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. 2019 Nov 15;19(1):1532.
doi: 10.1186/s12889-019-7617-0.

Hospital discharges-based search of acute flaccid paralysis cases 2007-2016 in Italy and comparison with the National Surveillance System for monitoring the risk of polio reintroduction

Paola Stefanelli  1 , Stefania Bellino  2 , Stefano Fiore  2 , Stefano Fontana  2 , Concetta Amato  2 , Gabriele Buttinelli  2 ; Regional Reference Centres of the National Surveillance System for Acute flaccid paralysis
Collaborators, Affiliations

Hospital discharges-based search of acute flaccid paralysis cases 2007-2016 in Italy and comparison with the National Surveillance System for monitoring the risk of polio reintroduction

Paola Stefanelli et al. BMC Public Health. .

Abstract

Background: Acute flaccid paralysis (AFP) surveillance has been adopted globally as a key strategy for monitoring the progress of the polio eradication initiative. Hereby, to evaluate the completeness of the ascertainment of AFP cases in Italy, a hospital-discharges based search was carried out.

Methods: AFP cases occurring between 2007 and 2016 among children under 15 years of age were searched in the Italian Hospital Discharge Records (HDR) database using specific ICD-9-CM diagnostic codes. AFP cases identified between 2015 and 2016 were then compared with those notified to the National Surveillance System (NSS).

Results: Over a 10-year period, 4163 hospital discharges with diagnosis of AFP were reported in Italy. Among these, 956 (23.0%) were acute infective polyneuritis, 1803 (43.3%) myopathy, and 1408 (33.8%) encephalitis, myelitis and encephalomyelitis. During the study period, a decreasing trend was observed for all diagnoses and overall the annual incidence rate (IR) declined from 5.5 to 4.5 per 100,000 children. Comparing NSS with HDR data in 2015-2016, we found a remarkable underreporting, being AFP cases from NSS only 14% of those recorded in HDR. In particular, the acute infective polyneuritis cases reported to NSS accounted for 42.6% of those detected in HDR, while only 0.9% of myopathy cases and 13.1% of encephalitis/myelitis/encephalomyelitis cases have been notified to NSS. The highest AFP IRs per 100,000 children calculated on HDR data were identified in Liguria (17.4), Sicily (5.7), and Veneto (5.1) Regions; regarding the AFP notified to the NSS, 11 out of 21 Regions failed to reach the number of expected cases (based on 1/100,000 rate), and the highest discrepancies were observed in the Northern Regions. Overall, the national AFP rate was equal to 0.6, therefore did not reach the target value.

Conclusions: AFP surveillance data are the final measure of a country's progress towards polio eradication. The historical data obtained by the HDR have been useful to assess the completeness of the notification data and to identify the Regions with a low AFP ascertainment rate in order to improve the national surveillance system.

Keywords: Acute flaccid paralysis; Hospital discharge records; National surveillance system; Polio.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a-b Acute Flaccid Paralysis by Italian Regions, years 2015–2016. Incidence rates per 100,000 children, data from Hospital Discharge Records (a); Difference between the number of reported and expected cases, data from the National Surveillance System (b). The maps have been produced using Stata software, version 13 (Stata Cooperation, College Station, Texas, USA)
See this image and copyright information in PMC

References

    1. WHO Acute Flaccid Paralysis Surveillance: the surveillance strategy for poliomyelitis eradication. Wkly Epidemiol Rec. 1998;16:113–120.
    1. Smith J, Leke R, Adams A, Tangermann RH. Certification of polio eradication: process and lessons learned. Bull World Health Organ. 2004;82:24–30. - PMC - PubMed
    1. Wilder-Smith A, Leong WY, Fernandez Lopez L, Amaku M, Quam M, Khan K, et al. Potential for international spread of wild poliovirus via travelers. BMC Med. 2015;13:133. doi: 10.1186/s12916-015-0363-y. - DOI - PMC - PubMed
    1. Istituto Superiore di Sanità [Italian National Institute of Health]. Scheda di segnalazione per la sorveglianza della paralisi flaccida acuta [Reporting sheet of the acute flaccid paralysis surveillance. Available from: http://www.salute.gov.it/imgs/C_17_pagineAree_820_listaFile_itemName_4_f.... Accessed 24 Oct 2019.
    1. La scheda di dimissione ospedaliera [Hospital discharge records]. Available from: http://www.salute.gov.it/portale/temi/p2_6.jsp?lingua=italiano&id=1232&a.... Accessed 24 Oct 2019.