Evaluation of Acute Flaccid Paralysis Surveillance System in Children < 15 years - Kenya, 2016–2018

  • Public health surveillance
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Acute Flaccid Paralysis (AFP) surveillance is key in monitoring progress of polio eradication and has contributed to decrease in wild poliovirus cases from 350,000 in 1988 to 33 in 2018 globally. In 2018, traces of vaccine –derived poliovirus were isolated in environmental samples in Kenya. We described epidemiological characteristics of AFP cases and evaluated the AFP surveillance system.
Using WHO case definition for AFP, we reviewed AFP data in MS Access database for the period 2016–2018. We assessed demographic characteristics, clinical information, polio vaccine doses received and final case classification. Stool adequacy was defined as two stool samples, 8 grams in weight, collected 24 hours apart, ≤14 days after onset of paralysis. Descriptive statistics were calculated using Epi Info 7 and revised CDC guidelines used to evaluate the following system attributes: Simplicity (ease of information flow), representativeness (number of counties report- ing AFP cases), timeliness (cases reported within 24 hours after paralysis onset) and sensitivity (annual AFP case detection rate).
We reviewed 1,575 records; median age was 4 years (IQR: 5.9), 853 (54.2%) were male, 1,011 (64.2%) had fever, 625 (39.7%) had asymmetrical paralysis, 1,407 (89.3%) had flaccid paralysis, 1,133 (71.9%) received 2 – 4 polio vaccine doses, stool adequacy was 99% (1,559/1,575). Test Results: were: Negative 1,464 (93%) and non-polio enterovirus 111 (7%). All counties in Kenya reported cases; Nairobi 122 (7.8%), and Lamu 7 (0.4%) reported highest and lowest number of cases respectively. Cases reported and investigated in time were 200 (12.7%) and 1,559 (99%) respectively. System was well structured with good information flow and feedback mechanism. AFP detection rate was 0.04/100,000 in 2016; 0.22/100,000 in 2017 and 0.22/100,000 in 2018.
The surveillance system was representative, timely and simple, however the sensitivity was low. AFP surveillance should be strengthened in low reporting counties to achieve the AFP indicator targets.

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