Polio Eradication in Bangladesh: Evaluation of AFP Surveillance Indicators, 2011-2015

Abstract

Abstract:As per recommendation from WHO, Bangladesh began a comprehensive plan for AFP (Acute Flaccid Paralysis) and EPI (Expanded Program on Immunisation) disease surveillance from 1997. The country has been maintaining key performance indicators for AFP surveillance for the past ten years. Bangladesh has been declared polio free on 27 th March 2014. The aim of this paper is to evaluate and describe results of AFP surveillance indicators for Bangladesh showing the progress made over time as well as identifying areas, which needs further improvements to maintain the polio free status. This retrospective study has been conducted using the surveillance data routinely collected from AFP cases on demographic characteristics and clinical & laboratory examination. Data of 7480 children less than 15 years old reported between January 2011 to December 2015 have been included in this study. Among all reported cases 59.22% cases were male children with a male: female ratio of 1.45:1. 54% of the reported AFP cases within the study period belong to 1-4 years of age. Among all reported cases, 56% have been diagnosed with Guillain-Barre Syndrome or GBS. Annual Non-Polio AFP rate has been successfully achieved nationally for each study year. Completeness and Timeliness of passive reporting from facilities have been satisfactory. 98% or more of all reported AFP cases within the study period has been investigated within 48 hours of notification. For over 95% of all reported AFP cases two stool samples were collected within 14 days of case reporting. 60 plus day follow up has been performed for at least 99% reported AFP cases within the study period. All epidemiological and laboratory surveillance indicators were successfully met for AFP surveillance. However it is important for Bangladesh to maintain long-term AFP case based surveillance along with introduction of Environmental surveillance due to the risk of poliovirus importation before global polio eradication.

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

“…However, importation of poliovirus remains a potential threat; therefore, it is essential to continue AFP surveillance. The study reported that half of the reported cases were of patients below 5 years of age, which is consistent with findings of a study conducted in Iran [10] and another one in Bangladesh [11]. However, higher percentages were reported in countries such as Congo (85.2%) [12] and Ghana (74.4%) [13], and lower percentages were reported in other countries including Italy (37%) [14].…”

“…This impressive vaccination coverage is explained by the repetitive campaigns conducted in 2013-2016 that targeted prevention of polio importation from Syrian refugees and the high awareness of parents to ensure completion of the vaccination schedule and taking recommended doses during campaigns. A similar finding was revealed in Bangladesh (75%) [11]. In Turkey, 84.5% of the studied cases had at least one oral polio vaccine dose [15].…”

“…However, higher percentages were reported in countries such as Congo (85.2%) [12] and Ghana (74.4%) [13], and lower percentages were reported in other countries including Italy (37%) [14]. Of all cases, the number of boys exceeded the number of girls, a finding also reported in other studies [11,13,14].…”

“…The evaluation of the viability of stool specimens sent to the laboratory is represented by the nonpolio enterovirus isolation rate, which should be at least 10% and was not achieved by the AFP surveillance system during the study period; this indicates that the reverse cold chain was not maintained in that period, except in 2016 where it was in line with the WHO target. A high nonpolio enterovirus isolation rate was reported in Ghana [13], Bangladesh [11], and Turkey [15]. More than 90% of the AFP cases reported during the study period and requiring 60-day follow-up examination had been examined at 60 days after the onset of paralysis, meeting the specified WHO target.…”

Evaluation of the Acute flaccid paralysis surveillance indicators in Zambia from 2015-2021: A retrospective analyses

“…The ndings that most (51%) reported AFP cases were <5 years is signi cant and implies that the surveillance system could have detected WPV or cVDPV (if it was present) since poliomyelitis commonly affect children within this age group 19 . Similarly, other studies that evaluated AFP surveillance systems also found that most AFP cases were in children less than 5 years in Nigeria (82%) 2 , Ghana (76%) 3 , Ethiopia (68%) 20 , Iran (53%) 21 , Bangladesh (54%) 22 , and Democratic Republic of the Congo (85%) 23 .…”