Call Now: +92 21 32635837|editor@medicalreviewintl.com
Facebook

AFP Surveillance: Review of Mohmand Agency FATA

Home/Journal/2012/June 2012/AFP Surveillance: Review of Mohmand Agency FATA

AFP Surveillance: Review of Mohmand Agency FATA

Dr Hamzullah khan, Dr Sarfaraz Khan Afridi, Dr Obaid ul Islam, World Health Organization Pakistan

Abstract:

Objectives:

To determine the status of the AFP surveillance system at Mohmand agency FATA in a sense to improve the sensitivity of the system in 2012.

Methodology: This is a retrospective analysis of the cases reported in 2011. The relevant information were recorded from the Rec files of these cases in accordance to the objectives of the study.

Results: A total of 25 cases were  reported in 2011 in Mohmand agency as AFP cases. Eleven were females (44%) and 14(56%) were males. The age range of these patients were from 6 months to 56 months of age. Mean age with SD was 37.12+33 months. Four cases were confirmed polio type 1 wild type cases.  The frequency of cases reported from various tehsils were: safi (36%), Pindialy and ekka ghund, Halimzai 16%, Prang ghar and ambar4%, and Khweze/baizai 8%. Fourteen (56% cases) reported as urgent cases. Majority of the cases (48%) discarded and lost to follow up, 205 cases diagnosed as traumatic neuritis, 4% as Guillain barre syndrome, and 8% as meningitis. 16 cases were cross reported from other agencies and the remaining from the agency itself. Ghallani AHQ Hospital, RHC Ekka ghund and Mechany BHU are main diagnostic and referral centers for AFP in the agency.

Conclusion: We have at time weak surveillance system for AFP and the being  a part of FATA and its security volatile situation, all makes it more suitable for the polio virus to circulate. There is low level of awareness and stigma associated with Polio vaccines which is alarming for public health workers. The cross reported cases ration is more which shows its weak catch up.

Key Words: AFP, Surveillance, Mohmand FATA

INTRODUCTION:

In 1988, the World Health Organization, together with Rotary International, UNICEF, and the U.S. Centers for Disease Control and Prevention passed the Global Polio Eradication Initiative, with the goal of eradicating polio by the year 20001. However, in 2011 incidence rates of the disease were dramatically reduced, and with after large reduction again in the early months of 2012, hopes for eliminating polio have been rekindled.Indiais the newest country to successfully eradicate Polio.

Acute flaccid paralysis (AFP) surveillance was introduced inPakistanin 1995, and by 1998, staff in all provinces were trained in AFP surveillance and were sending monthly case reports to the Expanded Program on Immunization (EPI) office. AFP surveillance was strengthened through surveillance assessments in many districts and introduction of computerized case line listings at the provincial and national levels. The poliovirus laboratory at the National Institutes of Health inIslamabadserves as both the National Poliomyelitis Laboratory and the WHO Regional Reference Laboratory for Poliomyelitis; it performs primary poliovirus isolation from stool specimens and intratypic differentiation of poliovirus2.

To monitor AFP surveillance performance, a reported non-polio AFP rate of greater than or equal to 1 per 100,000 population aged less than 15 years is used to indicate a sensitive AFP surveillance system.1

To the end of June 2011 241 cases globally have been reported (216 wild poliovirus type 1 and 25 wild polio type 3). This compares with 456 cases reported to the end of May in 2010 (399 type 1 and 57 type 3). Cases have been reported in the four endemic countries — Pakistan, Afghanistan, Nigeriaand India– as well as in the Democratic Republic of Congo, Chad, Angola, Mali, Cote. Over 80% of all cases seen this year come from three countries: Chad, the Democratic Republic of the Congoand Pakistan. In India, only 1 case of wild poliovirus has been reported4.

The situation in Pakistanis complex. The lowest number of cases reported in one year was 32 in 2007. In the first six months of 2011 there were 69 cases (compared with 37 in the same period in 2010). The remaining focuses lie in three parts of Pakistan(Balochistan, Karachiand FATA)5. At end of 2011 the WHO recorded a total of 650 cases worldwide. 310 of these were considered to be part of outbreaks. 16 countries recorded cases. Pakistan had the greatest number (198)6.

Present study  was designed as to determine the status of the AFP surveillance system at Mohamnd agency FATA in a sense to improve the sensitivity of the system in 2012.

RESEARCH METHODOLOGY:

Design: Retrospective study,

Sampling: 25 AFP cases,

Duration of study: Jan to Dec 2011.

Inclusion criteria were all AFP cases reported from the agency or cross reported from other districts/agencies for mohmand agency.

Exclusion criteria was age above 15 years or flaccid cases of duration more than 60 days after paralysis developed.

Procedure and techniques: the rec files of all the AFPs were collected and analyzed for various information’s to be collected. The relevant information were recorded from these cases in accordance to the objectives of the study.

Data Analysis:

Data was entered in the Ms excel program and analyzed for purposeful information.

RESULTS:

A total of 25 cases were  reported in 2011 in mohmand agency as AFP cases. Eleven were females (44%) and 14(56%) were males Table 1.

The age range of these patients were from 6 months to 56 months of age. Mean age with SD was 37.12+33 months.

The frequency of cases reported from various tehsils were:safi(36%), Pindialy and ekka ghund, Halimzai 16%, Prang ghar and ambar4%, and Khweze/baizai 8% (Table 2).

Fourteen (56% cases) reported as urgent cases (Table 3).Four cases were confirmed polio type 1 wild type cases (Table 4). 

Majority of the cases (28%) discarded and lost to follow up, 20% cases diagnosed as traumatic neuritis and enteroviruses each, 4% as Guillain barre syndrome, and 8% as meningitis, 20% of cases had enteroviruses in its stoll specimen. Table 5.

16 cases were cross reported from other agencies and the remaining from the agency itself. GhallaniAHQHospital, RHC Ekka ghund and Mechany BHU are main diagnostic and referral centers for AFP in the agency.

DISCUSSION:

Up to 3rd April four countries have reported cases: Pakistan 15, Nigeria 17, Afghanistan 5 and Chad 3 (total 40). In the same period in 2011 there were 86 cases6. As of the 5th of June 2012 , the total number of reported cases worldwide stands at 67, compared to 195 at this point in 2011. Pakistan has got a strong decline of cases, 21 compared to 49 at this point in 2011. Afghanistan doubles its cases, which pass from 4 at this point in 2011 to 8 in 2012. Nigeria has a very big surge of polio in the first part of 2012, with 39 cases as of the 5th of June of this year, compared to only 10 confirmed infections at this point to the precedent year6.

In our study there were 11(46%) females and 14 males (56%) male to females ration 1.3:1.dose children. And nearly one third of these children were zero  .in another study from malaysiait was noted that Thirty-four children with AFP were admitted in hospital in the last three years with the highest number (14) in 1998. The majority of children belonged to the age group 5-9 years with a male female ratio of 1.3:1. Nearly one third of the cases were either partially vaccinated or not vaccinated at all.7.

In present study 4 cases(16%) out of 25 AFP reported were polio confirmed cases. Another study that included monthly visits, educational activities, etc. At the result of this study, 64 AFP cases (22 of them poliomyelitis) were reported.8

NPEV (Non polio enteric viruses) were isolated from 20 of the sampling received from mohmand agency in the Laboratory. NPEV are a dominant cause of AFP and different serotypes of NPEV are randomly distributed in Pakistan. The untypable isolates need further characterization and analysis in order to determine their association with clinical presentation of a cases. Saeed M et al reported that NPEV-associated AFP were found to be 62%. The paralysis was found asymmetrical in 67% cases, the progression of paralysis to peak within 4 days was found in 72% cases and residual paralysis after 60 days of paralysis onset was observed in 39% cases associated with NPEV9.our NPEV ration is less than the findings of the aouthors cited above9.

In present study 4% 0f all non AFP cases were Guillan barre syndrome (GBS) of all non polio AFP cases. In a study from latin AmericaGBS were reported , representing 52% of all nonpolio AFP cases. This study confirmed  that with the disappearance of polio, GBS arises as the most common cause of AFP.10 A local study also reported that out of 74 patients presented with AFP 36 were male and 38 were female. Guillain Barre syndrome and enteroviral encephalopathy were the two leading causes of acute flaccid paralysis 11.

Traumatic neuritis was recorded in 20% of cases, while Alcala H reported that out of  246 children, 42 has poliomyelitis (17%); 156 has Guillain-Barré syndrome (GBS) (63.4%); 16 had traumatic neuritis of the sciatic nerve secondary to IM injections (TNC) (6.5%); five had transverse myelitis (2%); the rest (27) had other diseases misdiagnosed as polio (10.9%)12,

 In January 2012, completion of polio eradication was declared a programmatic emergency for global public health by the Executive Board of the World Health Organization (WHO). Despite major progress since the launch of the Global Polio Eradication Initiative (GPEI) in 1988, circulation of indigenous wild poliovirus (WPV) continues in three countries (Afghanistan,Nigeria, andPakistan). Although progress toward polio eradication was substantial in 2011, persistent WPV circulation in 2012, particularly in Nigeria and Pakistan, poses an ongoing threat to eradication efforts, underscoring the need for emergency measures by polio-affected countries and those at risk for outbreaks after importation.

Conclusion: We have at time weak surveillance system for AFP and the being  a part of FATA and its security volatile situation, all makes it more suitable for the polio virus to circulate. There is low level of awareness and stigma associated with Polio vaccines which is alarming for public health workers. The cross reported cases ration is more which shows its weak catch up. We need to increase the network of the AFP reporting sites. We also need to improve our zero reporting or passive surveillance system which is not functioning at time. Furthermore community surveillance system need to be established. And last but not the least the stigma to be reduced through awareness and social mobilization.

RERENCES:

  1. WHO Factsheet. Retrieved 2006-09-23.
  2. Centers for Disease Control and Prevention (CDC).Progress toward interruption of wild poliovirus transmission – worldwide, january 2011-march 2012. MMWR Morb Mortal Wkly Rep. 2012 May 18;61:353-7.
  3. Yusufzai A (2007). “Pakistan polio case in Australia”. BBC News.. Retrieved 2007-08-08.
  4. Global Polio Eradication Initiative Monthly Reports http://www.polioeradication.org/Mediaroom/Monthlysituationreports.aspx
  5. Arie S (2011) A return to “health as a right” is needed to reduce inequalities, says report. BMJ 343: 465
  6. WHO Wild Poliovirus List”. Retrieved 06 Apr 2012.
  7. Rasul CH, Das PL, Alam S, Ahmed S, Ahmed M. Clinical profile of acute flaccid paralysis. Med J Malaysia. 2002 Mar;57(1):61-5.
  8. Ertem M, Sarac A, Tumay S.Poliomyelitis eradication programme: acute flaccid paralysis surveillance in mardin and five other provinces around Mardin, Turkey 1998. Public Health. 2000;114(4):286-90.
  9. Saeed M, Zaidi SZ, Naeem A, Masroor M, Sharif S, Shaukat S, Angez M, Khan A.Epidemiology and clinical findings associated with enteroviral acute flaccid paralysis in Pakistan. BMC Infect Dis. 2007; 15;7:6.
  10. Olivé JM, Castillo C, Castro RG, de Quadros CA.Epidemiologic study of Guillain-Barré syndrome in children <15 years of age in Latin America. J Infect Dis. 1997 Feb;175; 1:S160-4.
  11. Anis-ur-Rehman, Idris M, Elahi M, Jamshed, Arif A.Guillain Barre syndrome: the leading cause of acute flaccid paralysis in Hazara division. J Ayub Med Coll Abbottabad. 2007;19(1):26-8.
  12. Alcalá H.
    [The differential diagnosis of poliomyelitis and other acute flaccid paralyses]. Bol Med Hosp Infant Mex. 1993;50(2):136-44

 

2017-04-26T12:35:15+00:00

Related Posts