Poliomyelitis Surveillance: The Compass for Eradication

Abstract

Effective disease surveillance is a key strategy of the global polio eradication initiative. In an effort to strengthen the quality of polio surveillance as a prerequisite to achieving and certifying eradication, surveillance assessments were conducted in 28 countries in the World Health Organization African, Eastern Mediterranean, and European Regions from 1992 to 1995 using a standard protocol and evaluation guidelines. Six general recommendations were made: Use surveillance data for public health decision-making and action, improve timeliness of information exchange and dissemination, standardize the data collected, ensure adequate surveillance infrastructure, improve local data analysis, and enhance teamwork among surveillance partners. The experience gained will position the Expanded Programme on Immunization to address the challenges of disease prevention in the 21st century.

Can a Minimum Rate of Investigation of Measleslike Illnesses Serve as a Standard for Evaluating Measles Surveillance?

“…The AFP standard has been an extremely effective tool with which to assess the quality of polio surveillance, and it has played an important part in the success of polio eradication efforts [2][3][4][5][6][7][8][9][10][11][12][13][14]. Establishment of a minimum standard rate of investigation to assess the adequacy of measles surveillance, however, raises new challenges.…”

“…When such countries report 0 polio cases, the report is credible because the level of investigation of patients with poliolike illness is adequate. Although the actual incidence of nonpolio AFP likely varied over time and by region, establishment of this standard of 1 AFP investigation per 100,000 children !15 years of age provided an effective management tool with which to ensure the quality of polio case finding [2][3][4][5][6][7][8][9][10][11][12][13][14].…”

Progress Toward Global Interruption of Wild Poliovirus Transmission, 2010-2013, and Tackling the Challenges to Complete Eradication

“…Although paralysis is a rare outcome of WPV (and cVDPV) infections (<1%) [27], acute flaccid paralysis (AFP) surveillance has been the proven means of tracing WPV transmission [28]. AFP surveillance consists of detecting and investigating acute paralysis in children, including timely collection of fecal specimens and prompt testing in accredited laboratories of the Global Polio Laboratory Network (GPLN) [29–31].…”

When is a disease eradicable? 100 years of lessons learned

“…Although the clinical case definition (acute flaccid paralysis) for polio eradication has high sensitivity, its low specificity requires a complex system for transferring stool specimens to an accredited World Health Organization laboratory for analysis. 30,31 The technical feasibility of both initiatives is best seen in the tremendous progress that has been made. The annual incidence of polio has fallen by more than 90% worldwide, from an estimated 350000 cases when the initiative was launched in 1988 to slightly more than 7000 reported in 1999 (Figure 1).…”