Academic journal article Bulletin of the World Health Organization

Acute Flaccid Paralysis Incidence and Zika Virus Surveillance, Pacific Islands/Incidence De la Paralysie Flasque Aigue et Surveillance Du Virus Zika, Iles Du Pacifique/Incidencia De la Paralisis Flacida Aguda Y Seguimiento del Virus De Zika, Islas del Pacifico

Academic journal article Bulletin of the World Health Organization

Acute Flaccid Paralysis Incidence and Zika Virus Surveillance, Pacific Islands/Incidence De la Paralysie Flasque Aigue et Surveillance Du Virus Zika, Iles Du Pacifique/Incidencia De la Paralisis Flacida Aguda Y Seguimiento del Virus De Zika, Islas del Pacifico

Article excerpt

Introduction

In February 2016, in response to outbreaks in several Pacific and South American countries, (1) Zika virus was declared a Public Health Emergency of International Health Concern by the World Health Organization (WHO). (2) This was based on increasing evidence that Zika virus infection maybe associated with congenital malformations and autoimmune neurological diseases, including microcephaly, cranial nerve dysfunction and Guillain-Barre syndrome. (1,2)

The emergence of the Zika virus has challenged basic outbreak surveillance systems in many at-risk, low-resource countries. Zika virus surveillance strategies need to be convenient, timely and cost-effective, ideally using routinely collected information. Data on the incidence of acute flaccid paralysis (AFP) in children younger than 15 years are routinely collected for polio surveillance by 177 of the 194 WHO Member States as part of the Global Polio Eradication Initiative. The most common cause of AFP is Guillain-Barre syndrome. (3) As the syndrome has been associated with Zika virus infection, increases in the incidence of AFP--routinely reported to the Global Polio Eradication Initiative--might provide a useful early warning for Zika virus outbreaks in resource-constrained settings. We analysed data from the Pacific Islands to test this hypothesis.

Local setting

The Pacific Islands, which fall within WHO's Western Pacific Region, are home to several of the world's smallest, least developed and most isolated populations. The collective population of these islands (excluding New Zealand) is approximately 11.4 million people, of whom 8.2 million reside in Papua New Guinea and the rest are dispersed-over the thousands of islands and atolls that make up the other 20 Pacific Island countries and territories. Most islands' health authorities rely on simple syndromic surveillance and ad hoc event reporting by clinicians for disease outbreak detection. Their ability to enhance early warning surveillance in response to acute public health threats such as Zika virus is hampered by limited coverage and sensitivity of existing early warning surveillance; limited capacity to investigate outbreaks; geographic isolation and widely dispersed populations; poor communication infrastructure; and inadequately resourced health systems.

Approach

We documented all Zika virus outbreaks and cases in the Pacific Islands for the years 2007-2015 and tested the significance of unexpected increases in AFP in years that correlated with Zika virus emergence.

We obtained data on Zika virus outbreaks in the 21 Pacific Island countries and territories from published and unpublished information. For published information, we performed a literature search using the search terms "Zika" and "Zika virus" in the PubMed database; the identified papers were reviewed for relevance to the Pacific Islands. Unpublished event-relevant information was extracted from WHO's weekly Pacific Surveillance Syndromic Reports (4) and from PacNet listserv posts. (5) PacNet is the email-based outbreak notification and discussion forum of the Pacific Public Health Surveillance Network. Data extracted included the start and end dates of events, and the reported number of suspected and confirmed cases. To verify information extracted from unpublished sources we consulted staff at WHO's Division of Pacific Technical Support in Fiji. We also collected information on Zika outbreaks and cases from January to November 2016 to provide a complete and up-to-date picture of Zika activity in the study area.

AFP surveillance for polio eradication purposes requires health workers to promptly report and investigate identified cases of AFP, including the results of testing for wild polio virus. We extracted data on the expected and reported annual incidence of AFP in children younger than 15 years for Pacific Island countries and territories from the Global Polio Eradication Initiative's surveillance database. …

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