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A contribution to the WHO global polio eradication initiative: the results of surveillance activities in Lombardy (Northern Italy), 2012-2015. Although in 2015 poliovirus (PV) transmission has been reported at the lowest levels ever recorded, the virus is still endemic in two countries ? Afghanistan and Pakistan. Until PV transmission is interrupted in these countries, all countries remain at risk of virus importation - especially vulnerable countries with weak public health and immunization services and travel or trade links to endemic countries. The high levels of immigration flows across the Mediterranean Sea jeopardize Italy for PV reintroduction. The ?WHO Strategic Plan of the Global Polio Eradication Initiative? indicates the nationwide surveillance of Acute Flaccid Paralysis (AFP) as the gold standard for detecting cases of poliomyelitis. In addition, systematic Environmental Surveillance (ES), seeking the presence of PV in sewage, is recognized as a powerful tool to confirm PV circulation in absence of AFP cases, especially in polio-free countries. In Italy, nationwide AFP surveillance has been set up in 1997, and ES has been established since 2005 in Milan and other five Italian cities (Bolzano, Parma, Sassari, Napoli and Palermo). This PhD project aimed at evaluating these two public health surveillance systems ongoing in Lombardy (Northern Italy) in the period spanning from 2012 to 2015, in order to improve their quality and efficiency, and to achieve the WHO criteria. The results of surveillance activities were described and the assessment of system attributes (including data quality, sensitivity and timeliness) were discussed. Additionally, in the framework of the ES, the circulation and characterization of non-polio Enterovirus (NPEV) was evaluated in the study population. The surveillance activities were carried out according to WHO guidelines from January 2012 to October 2015. For AFP surveillance, all children 1:8 was considered protective. From January 2012 to October 2015, 52 AFP cases were reported in Lombardy with an incidence rate of 1.04/100?000 children |
