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Surveillance of acute flaccid paralysis in The Netherlands, 1992-94
P M Oostvogel1, M A Spaendonck, R A Hirasing
1Research Laboratory for Infectious Diseases, WHO Collaborating Centre for Reference and Research on Poliomyelitis, Rijks Instituut voor Volksgezondheid en Milieu (RIVM), Bilthoven, Netherlands.
Insights
The Dutch Paediatric Surveillance System (NSCK) monitors acute flaccid paralysis (AFP) in children. Improvements are needed in reporting speed and lab testing for polio-free certification.
Area of Science:
- Pediatrics
- Infectious Disease Epidemiology
- Neurology
Background:
- Acute flaccid paralysis (AFP) surveillance is crucial for poliomyelitis eradication and certification.
- The Dutch Paediatric Surveillance System (NSCK) initiated AFP surveillance in October 1992.
- High pediatrician participation (over 90%) was achieved in the Dutch system.
Purpose of the Study:
- To assess the incidence and characteristics of AFP in children under 15 in the Netherlands.
- To evaluate the effectiveness of the NSCK surveillance system for poliomyelitis-free certification.
- To identify areas for improvement in the Dutch AFP surveillance.
Main Methods:
- Retrospective analysis of 52 AFP cases reported between October 1992 and December 1994.
- Calculation of AFP incidence rates per 100,000 children.
- Review of reporting delays and laboratory investigation completeness.
Main Results:
- An incidence of 0.7 per 100,000 children aged <15 years was observed.
- Guillain-Barré syndrome was the primary cause of AFP.
- Median reporting delay was 29 days; only 40.4% of patients had virological stool examination.
- The system underreported paralytic poliomyelitis cases during a concurrent outbreak.
Conclusions:
- The Dutch AFP surveillance system requires enhancements in coverage (including neurologists), reporting timeliness, and laboratory investigation completeness.
- These improvements are necessary to meet the criteria for poliomyelitis-free certification.
- The current system's limitations were highlighted during the 1992-93 polio outbreak.
Abstract:
Detection and investigation of all cases of acute flaccid paralysis (AFP) in children below 15 years of age are among the criteria for poliomyelitis-free certification. In the absence of poliomyelitis the incidence of AFP is around 1 per 100,000 children aged < 15 years. In the Netherlands, surveillance of AFP began in October 1992 under the supervision of the Dutch Paediatric Surveillance System (NSCK). Over 90% of clinically active paediatricians participated in the monthly reporting of new cases of AFP. From October 1992 to December 1994 (27 months), 52 cases of AFP were reported. The incidence was 0.7 per 100,000 over the period, and reported cases were evenly distributed throughout the country. The main cause of AFP was Guillain-Barré syndrome. The average time between onset of symptoms and visiting a doctor was less than 3 days. The median reporting delay was 29 days, although the system was not intended as surveillance for action. Virological examination of faeces was carried out for only 40.4% of AFP patients. The start of the NSCK surveillance system coincided with the 1992-93 outbreak of poliomyelitis in the Netherlands, but only 7 of the 18 children with paralytic poliomyelitis were reported through the AFP surveillance system. For certification purposes, the present AFP surveillance system in the Netherlands needs to be improved with respect to coverage by including neurologists, rapidity of reporting, and completeness of laboratory investigations.