Evaluation of the Acute Flaccid Paralysis Surveillance System in Polio-Free Jordan, 2012-2016: Retrospective Secondary Analysis

Abstract

BackgroundAs part of the polio-eradication strategy, the World Health Organization (WHO) has established a global acute flaccid paralysis (AFP) surveillance system. AFP surveillance has successfully helped Jordan achieve polio-free certification. However, there is a substantial risk of polio importation from neighboring countries including Syria and Iraq.ObjectiveThis study aimed to evaluate the AFP surveillance in Jordan and identify areas that need improvement.MethodsThis retrospective study is a secondary analysis of data that were routinely collected between 2012 and 2016 by Jordan’s Expanded Program on Immunization. The WHO’s minimum performance indicators were used to evaluate the AFP surveillance.ResultsCumulatively, 328 AFP cases had been reported. Almost half (n=168, 51.3%) of the patients were aged 1-5 years, and 55.8% (n=183) were male. All cases were discarded (classified as a nonpolio case). The most common cause of AFP was Guillain-Barre Syndrome (n=115, 35.1%). The annualized nonpolio AFP rate increased from 1.4/100,000 children below 15 years of age in 2012 to 4.3 in 2016. National and subnational sensitivities were not met in 2012 and 2013. Adequacy of stool specimens and timeliness of specimens arriving at and processed in the laboratory were constantly above the minimum target. Timeliness of the investigation met the expected target but with a decreasing trend. The nonpolio enterovirus isolation rate was below the target, except in 2016.ConclusionsThe AFP surveillance system in Jordan is performing well; however, additional efforts are needed to strengthen the subnational sensitivity. The cold chain from sample collection to laboratory testing has to be maintained to ensure the reliability of stool specimens required for isolation of the nonpolio enterovirus.

Enterovirus Surveillance (EVSurv) in Germany

“…The gold standard of polio surveillance is testing stools from patients with acute flaccid paralysis (AFP) for poliovirus. The AFP surveillance is used to achieve or confirm polio-free status in many countries [28][29][30][31][32]. However, polio-free countries are challenged by the sensitivity criteria (at least one AFP case per 100000 children under the age of 15 years per year) [33].…”

Acute flaccid paralysis incidence rate and epidemiology in children in Lebanon: a rise in numbers in the post-vaccination and refugee crisis era

“…This study revealed that 83.2% of AFP cases received at least 3 doses of OPV/IPV vaccine, 13.8% received less than three doses (out of which 26.4% were not vaccinated at all), and the remaining cases were unspecified (3.0%). This vaccination rate of 83.2% is considered significantly high compared to the same rate in Congo (58.9%) between 2008 and 2014 21 , but relatively low compared to the 98.3% found in Ikwa Ibom state, Nigeria 7 .…”

“…These numbers showed to be similar to the results recorded in a study conducted in Italy between 1997 and 2007 20 . However, similar studies in Jordan, Iran, Congo, and Bangladesh [21][22][23][24] suggested that the incidence was significantly higher in children under five years old.…”

A Retrospective Study on the Topographical and Etiological Aspects of Acute Flaccid Paralysis in Children in Kenitra Province, Morocco

“…In 76 percent of the cases, more than three doses of the vaccination were administered. 25,26 Furthermore, as part of the vaccine program, vaccination records are well protected at the provincial level. These data support and sustain the high level of poliovirus vaccine coverage in children under the age of one year.…”