionThe different initiatives implemented in 23 LGAs of Kaduna state to intensify AFP surveillance may be responsible for the significant improvement in the AFP surveillance performance indicators in 2016.

Outcomes of the Deployment of the Auto-Visual Acute Flaccid Paralysis Detection and Reporting (AVADAR) System for Strengthening Polio Surveillance in Africa From 2017 to 2018: Evaluation Study

“…In absolute terms, there was improvement in reporting across all countries, with the lowest evidence-based improvement being in Chad (32%). This further supports AFP surveillance intensification that AVADAR elaborates, leading to reduction in silent areas [12]. Considering the traditional AFP cases reported, the AVADAR cases, and the silent district reduction reported in the same period ( Table 2 and Table 3), we have provided the P values for comparisons in Table 4.…”

Acute flaccid paralysis in children in the post certification period of the Republic of Moldova as a country free of wild poliomyelitis

“…Referitor la sprijinirea eradicării globale OMS a propus testarea contacților cu PAF în anul 1988, un an în care 125 de țări din întreaga lume au raportat cazuri detectate în masele fecale sau în probele de mediu (1). Conform Organizaţiei Mondiale a Sănătăţii, toate cazurile de PAF tre-buie să fie investigate într-un laborator certificat de aceasta, de asemenea, pentru izolarea virusului se colectează două probe de mase fecale, la înregistrarea fiecărui caz de PAF, la cel puțin 24 de ore de la detectarea acestuia (6,7,8).…”

“…În 2016 în statul Kaduna, Nigeria s-a determinat o diminuare a ratei PAF, probabil datorită implementării diferitelor inițiative de intensificare a supravegherii PAF. În statul Kaduna rata anuală minimă PAF a constituit 2/100.000 la copii <15 ani și probele de mase fecale negative > 80%(6).În perioada anilor 2006-2007 România a raportat 28 de cazuri de paralizie acută flască (PAF) la tronsonul de vârstă de la 3 luni la 14 ani și 45 de cazuri de paralizie acută flască la vârsta cuprinsă între 6 luni -4 ani și 9 luni)(16). Un alt studiu a constatat că 48% din cazurile de PAF au apărut la copiii cu vârsta sub 5 ani(17).Date similare au fost raportate de Comitetul Naţional din Hong Kong, care au raportat 247 de boratorul Regional de Referinţă al OMS, Institutul de Poliomielită şi Encefalite Virale "M. P. Ciumacov", Moscova, cu teste din ultimă generaţie, prin tehnici de biologie moleculară -PCR.…”

“…Datele de supraveghere PAF din America arată că, în anul 2017 au fost raportate 1975 de cazuri de PAF, care corespundeau unei rate PAF de 1,17 cazuri, la o populație de 100.000. În absența transmisiei de polio sălbatic, era de așteptat ca rata PAF să se reducă la aproximativ 2/100000, considerată o rată acceptabilă a PAF(6). Un total de 4974 de cazuri de PAF au fost raportate de Irak între ianuarie 1997 și decembrie 2011(22).…”

Evaluating AVADAR Mobile Health Intervention Using a Multi-prong Approach

“…Acute accid paralysis (AFP) surveillance is one of the four bedrock strategies for polio eradication and it includes the detection and investigation of cases of new onset of accid paralysis in children aged <15 years or any person, of any age, whom a clinician suspected to have poliomyelitis [1](2). AFP surveillance aims to ensure that there is no case of AFP in our communities, which is an essential means of monitoring the progress towards polio eradication (2) .…”