Surveillance of poliomyelitis in the United Kingdom

Routine surveillance of poliomyelitis is undertaken through statutory notification, laboratory reporting, and examination of death certificates where poliomyelitis is mentioned. All health districts report weekly and include zero reporting of poliomyelitis in their returns. UK weekly reports on poliomyelitis are forwarded to WHO Europe. There have been no wild virus cases for over a decade. Since August 1991, there has been active surveillance of acute flaccid paralysis (AFP) in children under 16 years. All Consultant Paediatricians are contacted monthly through the British Paediatric Surveillance Unit and asked for reports of any cases of AFP. These are then investigated further. The study protocol specifies the investigations that are required for AFP cases, including stool samples for virology. AFP rates from this surveillance, approximately one per hundred thousand children under 16 years, provide a valuable guide for industrialised countries; consideration is being given to extending this scheme into the adult population. In 1992, a 44-year-old man died after sudden onset of AFP. Histology suggested poliomyelitis, and intensive investigations were undertaken to establish a diagnosis. The role of AFP surveillance and investigation of suspected cases are discussed in the light of the need to establish that poliomyelitis has been eliminated.