Defining Polio: Closing the Gap in Global Surveillance

Background: By late 2012 the Global <a title="Learn more about Poliomyelitis" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/poliomyelitis">Polio</a> Eradication Initiative (GPEI) had nearly eradicated this ancient <a title="Learn more about...

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Autores principales:	Bachir Tajaldin, Khaled Almilaji, Paul Langton, Annie Sparrow
Formato:	article
Lenguaje:	EN
Publicado:	Ubiquity Press 2015
Materias:	polio vaccination conflict Syria clinical diagnosis acute flaccid paralysis Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/b2d5d8e2d0e94b0eaac633ea567adfb9
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spelling	oai:doaj.org-article:b2d5d8e2d0e94b0eaac633ea567adfb92021-12-02T04:25:34ZDefining Polio: Closing the Gap in Global Surveillance2214-999610.1016/j.aogh.2015.06.007https://doaj.org/article/b2d5d8e2d0e94b0eaac633ea567adfb92015-11-01T00:00:00Zhttps://annalsofglobalhealth.org/articles/1511https://doaj.org/toc/2214-9996Background: By late 2012 the Global <a title="Learn more about Poliomyelitis" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/poliomyelitis">Polio</a> Eradication Initiative (GPEI) had nearly eradicated this ancient <a title="Learn more about Infectious Disease" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/infectious-disease">infectious disease</a>. Successful surveillance programs for <a title="Learn more about Flaccid paralysis" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/flaccid-paralysis">acute flaccid paralysis</a> however rely on broad governmental support for implementation. With the onset of conflict, public health breakdown has contributed to the resurgence of polio in a number of regions. The current laboratory based <a title="Learn more about Case definition" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/case-definition">case definition</a> may be a contributory factor in these regions. Objective: We sought to compare case definition rates using strict laboratory based criteria to rates obtained using the clinical criteria in modern day Syria. We also sought to examine this distribution of cases by sub-region. Methods: We examined the World Health Organization (WHO) reported figures for Syria from 2013–2014 using laboratory based criteria. We compared these with cases obtained when clinical criteria were applied. In addition we sought data from the opposition controlled Assistance Coordination Unit which operates in non-Government controlled areas where WHO data maybe incomplete. Cases were carefully examined for potential overlap to avoid double reporting. Findings: Whilst the WHO data clearly confirmed the polio outbreak in Syria, it did so with considerable delay and with under reporting of cases, particularly from non-government controlled areas. In addition, laboratory based case definition led to a substantial underestimate of polio (36 cases) compared with those found with the clinically compatible definition (an additional 46 cases). Rates of adequate diagnostic specimens from suspected cases are well below target, no doubt reflecting the effect of conflict in these areas. Conclusions: We have identified a gap in the surveillance of polio, a global threat. The current laboratory based definition, in the setting of conflict and insecurity, leads to under diagnosis of polio with potential delays and inadequacies in coordinating effective responses to contain outbreaks and eradicate polio. Breakdown in public health measures as a contributing factor is likely to result in a resurgence of previously controlled infectious diseases. The clinical definition should be reinstituted to supplement the lab-based definition.Bachir TajaldinKhaled AlmilajiPaul LangtonAnnie SparrowUbiquity PressarticlepoliovaccinationconflictSyriaclinical diagnosisacute flaccid paralysisInfectious and parasitic diseasesRC109-216Public aspects of medicineRA1-1270ENAnnals of Global Health, Vol 81, Iss 3, Pp 386-395 (2015)
institution	DOAJ
collection	DOAJ
language	EN
topic	polio vaccination conflict Syria clinical diagnosis acute flaccid paralysis Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
spellingShingle	polio vaccination conflict Syria clinical diagnosis acute flaccid paralysis Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270 Bachir Tajaldin Khaled Almilaji Paul Langton Annie Sparrow Defining Polio: Closing the Gap in Global Surveillance
description	Background: By late 2012 the Global <a title="Learn more about Poliomyelitis" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/poliomyelitis">Polio</a> Eradication Initiative (GPEI) had nearly eradicated this ancient <a title="Learn more about Infectious Disease" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/infectious-disease">infectious disease</a>. Successful surveillance programs for <a title="Learn more about Flaccid paralysis" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/flaccid-paralysis">acute flaccid paralysis</a> however rely on broad governmental support for implementation. With the onset of conflict, public health breakdown has contributed to the resurgence of polio in a number of regions. The current laboratory based <a title="Learn more about Case definition" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/case-definition">case definition</a> may be a contributory factor in these regions. Objective: We sought to compare case definition rates using strict laboratory based criteria to rates obtained using the clinical criteria in modern day Syria. We also sought to examine this distribution of cases by sub-region. Methods: We examined the World Health Organization (WHO) reported figures for Syria from 2013–2014 using laboratory based criteria. We compared these with cases obtained when clinical criteria were applied. In addition we sought data from the opposition controlled Assistance Coordination Unit which operates in non-Government controlled areas where WHO data maybe incomplete. Cases were carefully examined for potential overlap to avoid double reporting. Findings: Whilst the WHO data clearly confirmed the polio outbreak in Syria, it did so with considerable delay and with under reporting of cases, particularly from non-government controlled areas. In addition, laboratory based case definition led to a substantial underestimate of polio (36 cases) compared with those found with the clinically compatible definition (an additional 46 cases). Rates of adequate diagnostic specimens from suspected cases are well below target, no doubt reflecting the effect of conflict in these areas. Conclusions: We have identified a gap in the surveillance of polio, a global threat. The current laboratory based definition, in the setting of conflict and insecurity, leads to under diagnosis of polio with potential delays and inadequacies in coordinating effective responses to contain outbreaks and eradicate polio. Breakdown in public health measures as a contributing factor is likely to result in a resurgence of previously controlled infectious diseases. The clinical definition should be reinstituted to supplement the lab-based definition.
format	article
author	Bachir Tajaldin Khaled Almilaji Paul Langton Annie Sparrow
author_facet	Bachir Tajaldin Khaled Almilaji Paul Langton Annie Sparrow
author_sort	Bachir Tajaldin
title	Defining Polio: Closing the Gap in Global Surveillance
title_short	Defining Polio: Closing the Gap in Global Surveillance
title_full	Defining Polio: Closing the Gap in Global Surveillance
title_fullStr	Defining Polio: Closing the Gap in Global Surveillance
title_full_unstemmed	Defining Polio: Closing the Gap in Global Surveillance
title_sort	defining polio: closing the gap in global surveillance
publisher	Ubiquity Press
publishDate	2015
url	https://doaj.org/article/b2d5d8e2d0e94b0eaac633ea567adfb9
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Defining Polio: Closing the Gap in Global Surveillance

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