赞比亚 2015-2021 年急性弛缓性麻痹监测指标评估：回顾性分析。
Evaluation of the Acute flaccid paralysis surveillance indicators in Zambia from 2015-2021: a retrospective analysis.
机构信息
World Health Organization Country Office, Lusaka, Zambia.
United States Centers for Disease Control and Prevention, Atlanta, USA.
出版信息
BMC Public Health. 2023 Nov 12;23(1):2227. doi: 10.1186/s12889-023-17141-1.
BACKGROUND
The resurgence of poliovirus infection in previously polio free regions and countries calls for renewed commitment to the global polio eradication efforts including strengthening of Acute Flaccid Paralysis (AFP) surveillance systems. Zambia is one of the countries substantially at risk for the importation of poliovirus infection from neighbouring countries including Malawi, Mozambique, and Democratic Republic of the Congo (DRC). This study describes a seven-year AFP surveillance, assesses the surveillance indicators, and highlights areas for improvement.
METHODS
We conducted retrospective analysis of the routinely collected AFP surveillance data from January 2015 to December 2022. The AFP surveillance indicators performance was assessed using the World Health Organisation's recommended minimum AFP surveillance indicators performance.
RESULTS
Cumulatively, a total of 1715 AFP cases were reported over the study period. More than half, 891 (52%) of reported cases were aged < 5 years with 917 (53.5%) of males. More than half, 1186 (69.2%) had fever at onset, 718 (41.9%) had asymmetric paralysis and 1164 (67.9%) had their paralysis progressed within 3 days of onset. The non-polio AFP rate ranges from 3.4 to 6.4 per 100,000 children < 15 years old and stool adequacy ranging from 70.9% to 90.2% indicating sensitive surveillance with late detection of cases. The percentage of cases with early stool collection, timely transportation was above the World Health Organisation (WHO) minimum of 80% but with declining proportion of stools arriving in the laboratory in optimal condition. Completeness of 60-days follow-up evaluation was suboptimal ranging from 0.9% to 28.2%.
CONCLUSION
The AFP surveillance system in Zambia is doing well. However, additional efforts are needed to improve early detection of cases; stool sample collection, transportation and monitoring to ensure arrival in good condition in the laboratory; and improve 60-days follow-up evaluation for evidenced-based classification of inadequate AFP cases and proper care.
背景
在曾经无脊髓灰质炎的地区和国家重新出现脊髓灰质炎病毒感染，这要求重新承诺开展全球消灭脊髓灰质炎努力，包括加强急性弛缓性麻痹（AFP）监测系统。赞比亚是面临从包括马拉维、莫桑比克和刚果民主共和国（DRC）等邻国输入脊髓灰质炎病毒感染风险的国家之一。本研究描述了为期七年的 AFP 监测，评估了监测指标，并强调了改进的领域。
方法
我们对 2015 年 1 月至 2022 年 12 月期间常规收集的 AFP 监测数据进行了回顾性分析。使用世界卫生组织（WHO）推荐的 AFP 监测最低指标性能评估 AFP 监测指标的表现。
结果
在研究期间，共报告了 1715 例 AFP 病例。报告病例中有一半以上，即 891 例（52%）年龄<5 岁，其中 917 例（53.5%）为男性。超过一半，即 1186 例（69.2%）在发病时发热，718 例（41.9%）有不对称性麻痹，1164 例（67.9%）在发病后 3 天内瘫痪进展。非脊灰 AFP 发生率为每 10 万名<15 岁儿童 3.4-6.4 例，粪便充足率为 70.9%-90.2%，表明监测灵敏，发病后病例检测较晚。早期采集粪便、及时运送的病例比例高于世界卫生组织（WHO）规定的 80%，但到达实验室的粪便到达实验室的情况逐渐恶化。60 天随访评估的完整性也不理想，范围从 0.9%到 28.2%。
结论
赞比亚的 AFP 监测系统运行良好。然而，需要进一步努力，以提高病例的早期发现；改善粪便样本的采集、运输和监测，以确保在实验室良好条件下送达；并改善 60 天随访评估，以对不充分的 AFP 病例进行循证分类和适当护理。
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