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Defining Polio: Closing the Gap in Global Surveillance
Bachir Tajaldin1, Khaled Almilaji1, Paul Langton1
1Icahn School of Medicine at Mount Sinai, New York, NY.
Annals of Global Health
|November 29, 2015
Summary
The laboratory-based polio case definition underestimates cases in conflict zones like Syria. Reinstating the clinical definition is crucial for accurate diagnosis and effective outbreak control to combat this global threat.
Area of Science:
- Public Health
- Epidemiology
- Infectious Diseases
Background:
- The Global Polio Eradication Initiative (GPEI) neared eradication by 2012, but conflict has led to polio resurgence.
- Public health infrastructure breakdown in conflict zones hinders surveillance programs for acute flaccid paralysis.
- Current laboratory-based case definitions may contribute to underreporting in these regions.
Purpose of the Study:
- To compare polio case detection rates using laboratory versus clinical criteria in Syria.
- To analyze the geographical distribution of polio cases within Syria.
- To assess the impact of conflict on polio surveillance data.
Main Methods:
- Analysis of World Health Organization (WHO) reported polio figures for Syria (2013-2014) using laboratory criteria.
- Comparison with cases identified using clinical criteria.
- Inclusion of data from the Assistance Coordination Unit for non-government controlled areas to address potential WHO data gaps.
Main Results:
- WHO data confirmed a polio outbreak but showed delays and underreporting, especially from non-government controlled areas.
- The laboratory-based definition underestimated polio cases by 36, while the clinical definition identified an additional 46 cases.
- Adequate diagnostic specimen collection rates were significantly below targets, reflecting the impact of conflict.
Conclusions:
- A surveillance gap exists, with the laboratory-based definition underdiagnosing polio in conflict settings.
- Underdiagnosis can delay response efforts and hinder polio eradication.
- Reinstating the clinical definition alongside the laboratory-based one is recommended to improve polio surveillance and control.
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