Australian National Enterovirus Reference Laboratory annual report, 2015

Abstract

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 The global eradication of wild poliovirus type 2 was certified in 2015 and Sabin poliovirus type 2 will be withdrawn from oral polio vaccine in April 2016.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.

Acute flaccid myelitis – has it gone unrecognised in Australian children?

“…13,14 EV-D68 has been previously isolated in Australia, with the first report from AFP cases identified in 2010 during a retrospective review of enterovirus surveillance data. 15,16 However, no clusters of EV-D68-associated AFM have been recognised or reported. We acknowledge that the association of EV-D68 with this AFM cluster is indirect, limited to a single patient, and that EV-A71 was detected in another AFM-compatible patient in this period.…”

Polio – The old foe and new challenges: An update for clinicians

“…AFP cases are reviewed by the PEP on a monthly basis to reach a consensus diagnosis, including for cases with inadequate stool collection to exclude poliovirus. 11,26 Between 1995 and 1999, a total of 143 cases of AFP were identified by the APSU, representing 0.8 cases per 100 000 children aged <15 years; 12-54% of cases had adequate stool collection, both below the WHO surveillance benchmarks. 3,24,26 Under-reporting by clinicians was the major contributing factor.…”

“…11,26 Between 1995 and 1999, a total of 143 cases of AFP were identified by the APSU, representing 0.8 cases per 100 000 children aged <15 years; 12-54% of cases had adequate stool collection, both below the WHO surveillance benchmarks. 3,24,26 Under-reporting by clinicians was the major contributing factor. 27 To improve Australia's ability to meet surveillance benchmarks, the Paediatric Active Enhanced Disease Surveillance (PAEDS) Network was established in 2007 to complement APSU surveillance, among other activities.…”

“…28 PAEDS surveillance nurses at five paediatric tertiary hospitals nationwide actively identify admissions of possible AFP and collect demographic and clinical data. 21,26,27 A total of 718 cases were reported by the PAEDS arm between 2007 and 2015; Australia has met its WHO surveillance detection requirements in each year since PAEDS involvement, though stool collection rates remained below the 80% target. 26 As an additional response to sub-optimal stool collection, environmental surveillance was introduced in Australia in 2014.…”

Summary of national surveillance data on vaccine preventable diseases in Australia, 2012–2015

“…105 In the most recent published report, the PEP classified 58 cases as non-polio acute flaccid paralysis (AFP), a rate of 1.4 cases per 100,000 children less than 15 years of age, 106 which exceeded the WHO AFP surveillance performance criterion of 1 case of non-polio AFP per 100,000 children. 106…”