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. 2018 Nov;23(47):1700423.
doi: 10.2807/1560-7917.ES.2018.23.47.1700423.

Acute flaccid paralysis (AFP) surveillance: challenges and opportunities from 18 years' experience, Spain, 1998 to 2015

Josefa Masa-Calles  1   2 , Nuria Torner  2   3   4 , Noemí López-Perea  1   2 , María de Viarce Torres de Mier  1   2 , Beatriz Fernández-Martínez  1   2 , María Cabrerizo  5 , Virtudes Gallardo-García  6 , Carmen Malo  7 , Mario Margolles  8 , Margarita Portell  9 , Natividad Abadía  10 , Aniceto Blasco  11 , Sara García-Hernández  12 , Henar Marcos  13 , Núria Rabella  14 , Celia Marín  15 , Amelia Fuentes  16 , Isabel Losada  17 , Juan García Gutiérrez  18 , Alba Nieto  18 , Visitación García Ortúzar  19 , Manuel García Cenoz  2   20 , José María Arteagoitia  21 , Ángela Blanco Martínez  22 , Ana Rivas  23 , Daniel Castrillejo  24 ; Spanish AFP Surveillance Working Group  25
Affiliations

Acute flaccid paralysis (AFP) surveillance: challenges and opportunities from 18 years' experience, Spain, 1998 to 2015

Josefa Masa-Calles et al. Euro Surveill. 2018 Nov.

Abstract

Acute flaccid paralysis (AFP) surveillance is key for global polio eradication. It allows detecting poliovirus (PV) reintroductions from endemic countries. This study describes AFP surveillance in Spain from 1998 to 2015. During this time, 678 AFP cases were reported to the Spanish National Surveillance Network. The mean notification rate was 0.58 AFP cases/100,000 population under 15 years old (range: 0.45/100,000-0.78/100,000). Two periods (P) are described: P1 (1998-2006) with the AFP notification rate ranging from 0.66/100,000 to 0.78/100,000, peaking in 2001 (0.84/100,000); and P2 (2007-2015) when the AFP rate ranged from 0.43/100,000 to 0.57/100,000, with the lowest rate in 2009 (0.31/100,000). No poliomyelitis cases were caused by wild PV infections, although two Sabin-like PVs and one imported vaccine-derived PV-2 were detected. Overall, 23 (3.4%) cases met the hot case definition. Most cases were clinically diagnosed with Guillain-Barré syndrome (76.9%; 504/655). The adequate stool collection rate ranged from 33.3% (7/21) to 72.5% (29/40). The annual proportion of AFP cases with non-polio enterovirus findings varied widely across the study period. AFP surveillance with laboratory testing for non-polio enteroviruses must be maintained and enhanced both to monitor polio eradication and to establish sensitive surveillance for prompt detection of other enteroviruses causing serious symptoms.

Keywords: Spain; acute flaccid paralysis surveillance; enterovirus; poliomyelitis eradication; surveillance; vaccine preventable disease.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Cases of poliomyelitis, type of polio vaccines and vaccination coverage, Spain, 1931–2015
Figure 2
Figure 2
Acute flaccid paralysis surveillance system in Spain, reporting information flowchart
Figure 3
Figure 3
Acute flaccid paralysis surveillance system in Spain, case reporting, investigation, classification and follow-up, Spain, 1998–2015
Figure 4
Figure 4
Acute flaccid paralysis (AFP) hospitalisation ratea and AFP detection rateb per 100,000 population under 15 years of age, Spain, 2000c–2015
See this image and copyright information in PMC

References

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