This project was funded and supported by the US Centers for Disease Control and Prevention. Even in regions that have been certified as polio free, such as Europe  and the Americas , AFP surveillance activities are undertaken as a way of maintaining certification standards [1, 7] and remaining vigilant in the event of reimportation of the virus as a result of migration from polio-infected areas [12–15]. Background More than 99% of poliovirus infections are non-paralytic and therefore, not detected by acute flaccid paralysis (AFP) surveillance. Environmental surveillance (ES) can detect circulating polioviruses from sewage without relying on clinical presentation. In the years before the VPV program was introduced (ie, 2011 and 2012), the majority of AFP cases were reported through public healthcare facilities, such as hospitals and maternal and child health centers. There are currently 60 sampling sites for environmental detection in 40 towns and districts of the country. The NPAFP rates in areas with access limitations increased during the outbreak years to 5.4 and 7.1 in 2013 and 2014, respectively, and remained above preoutbreak levels in the succeeding years, with rates of 4.6 and 5.2 being reported in 2015 and 2016, respectively. Introduction: Polio has been eliminated from all countries except four, including Pakistan, where polio is still endemic. Other reporting sources during this period included regular polio program staff, which accounted for 30% of reporting in 2012, and private healthcare providers, including traditional healers, which accounted for 21% of reporting in 2012. Strengthening AFP surveillance systems is thus seen not just as essential to interrupting poliovirus circulation in areas with ongoing transmission but also for protecting the gains already achieved in places where the disease has been eliminated. Bannu due to its geographical location stands out to be one of highest risk areas for Poliomyelitis. Over the past couple of years, the number of sites for environmental surveillance has increased, making it the largest environmental surveillance network in the world. Systems for AFP surveillance are particularly crucial in countries like Somalia, where the dilapidated healthcare infrastructure makes for increased vulnerability to polio outbreaks despite the elimination of indigenous WPV transmission. Statistical analyses were performed using SAS software (version 9.3; SAS Institute), and statistical significance was defined as P < .05. The objectives of this study were to All authors: No reported conflicts of interest. When limited by accessibility status, case reporting levels and sources in areas with security and access limitations mirrored national trends during 2011–2016. For more information on surveillance activities, see the photo essay: “The journey of a stool sample: Understanding polio surveillance”, EPI Building, Block-D, Prime Minister's Health Complex, Chak Shahzad, 44000, Islamabad, Acute Flaccid Paralysis (AFP) Surveillance, Testing Stool Surveys From Healthy Children, “The journey of a stool sample: Understanding polio surveillance”. The VPV program, a community-based program, was established to enhance polio eradication activities in Somalia by strengthening surveillance and improving vaccination coverage in local communities. Abbreviations: AFP, acute flaccid paralysis; WPV, wild poliovirus. The country’s healthcare system has been severely weakened by political crisis, and, as a result, the delivery of immunization services lags considerably behind recommended global standards. Further, from 2012 to 2015, the nonpolio AFP rate improved from 2.8 to 4.8 cases per 100000 persons aged <15 years. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Surveillance is one of the main pillars of the Polio Eradication Programme. With extensive ES and continued circulation of polioviruses, Pakistan presents a unique opportunity to quantify the impact of … Acute Flaccid Paralysis (AFP) Surveillance of polio virus in Pakistan is a systematic collection, analysis and interpretation of data and the dissemination of information. Despite an expansion in the number of reporting sites by the national polio program, VPVs have accounted for the majority of AFP cases detected in Somalia over the past 3 years, that is, from 2014 to 2016. Volunteers involved in the program, commonly referred to as VPVs, were recruited from local communities in nearly all districts of the country, with early priority given to districts designated as high risk based on predefined criteria. Clinicians must follow all cases of AFP for a minimum of 60 days and correlate with virus intra-typing. This project was undertaken as part of the process of evaluating improvements in a public health surveillance system and was not considered to be human subjects research. This work is written by (a) US Government employee(s) and is in the public domain in the US. We computed the mean number days from paralysis onset to case reporting and 95% confidence intervals (CIs). Published by Oxford University Press for the Infectious Diseases Society of America 2018. A crucial step in the investigation is the collection of 2 stool specimens from the case patients ≥24 hours apart. VPVs accounted for only 2% of reported cases in 2013, having begun their activities in September of the same year. Current scenario of Polio 3. The mean duration from paralysis onset to notification was the same (4.5 days) for AFP cases reported by both VPVs and other reporting sources during 2014–2016. Delving into the detail: Greater episodic detail in narratives of a critical life event predicts an increase in adolescent depressive symptoms across one year. US Centers for Disease Control and Prevention, Atlanta, Georgia, Correspondence: C. Mbaeyi, US Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS-A04, Atlanta, GA 30333 (. Mbaeyi C, Saatcioglu A, Tangermann RH, Hadler S, Ehrhardt D. Sousa IPJr, Burlandy FM, Oliveira SS, et al. Although we could not determine from our data whether AFP cases identified by VPVs could have otherwise been detected by other reporting sources, our findings strongly suggest that much of the improvement in surveillance has been driven by the activities of VPVs. Paris (AFP) - 01/02/2021 - 14:44 Bitcoin passes $30,000 for the first time. Abbreviation: AFP, acute flaccid paralysis. Once collected, VPVs work closely with the district polio officer to ensure that the specimens are transported in a timely manner to the regional polio laboratory in Nairobi, Kenya, where testing is conducted. The Global Polio Eradication Initiative (GPEI) has made tremendous gains in the last 28 years, with over 99% reduction in wild poliovirus (WPV) [1,2,3].Poliomyelitis is characterized by sudden weakness or floppy paralysis of any of the limbs, most especially in children [4,5,6,7,8].Acute flaccid paralysis (AFP) surveillance is the gold standard for poliomyelitis control and prevention. Notification speeds have since improved, with >80% of cases being reported within 7 days during 2014–2016. Stool samples of children with Acute Flaccid Paralysis (AFP) were collected from Khyber Pakhtunkhwa (KP) and Federally Administered Tribal Areas (FATA) of Pakistan as per WHO guidelines within 14 days from the date of onset. All stool specimens collected from reported AFP cases are tested at the Regional Reference Laboratory (RRL) for polio eradication in Islamabad. Improved AFP surveillance will also serve as a key factor for certification of the country and continent as polio free when the disease is eventually eliminated from Africa. Abbreviations: AFP, acute flaccid paralysis; CI, confidence interval; SD, standard deviation; VPVs, Village Polio Volunteers. In the years after program introduction, VPVs accounted for a high proportion of AFP cases reported in Somalia. These NPAFP rates were derived from AFP cases from which neither wild nor vaccine-derived polioviruses were isolated. Building trust at the grassroots level through community-based programs is beneficial on multiple levels because programs like the VPV program often evolve to encompass other disease surveillance and prevention activities. The contributions of VPVs to case reporting further improved in the following years. We compared the NPAFP rate in 2015, the year after the 2013–2014 polio outbreak, to the rate in 2012, the year before the outbreak, by calculating the incidence rate ratio using a Poisson regression model, adjusting for geopolitical zones. After the end of the outbreak, NPAFP rates have declined from levels during the outbreak, but they have remained significantly above preoutbreak levels. The Village Polio Volunteers (VPV) program was established in 2013 in a bid to strengthen polio eradication activities in Somalia, including AFP surveillance, given the country’s vulnerability to polio outbreaks. Surveillance performance was assessed for the five 2019 priority countries in EMR (Afghanistan, Djibouti, Pakistan, Somalia, and Sudan) for 2018 and 2019 (Table 1). However, despite the recession and eventual cessation of the outbreak in 2014, the NPAFP rate rose from levels in 2013, largely owing to the contributions of the newly introduced VPV program. 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