Evaluation of the Functionality and Effectiveness of the CORE Group Polio Project’s Community-Based Acute Flaccid Paralysis Surveillance System in South Sudan
| Autor: | Anthony Kisanga, Lee Losey, Bausumo Abiuda, Peter Walyaula, Omongot Samson |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
030231 tropical medicine
Population Indigenous 03 medical and health sciences 0302 clinical medicine Health facility Virology Poliomyelitis eradication medicine Humans Paralysis Child education Socioeconomics South Sudan education.field_of_study Transmission (medicine) Community Participation Health Plan Implementation Outbreak Articles medicine.disease Polio Vaccination Poliomyelitis Infectious Diseases Geography Population Surveillance Acute Disease Parasitology |
| Zdroj: | The American Journal of Tropical Medicine and Hygiene |
| ISSN: | 1476-1645 0002-9637 |
| DOI: | 10.4269/ajtmh.19-0120 |
| Popis: | Civil war broke out in South Sudan in 2013 just 2 years after the country gained independence, leading to the internal displacement of 1.9 million people. More than two million people sought refuge in neighboring countries.1 Many health facilities were destroyed and a large portion of the health facility staff members were displaced or killed leading to a collapse of the health system, including immunization and surveillance functions. Jonglei, Upper Nile, and Unity State were among the most affected states. The non-polio acute flaccid paralysis (NPAFP) rate per 100,000 children younger than 15 years as recorded by the surveillance system declined considerably between 2013 and 2014: from 3.3 to 1.0 in Jonglei; 1.7 to 1.4 in Unity State; and 3.5 to 1.3 in Upper Nile–all substantially lower than the expected rate of at least two cases per 100,000 children.2,3 In addition, there were several silent counties and subcounties that reported no cases at all. South Sudan experienced an outbreak of circulating vaccine-derived poliovirus (cVDPV) in Unity State in 2014 and 2015. The Horn of Africa Technical Advisory Group concluded that the AFP surveillance system at the subnational level in South Sudan was not sensitive enough to detect low levels of ongoing wild poliovirus (WPV) transmission. A surveillance review conducted in South Sudan by external reviewers in 2011 indicated that AFP surveillance was only sensitive in areas that were accessible to the Polio Eradication Initiative field staff. The review revealed that clear gaps existed in inaccessible areas as a result of insecurity, isolated geographical locations because of flooding, and unusable roads. The WHO reported in 2016 that although South Sudan had been polio-free since 2009, it was still at risk of WPV transmission because of inadequate AFP surveillance, low immunization coverage, insecurity, and population movement.4 Polio situation in South Sudan. Although the last indigenous WPV case was reported in 2001, South Sudan experienced large imported WPV outbreaks in 2004, 2005, 2008, and 2009, affecting nine of the 10 states. The last case was reported in June 2009.5 In 2010, the Global Polio Eradication Initiative categorized South Sudan as one of the four countries in Africa with re-established WPV transmission.6 In addition, South Sudan experienced repeated outbreaks of cVDPV in Warrap and Western Equatoria States in 2011 and 2012. In 2014, South Sudan reported another outbreak of cVDPV type 2 (cVDPV2) in the Protection of Civilian Sites1 and in Bentiu, Rubkona County, Unity State. An additional case of cVDPV2 was reported in June 2015 from Mayom County, Unity State. A detailed investigation of this case showed that the child had no history of polio vaccination (classified as a “zero dose child”) and the community had not been reached with routine immunization or supplementary immunization activities since December 2013. |
| Databáze: | OpenAIRE |
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