Surveillance

Acute flaccid paralysis (AFP) surveillance

Nationwide AFP (acute flaccid paralysis) surveillance is the gold standard for detecting cases
of poliomyelitis. The four steps of surveillance are:

1. finding and reporting children with acute flaccid paralysis (AFP)

2. transporting stool samples for analysis
3. isolating and identifying poliovirus in the laboratory
4. mapping the virus to determine the origin of the virus strain.

Environmental surveillance

Environmental surveillance involves testing sewage or other environmental samples for the
presence of poliovirus. Environmental surveillance often confirms wild poliovirus infections in
the absence of cases of paralysis. Systematic environmental sampling (e.g. in Egypt and
Mumbai, India) provides important supplementary surveillance data. Ad-hoc environmental
surveillance elsewhere (especially in polio-free regions) provides insights into the
international spread of poliovirus.

Surveillance indicators

Indicator Minimum levels for certification standard surveillance

At least 80% of expected routine (weekly or monthly) AFP surveillance
Completeness of reports should be received on time, including zero reports where no AFP
reporting cases are seen. The distribution of reporting sites should be
representative of the geography and demography of the country
At least one case of non-polio AFP should be detected annually per 100
Sensitivity of
000 population aged less than 15 years. In endemic regions, to ensure
surveillance
even higher sensitivity, this rate should be two per 100 000.
All AFP cases should have a full clinical and virological investigation with
at least 80% of AFP cases having ‘adequate’ stool specimens collected.
Completeness of ‘Adequate’ stool specimens are two stool specimens of sufficient quantity
case investigation for laboratory analysis, collected at least 24 hours apart, within 14 days
after the onset of paralysis, and arriving in the laboratory by reverse cold
chain and with proper documentation.
Completeness of At least 80% of AFP cases should have a follow-up examination for
follow-up residual paralysis at 60 days after the onset of paralysis
Laboratory All AFP case specimens must be processed in a WHO-accredited
performance laboratory within the Global Polio Laboratory Network (GPLN)

Performance of AFP surveillance and incidence of pol

Countries highlighted in yellow are endemic.
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Wild poliovirus-infected districts, 2010–2011
 Wild poliovirus-infected districts, 2009–2010

Data in WHO/HQ as of 08 February 2011

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most Independent polio campaign monitoring is carried out to assess the quality
and impact of supplementary immunization activities. It is critical to guiding any necessary
mid-course corrections if gaps or problems are found.

The basic elements of monitoring include recording: the number and source of independent
monitors, the number of children monitored, the percentage of children whose fingers are
marked to prove they were vaccinated (both in house-to-house monitoring and out-of-house)
and the proportion of districts monitored.

Real-time, independent monitoring data answers the question, "How many children did we
reach with vaccine?" It allows rapid changes to be made to cover missing children and stop
polio transmission more quickly.

The results of the independent monitoring are made available internationally within 15 days
of each immunization round.

Reports by country are available through

Polio eradication targets

The Global Polio Eradication Initiative strategic plan for 2010–2012 has put in place targets
towards interrupting wild poliovirus globally. All polio eradication activities are focused on
achieving these global targets.

Polio eradication targets 2010–2013