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The Pan African Medical Journal 2023acute flaccid paralysis (AFP) surveillance is the gold standard of the Global Polio Eradication Initiative (GPEI) for detecting cases of poliomyelitis and tracking...
INTRODUCTION
acute flaccid paralysis (AFP) surveillance is the gold standard of the Global Polio Eradication Initiative (GPEI) for detecting cases of poliomyelitis and tracking poliovirus transmission. Nigeria's AFP surveillance performance indicators are among the highest in countries of the World Health Organization (WHO) African Region. The primary AFP surveillance performance indicators are the rate of non-polio AFP among children and the proportion of timely, adequate specimen collection. The surveillance working group of the National Emergency Operations Centre assessed the quality of AFP surveillance data in some reportedly high-performing states.
METHODS
we conducted a retrospective review of AFP surveillance performance indicators in Nigeria for 2010-2019. We also reviewed data in reports from four groups of surveillance peer reviews and validation visits (conducted by in-country GPEI partners) during August 2017-May 2019 in 16 states with high primary AFP surveillance indicators; the validation visits reviewed clinical information and the dates of specimen collection and onset of paralysis with caretakers.
RESULTS
there were consistently increasing AFP surveillance primary performance indicators during 2010-2016, followed by declines during 2017-2019. From the data for 16 states with peer reviews conducted from August 2017-May 2019, overall concordance of reported and "true" (validated) AFP indicator data in peer review investigations was highly variable. True AFP concordance ranged from 58%-100%, and stool timeliness concordance ranged from 56%-95%. The most common clinical causes of reported AFP cases that were not true AFP were spastic paralysis, malaria, sickle cell disease, and malnutrition. All the states that participated in peer reviews developed surveillance improvement plans based on the gaps identified.
CONCLUSION
Nigeria has highly sensitive AFP surveillance according to reported primary AFP performance indicators. The findings of peer reviews indicate that the AFP surveillance system needs to be strengthened and well-supervised to enhance data quality.
Topics: Child; Humans; Nigeria; alpha-Fetoproteins; Population Surveillance; Poliomyelitis; Poliovirus; Paralysis
PubMed: 38370096
DOI: 10.11604/pamj.supp.2023.45.2.39450 -
African Health Sciences Sep 2023The control of poliomyelitis in Uganda dates back as far as 1950 and acute flaccid paralysis (AFP) surveillance has since been used as a criterion for identifying wild...
BACKGROUND
The control of poliomyelitis in Uganda dates back as far as 1950 and acute flaccid paralysis (AFP) surveillance has since been used as a criterion for identifying wild polioviruses. Poliovirus isolation was initially pursued through collaborative research however, in 1993, the Expanded Program on Immunization Laboratory (EPI-LAB) was established as a member of the Global Poliovirus Laboratory Network (GPLN) and spearheaded this activity at Uganda Virus Research Institute.
OBJECTIVES
The aim of this report is to document the progress and impact of the EPI-LAB on poliovirus eradication in Uganda.
METHODS
Poliovirus detection and identification were achieved fundamentally through tissue culture and intra-typic differentiation of the poliovirus based on the real-time reverse transcriptase polymerase chain reaction (rRT PCR). The data obtained was entered into the national AFP database and analysed using EpiInfo statistical software.
RESULTS
Quantitative and qualitative detection of wild and Sabin polioviruses corresponded with the polio campaigns. The WHO target indicators for AFP surveillance were achieved essentially throughout the study period.
CONCLUSION
Virological tracking coupled with attaining standard AFP surveillance indicators has been pivotal in achieving and maintaining the national wild polio-free status. Laboratory surveillance remains key in informing the certification process of polio eradication.
Topics: Humans; Uganda; alpha-Fetoproteins; Population Surveillance; Poliomyelitis; Poliovirus; Immunization
PubMed: 38357183
DOI: 10.4314/ahs.v23i3.23 -
Health Science Reports Feb 2024Poliomyelitis is an acute neurologic condition that causes muscle weakness, permanent flaccid paralysis, and even death. The world has seen a drastic fall in the number...
BACKGROUND AND AIMS
Poliomyelitis is an acute neurologic condition that causes muscle weakness, permanent flaccid paralysis, and even death. The world has seen a drastic fall in the number of poliovirus cases owing to effective immunization programs and preventive measures. Pakistan and Afghanistan still remain the two endemic countries for poliovirus, particularly, the WPV1 strain. Global Polio Eradication Initiative (GPEI) has set a target to eradicate all WPV1 cases by the end of 2023. However, the re-emergence of WPV1 cases has posed a serious setback for the achievement of this target. This article aims to discuss the public health challenges that contribute to resurgence of poliovirus cases.
METHODS
A comprehensive literature search was conducted using various databases including Cochrane, Google Scholar, PubMed, Science Direct, MEDLINE. Only articles written in English were considered. All the articles reporting the incidence of poliovirus and WPV1 cases in Pakistan, surveillance data and global context of poliovirus outbreak were evaluated to write this correspondence. In addition, references from the selected articles were also examined to ensure a comprehensive review of the literature.
RESULTS
This article highlights the factors contributing to the re-emergence of WPV1 cases in Pakistan. Low vaccine coverage, attacks on frontline polio health workers, misinformation, and reluctance to vaccine acceptance pose a daunting challenge for polio eradication. Further, gaps in AFP surveillance and sensitivity may underestimate the true extent of the emerging genetic clusters. The Covid-19 pandemic and subsequent flooding in the affected area have further worsened the underdeveloped public health infrastructure.
CONCLUSION
Despite the challenges, the country has observed a significant decline in the number of cases in the past 2 years. It is high time to capitalize on the decrease in WPV1 cases by intensifying the efforts to mitigate and limit the spread of the disease.
PubMed: 38343664
DOI: 10.1002/hsr2.1862 -
Disaster after disaster: the outbreak of infectious diseases in Pakistan in the wake of 2022 floods.Annals of Medicine and Surgery (2012) Feb 2024In June 2022, Pakistan witnessed catastrophic floods, affecting millions of people. The ensuing epidemics of cholera, cryptosporidiosis, rotavirus infections,... (Review)
Review
In June 2022, Pakistan witnessed catastrophic floods, affecting millions of people. The ensuing epidemics of cholera, cryptosporidiosis, rotavirus infections, generalized diarrhoea, typhoid and paratyphoid fevers, as well as the frequency of vector-borne diseases including malaria and dengue fever, are studied in this investigation. It also explores the latest outbreak of poliomyelitis and the frequency of respiratory diseases such COVID-19, diphtheria, and tuberculosis, as well as how floods have contributed to skin and eye problems. The report also describes the obstacles governments must overcome in order to manage these health emergencies and offers possible solutions for reducing the effects of ongoing and anticipated epidemics. This flood emphasizes the pressing need for international action and acts as an alarming indicator of the significant impact of climate change. It emphasizes how crucial it is to have effective flood response and preparation strategies in developing nations that are vulnerable to natural disasters.
PubMed: 38333326
DOI: 10.1097/MS9.0000000000001597 -
Open Forum Infectious Diseases Feb 2024Patients with severe primary immunodeficiency are at risk for complications from live-attenuated vaccines. Here, we report a case of a vaccine-associated paralytic polio...
Patients with severe primary immunodeficiency are at risk for complications from live-attenuated vaccines. Here, we report a case of a vaccine-associated paralytic polio and Bacille Calmette-Guérin disease in a 6-month-old girl with severe combined immunodeficiency resulting from homozygous recombinant activating gene 1 deficiency. The patient was successfully treated with intravenous immunoglobulins and oral pocapavir for poliovirus, and antimycobacterial therapy for regional Bacille Calmette-Guérin disease, allowing stem cell transplant. Following transplantation, poliovirus type 3 with 13 mutations was detected from cerebrospinal fluid but not from stool, indicating ongoing viral evolution in the central nervous system despite pocapavir treatment. Clinical improvement and immune reconstitution allowed the patient to be successfully discharged with no further detection of poliovirus.
PubMed: 38328499
DOI: 10.1093/ofid/ofad678 -
Human Vaccines & Immunotherapeutics Dec 2024DTaP5-HBV-IPV-Hib (Vaxelis®) is a hexavalent combination vaccine (HV) indicated in infants and toddlers for the prevention of diphtheria, tetanus, pertussis, hepatitis...
A phase 4, open-label study to evaluate the safety and immunogenicity of DTaP5-HBV-IPV-Hib in children previously vaccinated with DTaP2-HBV-IPV-Hib or DTaP5-HBV-IPV-Hib (V419-016).
DTaP5-HBV-IPV-Hib (Vaxelis®) is a hexavalent combination vaccine (HV) indicated in infants and toddlers for the prevention of diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis, and invasive disease due to type b. Switching between HVs during the childhood vaccination series is sometimes necessary due to, for example, vaccine availability, health-care provider preference, and/or tender awards. The purpose of this study was to describe the safety, tolerability, and immunogenicity of a booster dose of Vaxelis® in participants who previously received a primary infant series of either DTaP2-HBV-IPV-Hib (Hexyon®) or Vaxelis®. Healthy participants approximately 11-13 months of age who previously received a two-dose primary series of Hexyon® (HHV group) or Vaxelis® (VVV group) all received a Vaxelis® booster dose. Immunogenicity was evaluated by measuring antibody levels to individual vaccine antigens approximately 30 days following booster vaccination. Safety was evaluated as the proportion of participants with adverse events (AEs). The proportions of participants with antibody-specific responses for antigens contained in both Vaxelis® and Hexyon® at 30 days post-toddler-booster vaccination with Vaxelis® were comparable between groups, and higher in the VVV group for Vaxelis® antigens PRN and FIM2/3. The overall proportions of participants with AEs were generally comparable between groups. Following a booster dose of Vaxelis®, immune responses were comparable between groups for all shared antigens, and higher in the VVV group for antigens found only in Vaxelis®. The booster was well tolerated in both groups. These data support the use of Vaxelis® as a booster in mixed HV regimens.
Topics: Humans; Infant; Haemophilus influenzae type b; Hepatitis B virus; Diphtheria-Tetanus-Pertussis Vaccine; Vaccines, Combined; Tetanus; Diphtheria; Whooping Cough; Poliovirus Vaccine, Inactivated; Hepatitis B Vaccines; Haemophilus Vaccines; Immunization Schedule; Antibodies, Bacterial
PubMed: 38327239
DOI: 10.1080/21645515.2024.2310900 -
NeuroRehabilitation 2024People with late effects of polio (LEoP) may need rehabilitation to manage everyday life but knowledge of the benefits of interdisciplinary rehabilitation is limited.
Changes in self-perceived performance and satisfaction with performance of daily activities following interdisciplinary rehabilitation in people with late effects of polio.
BACKGROUND
People with late effects of polio (LEoP) may need rehabilitation to manage everyday life but knowledge of the benefits of interdisciplinary rehabilitation is limited.
OBJECTIVE
To evaluate changes in performance and satisfaction with performance of activities among people with LEoP following interdisciplinary rehabilitation.
METHODS
A pre-post retrospective study based on data on 102 participants with LEoP from a rehabilitation clinic. Changes in performance and satisfaction with performance of daily activities before and after interdisciplinary rehabilitation were assessed with the Canadian Occupational Performance Measure (COPM).
RESULTS
There were statistically significant increases in the mean performance and mean satisfaction with performance COPM scores from admission to discharge. Twenty-three percent and 19% of the participants, respectively, had improved their performance and satisfaction with performance, 25% and 26% of the participants had no changes, and 19% and 22% of the participants, respectively, rated their performance and satisfaction lower at discharge compared to admission.
CONCLUSION
Interdisciplinary rehabilitation can enhance self-rated performance and satisfaction with performance of daily activities among people with LEoP. Future studies of rehabilitation for people with LEoP should use a prospective design and capture the participants' process of change related to their rehabilitation period.
Topics: Humans; Activities of Daily Living; Retrospective Studies; Canada; Postpoliomyelitis Syndrome; Patient Discharge
PubMed: 38306063
DOI: 10.3233/NRE-230219 -
Frontiers in Public Health 2023The polioviruses (PVs) are mainly transmitted by direct contact with an infected person through the fecal-oral route and respiratory secretions (or more rarely via... (Review)
Review
The polioviruses (PVs) are mainly transmitted by direct contact with an infected person through the fecal-oral route and respiratory secretions (or more rarely via contaminated water or food) and have a primary tropism for the gut. After their replication in the gut, in rare cases (far less than 1% of the infected individuals), PVs can spread to the central nervous system leading to flaccid paralysis, which can result in respiratory paralysis and death. By the middle of the 20th century, every year the wild polioviruses (WPVs) are supposed to have killed or paralyzed over half a million people. The introduction of the oral poliovirus vaccines (OPVs) through mass vaccination campaigns (combined with better application of hygiene measures), was a success story which enabled the World Health Organization (WHO) to set the global eradication of poliomyelitis as an objective. However this strategy of viral eradication has its limits as the majority of poliomyelitis cases today arise in individuals infected with circulating vaccine-derived polioviruses (cVDPVs) which regain pathogenicity following reversion or recombination. In recent years (between January 2018 and May 2023), the WHO recorded 8.8 times more cases of polio which were linked to the attenuated OPV vaccines (3,442 polio cases after reversion or recombination events) than cases linked to a WPV (390 cases). Recent knowledge of the evolution of RNA viruses and the exchange of genetic material among biological entities of the intestinal microbiota, call for a reassessment of the polio eradication vaccine strategies.
Topics: Humans; Poliomyelitis; Central Nervous System; Behavior Therapy; Poliovirus Vaccines; Vaccines
PubMed: 38259741
DOI: 10.3389/fpubh.2023.1284337