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Performance of acute flaccid paralysis surveillance compared with World Health Organization standards

Authors

  • Shalini Desai,

    Corresponding author
    1. Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Canada
    • Correspondence: Dr Shalini Desai, Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, 1st Floor, 180 Queen Street West, Toronto, Ontario M5V 3L7, Canada. Fax: 416 952 2235; e-mail: shalini.desai@phac-aspc.gc.ca

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  • Tiffany Smith,

    1. Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Canada
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  • Bruce R Thorley,

    1. Enterovirus Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute, Melbourne, Victoria, Australia
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  • Danielle Grenier,

    1. Canadian Paediatric Surveillance Program, Canadian Paediatric Society, Ottawa, Ontario, Canada
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  • Nigel Dickson,

    1. New Zealand Pediatric Surveillance Unit, Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
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  • Ekkehardt Altpeter,

    1. Federal Office of Public Health, Bern, Switzerland
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  • SPSU Committee,

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    • SPSU Committee: Chair: Christoph Rudin Basel, Switzerland. Vera Bernet-Büttiker, Zürich, Switzerland; Bernard Laubscher, Neuchatel, Switzerland; Giacomo Simonetti, Bern, Switzerland; Klara Posfay Barbe, Geneva, Switzerland; Mirjam Mäusezahl-Feuz, Bern, Switzerland; Daniela Beeli-von Büren, Bern, Switzerland.
  • Martine Sabbe,

    1. Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium
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  • Elizabeth Elliott,

    1. Australian Paediatric Surveillance Unit, Kids Research Institute, The Children's Hospital at Westmead, Australia
    2. The University of Sydney, Sydney, New South Wales, Australia
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  • Yvonne Zurynski

    1. Australian Paediatric Surveillance Unit, Kids Research Institute, The Children's Hospital at Westmead, Australia
    2. The University of Sydney, Sydney, New South Wales, Australia
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  • Conflict of interest: None.

Abstract

Aim

To compare acute flaccid paralysis (AFP) surveillance systems used by members of the International Network of Paediatric Surveillance Units (INoPSU) across the five AFP surveillance performance indicators recommended by the World Health Organization (WHO) for the maintenance of polio-free certification.

Methods

A survey was administered to AFP surveillance co-ordinators in five INoPSU member countries (Australia, Belgium, Canada, New Zealand and Switzerland). Data collected included information on surveillance system processes, WHO-recommended performance indicators, investigative practices and final diagnoses of cases from 2006 to 2010.

Results

All countries contacted completed the survey. Each country used similar case definitions and processes for collecting AFP data. All countries used at least one of the WHO indicators for surveillance. No country consistently met the performance indicator for incidence or stool sampling. In all countries, at least one form of neurological testing was used to diagnose cases of AFP. Guillain-Barré syndrome was the most common final diagnosis in all countries for all years examined.

Conclusions

Industrialised countries surveyed do not consistently meet the WHO-recommended AFP surveillance performance indicators. An opportunity exists for INoPSU to suggest a standard way for member countries to collect AFP data in order to examine the potential for strengthening the current systems or introducing additional enterovirus surveillance or alternative/complementary neurological performance measures suitable for countries that have eliminated polio. INoPSU member countries are evaluating these possibilities.

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