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Acute flaccid paralysis (AFP) surveillance: challenges and opportunities from 18 years’ experience, Spain, 1998 to 2015
- Josefa Masa-Calles1,2 , Nuria Torner2,3,4 , Noemí López-Perea1,2 , María de Viarce Torres de Mier1,2 , Beatriz Fernández-Martínez1,2 , María Cabrerizo5 , Virtudes Gallardo-García6 , Carmen Malo7 , Mario Margolles8 , Margarita Portell9 , Natividad Abadía10 , Aniceto Blasco11 , Sara García-Hernández12 , Henar Marcos13 , Núria Rabella14 , Celia Marín15 , Amelia Fuentes16 , Isabel Losada17 , Juan García Gutiérrez18 , Alba Nieto18 , Visitación García Ortúzar19 , Manuel García Cenoz2,20 , José María Arteagoitia21 , Ángela Blanco Martínez22 , Ana Rivas23 , Daniel Castrillejo24 , Spanish AFP Surveillance Working Group25
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View Affiliations Hide AffiliationsAffiliations: 1 National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain 2 Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain 3 Public Health Agency of Catalonia, Generalitat of Catalonia, Spain 4 Department of Medicine, University of Barcelona, Barcelona, Spain 5 National Polio Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain 6 Servicio de Vigilancia y Salud Laboral, Consejería de Salud, Andalucía, Spain 7 Servicio de Vigilancia en Salud Pública, D.G. de Salud Pública, Departamento de Sanidad, Aragón, Spain 8 Servicio de Vigilancia Epidemiológica, Consejería de Sanidad, Instituto de Investigación Sanitaria del Principado de Asturias, Spain 9 Servicio de Vigilancia Epidemiológica, Conselleria de Salut, Família i Bienestar Social Baleares, Spain 10 Servicio de Epidemiologia y Prevención, Dirección General Salud Pública, Servicio Canario de Salud, Canarias, Spain 11 Sección de Vigilancia Epidemiológica, D.G. de Salud Pública, Cantabria, Spain 12 Servicio de Epidemiología, D.G. de Salud Pública, Consejería de Sanidad, Castilla-La Mancha, Spain 13 Servicio de Vigilancia Epidemiológica y Enfermedades Transmisibles, D.G. de Salud Pública, Consejería de Sanidad, Castilla y León, Spain 14 Microbiology Department, Hospital de la Santa Creu i Sant Pau, Microbiology & Genetics Department, Universitat Autònoma de Barcelona, Barcelona, Spain 15 Servei de Vigilància i Control Epidemiològic, Conselleria de Sanitat Universal i Salut Pública, Comunitat Valenciana, Spain 16 Subdirección de Epidemiología. D.G. de Salud Pública, Servicio Extremeño de Salud, Consejería de Salud y Políticas Sociales, Extremadura, Spain 17 Servizo de Epidemioloxía, Dirección Xeral de Saúde Pública, Consellería de Sanidade, Xunta de Galicia, Spain 18 Servicio de Epidemiología, Subdirección General de Epidemiología, Dirección General de Salud Pública, Comunidad Autónoma de Madrid, Spain 19 Servicio de Epidemiología, D. G. de Salud Pública y Adicciones, Consejería de Salud, Región de Murcia, Spain 20 Servicio de Epidemiología y Prevención Sanitaria, Instituto de Salud Pública de Navarra, IdiSNA, Spain 21 Servicio de vigilancia epidemiológica y vacunas, Dirección de Salud Pública y Adicciones, Departamento de Salud, País Vasco, Spain 22 Sección de Vigilancia Epidemiológica y Control de Enfermedades Transmisibles, D.G de Salud Pública y Consumo, Consejería de Salud, La Rioja, Spain 23 Servicio de Epidemiología, Consejería de Sanidad y Consumo, Ceuta, Spain 24 Servicio de Epidemiología, D.G. de Sanidad y Consumo, Consejería de Presidencia y Salud Pública, Melilla, Spain 25 The other members of the Spanish AFP Surveillance Working Group are listed at the end of this articleJosefa Masa-Callesjmasa isciii.es
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Citation style for this article: Masa-Calles Josefa, Torner Nuria, López-Perea Noemí, Torres de Mier María de Viarce, Fernández-Martínez Beatriz, Cabrerizo María, Gallardo-García Virtudes, Malo Carmen, Margolles Mario, Portell Margarita, Abadía Natividad, Blasco Aniceto, García-Hernández Sara, Marcos Henar, Rabella Núria, Marín Celia, Fuentes Amelia, Losada Isabel, Gutiérrez Juan García, Nieto Alba, Ortúzar Visitación García, Cenoz Manuel García, Arteagoitia José María, Martínez Ángela Blanco, Rivas Ana, Castrillejo Daniel, Spanish AFP Surveillance Working Group. Acute flaccid paralysis (AFP) surveillance: challenges and opportunities from 18 years’ experience, Spain, 1998 to 2015. Euro Surveill. 2018;23(47):pii=1700423. https://doi.org/10.2807/1560-7917.ES.2018.23.47.1700423 Received: 29 Jun 2017; Accepted: 06 Jul 2018
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.
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