[Poliomyelitis eradication in Poland--assessment of the program implementation]

The study aimed to investigate the quality of acute flaccid paralysis (AFP) surveillance in Poland prior to certification of polio-free status of the European Region in 2002. All cases reported to the National Institute of Hygiene in 1998-2002 were included in the study. To assess the surveillance quality we used the WHO indicators and timelines analysis of the undertaken actions. In total 320 AFP cases in children under 15 years were reported (annual incidence per 100,000 from 0.57 in 2000 to 1.05 in 2001 and 1.06 in 2002). Incidence was significantly higher in boys (RR = 1.42, p = 0.002) and in the age group 0-4 years (RR = 1.77, p < 0.0001). Mean incidence in voyvodeships ranged from 0.42 in Zachodnio-pomorskie to 1.45 in Swietokrzyskie. Percentage of cases with timely stool collection increased from 39% in 1998 to 82% in 2002 and the percentage of cases reported within 2 days from hospitalization--from 14% in 1998 to 48% in 2002. The median number of days from hospitalization to reporting decreased from 4 in 1998-2000 to 3 in 2001-2002 (p < 0.0001) and the median number of days from onset to first stool sample collection--from 7 in 1999-2000 to 5 in 2000-2002 (p < 0.0001). In the investigated 1350 stool samples from AFP cases and their contacts 76 strains of poliovirus were isolated--all Sabin-like. In conclusion the surveillance indicators improved during the study period. The quality of surveillance however is uneven on the sub-national level. Consequently, imported polio cases might be detected with delay. Continuation of enhanced AFP surveillance in Poland is warranted.