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Poliomyelitis Surveillance in Ireland

Poliomyelitis Surveillance in Ireland. 4 th April, 2014. Acknowledgement.

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Poliomyelitis Surveillance in Ireland

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  1. Poliomyelitis Surveillance in Ireland 4th April, 2014

  2. Acknowledgement The health Protection Surveillance Centre (HPSC) would like to thank all those who have contributed to polio surveillance, the National Virus Reference Laboratory, the Irish Paediatric Surveillance Unit (IPSU), paediatricians and all others who have provided data in relation to polio surveillance.

  3. Rationale for polio surveillance • Europe has been polio free since 2002, but poliomyelitis virus continues to circulate in other countries • In 2013, polio was identified in • Afghanistan, Nigeria and Pakistan – endemic • Syria, the Horn of Africa, Cameroon, Somalia , other African countries – outbreaks • Egypt, Israel, the West Bank and Gaza Strip – environmental or asymptomatic individuals • As long as a single child remains infected, children in all countries are at risk of contracting polio.

  4. Cases of polio in Ireland The last notified case of polio was in 1984

  5. Irish surveillance for Poliomyelitis- methods • Acute flaccid paralysis (AFP) in ALL children < 15 years of age • Investigation of suspect cases of CNS infection (e.g. meningitis, encephalitis, AFP) of all ages if travel or epi-links to contacts from areas where polio virus circulating,

  6. Definition of AFP Acute flaccid Paralysis (AFP) isa clinical syndrome characterised by rapid onset of weakness, including (less frequently) weakness of respiratory and swallowing, progressing to maximum severity within several days to weeks. AFP is a complex clinical syndrome with a broad array of potential aetiologies.

  7. AFP surveillance and Polio • Surveillance of AFP is used in surveillance for poliomyelitis in the context of the global polio eradication initiative • Polio is caused by a human enterovirus called the poliovirus. Wild polioviruses are those that occur naturally. There are three serotypes of wild poliovirus – type 1, type 2, and type 3 • Polio is one of only a limited number of diseases that can be eradicated as there are no long-term carriers of the disease and an inexpensive vaccine is available

  8. Potential aetiologies associated with AFP Includes possible illness due to: • Guillian-Barré syndrome • Transverse myelitis • Traumatic neuritis • Viral infections caused by other enterovirusestoxins and tumours

  9. Objectives of AFP surveillance • To rapidly detect re-importation of poliovirus into polio-free areas • To ensure that robust surveillance systems are in place so that if AFP caused by polio virus that it would be identified quickly

  10. Investigation of AFP in children < 15 years of age • AFP case admitted to hospital • Collect 2 stool specimens as early as possible, 24 hours apart, within 2 weeks of paralysis onset and send to National Virus Reference Laboratory (NVRL) • Complete AFP enhanced surveillance form and return to Paula Flanagan, HPSC, 25‐27 Middle Gardiner Street, Dublin 1, Tel: 01 876 5300, Fax: 01 856 1299 • Surveillance forms available on ward or available at http://www.hpsc.ie/hpsc/A-Z/VaccinePreventable/Polio/AcuteFlaccidParalysisAFP/ • When returning your monthly IPSU (Irish Paediatric Surveillance Unit) card indicate if you have seen a case in previous month

  11. AFP reports in children < 15 years of age, by year of onset of paralysis, 2009-2013

  12. AFP cases by Age Group 2009-2013

  13. AFP cases by Diagnosis2009-2013 *Isolated facial paralysis of any cause, spastic or chronic paralysis, meningitis, coma etc. ** No enhanced surveillance form completed, suspect case reported via Irish Paediatric Surveillance Unit (IPSU) only

  14. Vaccination uptake of 3 doses polio vaccine at 12 months, by LHO, Q3 2013* National uptake = 92% (range 88%-95%) *Source: HPSC Q3 2013 report located at http://www.hpsc.ie

  15. Vaccination uptake of 3 doses polio vaccine at 24 months, by LHO, Q3 2013* National uptake = 96% (range 94%-98%) *Source: HPSC Q3 2013 report located at http://www.hpsc.ie

  16. WHO recommendations to decrease risk of Wild Polio Virus (WPV) importation and possible spread and disease Vaccination recommendations • Maintain national vaccination coverage with completed polio vaccination > 90% • Identify those at risk of low immunisation and implement vaccination as needed National data • 3 doses at 12 months is 92% (Q3 2013) • 3 doses at 24 months is 96% (Q2 2013) • Currently national data is not available by ethnicity, migrant or other risk factor status

  17. Recommendations to decrease the risk of WPV importation and possible spread and disease in Ireland(2) • Improve surveillance- Paediatric AFP surveillance • All AFP cases in children < 15 years of age (regardless of presumed diagnosis) should be investigated for enteroviral/polio virus specific infection • Children < 15 years of age who present with aseptic meningitis, encephalitis,other neurological symptoms (non-AFP) should be systematically tested for polio virus IF they have links (direct travel or contact with individuals from these countries where wild polio has been identified)

  18. For older child and adult surveillance for polio virus • Older children (> 15 years) and adult patients, with a history of travel to, or contact with individuals from, countries where wild polio has been identified AND who present with AFP, aseptic meningitis, encephalitis,other neurological symptoms (non-AFP) should be systematically tested for polio virus.

  19. Laboratory investigation (NVRL) - Summary Two stool samples should be taken as soon as possible (at least within 2 weeks of onset and 24 hours apart) and sent to the NVRL with clinical detail to facilitate rapid investigation and feedback • All paediatric cases of AFP • All cases of AFP, aseptic meningitis, encephalitis, other neurological symptoms (non-AFP) especially IF there are epi-links to countries (or individuals returned from these countries) where polio virus is circulating

  20. Thank you For more information http://www.hpsc.ie/hpsc/A-Z/VaccinePreventable/Polio/

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