A method for active surveillance of selected communicable diseases
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1WHO Suva, 3rd Floor YWCA Building, Sukuna Park, PO Box 113, Suva, Fiji. olearym@who.org.fj
Insights
A hospital-based surveillance system was established in the Western Pacific to track acute flaccid paralysis (AFP), measles, and neonatal tetanus. High compliance rates indicate its suitability for polio eradication certification.
Area of Science:
- Public Health
- Epidemiology
- Infectious Disease Surveillance
Background:
- The Western Pacific Region launched an initiative in 1991 to eradicate poliomyelitis by 2000.
- Eradication confirmation requires a robust certification process with specific criteria.
- A sensitive hospital-based surveillance system was developed to detect acute flaccid paralysis (AFP) at the background rate.
Purpose of the Study:
- To establish and evaluate a hospital-based surveillance system for poliomyelitis eradication.
- To assess the system's sensitivity in detecting AFP, measles, and neonatal tetanus.
- To determine compliance with reporting standards for certification.
Main Methods:
- Instituted a hospital-based surveillance system across Pacific countries starting in 1997.
- Collected monthly reports from 53 hospitals on AFP, suspect measles, and neonatal tetanus cases.
- Monitored submission rates to ensure compliance with certification standards.
Main Results:
- The surveillance system included AFP, measles, and neonatal tetanus.
- By mid-1998, 53 hospitals were participating in the surveillance.
- Over 80% of forms were submitted to WHO in 1998, meeting certification standards.
Conclusions:
- The hospital-based surveillance system demonstrated excellent compliance, meeting certification standards for polio eradication.
- The system's success suggests potential for expansion to include other febrile rash illnesses.
- Effective public health action and laboratory confirmation are crucial for comprehensive disease surveillance.
Abstract:
In 1991, an initiative was launched in the Western Pacific Region of WHO to eradicate poliomyelitis by the year 2000. Confirmation of eradication requires a certification process, in which specific criteria must be met. A hospital-based surveillance system was developed. It was sensitive enough to detect, at least one case of acute flaccid paralysis (AFP) per 100,000 children under age 15 per year, which is considered the "background rate" of AFP. This system was instituted in 1997 in most countries in the Pacific, and included measles and neonatal tetanus as well as AFP. By mid-1998, 53 hospitals in the Pacific were submitting monthly forms indicating whether or not AFP, suspect measles, or neonatal tetanus had been seen in the preceding month. Compliance was excellent, with over 80% of forms submitted to WHO in 1998, thus meeting the certification standard. In 1999 a proposal was made to expand this method, in selected countries, to encompass most conditions presenting with acute fever plus rash, thus including, for example, cases of rubella and dengue. Important aspects of such surveillance include the capacity to confirm diagnoses in the laboratory, and to take effective public health action. A coordinated laboratory network had been established previously for virological analysis of stool specimens for conditions causing AFP, but laboratory support for other conditions is currently the responsibility of individual hospitals to arrange.
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