Surveillance performance was assessed for the five 2019 priority countries in EMR (Afghanistan, Djibouti, Pakistan, Somalia, and Sudan) for 2018 and 2019 (Table 1). Hagan JE, Wassilak SG, Craig AS, et al. Duration from Paralysis Onset to Notification of Acute Flaccid Paralysis Cases by Year and Reporting Source, Somalia, 2014–2016. 701–716) Kenya’s AFP surveillance system surpassed the WHO recommended minimum targets for both non-polio AFP rate and stool adequacy during the period studied. The objectives of this study were to 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. AFP case counts spiked during the polio outbreak, increasing to 546 and 420 cases during 2013 and 2014, respectively. Environmental surveillance involves testing sewage or other environmental samples for the presence of poliovirus. The programme is able to identify where the polio virus is circulating through its highly sensitive surveillance activities. 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. Detection of poliovirus circulation is often predicated on the ability to identify AFP cases and test their stool specimens for poliovirus infection in a timely manner. As the morbidity:infection ratio of PV infection is very low, this fact contributes to the sensitivity of ENV which under optimal conditions can be better than that of the standard acute flaccid paralysis (AFP) surveillance. Compared with the 194 laboratory-confirmed WPV cases identified in 2013, only 5 WPV cases were identified in 2014. With extensive ES and continued circulation of polioviruses, Pakistan presents a unique opportunity to quantify the impact of … WHO recommends that ≥80% of stool specimens arriving in the laboratory must be adequate. In addition to AFP surveillance, environmental surveillance helps enhance the sensitivity of surveillance for polioviruses. Since 2005 the average global child mortality rate has fallen by 3.6% per year1 and Wang et al.1 estimate that the impact of ‘secular trends’, which include technological developments such as vaccines, had the largest impact on reductions in child mortality rates. To assess the impact of the VPV program on AFP surveillance, we reviewed documents provided by the WHO Liaison Office for Somalia, the managing organization for the country’s polio program. All authors: No reported conflicts of interest. Progress towards poliomyelitis eradication: Pakistan, January 2016–September 2017 Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2017 17 November 2017, vol. The patterns of reporting held in 2013, the first year of the polio outbreak, with public healthcare facilities again being the main reporting source for AFP cases. With respect to other key surveillance indicators, stool specimen adequacy rates remained stable and above the recommended level during the period under review. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. Timeliness of reporting standards, pegged at ≤7 days from paralysis onset, declined steeply from 90% to 70% in 2013, mostly owing to intensified surveillance activities and late reporting of cases that were previously undetected by the surveillance system. The aforementioned factors led to the establishment of the Village Polio Volunteers (VPV) program in September 2013. Thank you for submitting a comment on this article. We limited our analyses to districts with security and access limitations during the period under review. AFP surveillance performance indicators should be monitored at all levels Depth of analysis depends on the level at which it is being conducted. Identification of ≥2 nonpolio AFP (NPAFP) cases per 100000 persons aged <15 years is recommended by the World Health Organization (WHO) as a benchmark for surveillance activities in regions with active poliovirus transmission or places at significant risk of outbreaks [8, 9]. In the years after program introduction, VPVs accounted for a high proportion of AFP cases reported in Somalia. 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. The establishment of the VPV program to supplement existing structures in place for AFP surveillance has proved to be of vital importance in enhancing the country’s capacity to mount an effective response to outbreaks and maintain its polio-free status. Surveillance for wild poliovirus through reporting and laboratory testing of all cases of acute flaccid paralysis (AFP) among children under fifteen years of age. Stool specimen adequacy rates were consistently >95% during 2011–2016 except in 2013, when the rate dropped to 86.8%. The contributions of VPVs to case reporting further improved in the following years. Most counties achieved targets for both key surveillance indicators. 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. The NPAFP rate for 2015 (the year after the outbreak) was 1.7 times that in 2012, the year before outbreak onset. Even in regions that have been certified as polio free, such as Europe [10] and the Americas [11], 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]. VPVs accounted for only 2% of reported cases in 2013, having begun their activities in September of the same year. PESHAWAR: The health department has been diagnosing coronavirus patients quickly with the help of antigen detection rapid diagnostic test (Ag-RDT) as … Your comment will be reviewed and published at the journal's discretion. 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