Acute flaccid paralysis surveillance system data analysis, Pujehun, Sierra Leone, 2011-2020

The Acute Flaccid Paralysis (AFP) surveillance system was established to detect poliovirus and to measure  progress toward Poliovirus  eradication. Vaccine-derived poliovirus outbreaks have been reported  worldwide in 2020, including in Sierra Leone. We analyzed AFP  surveillance data to describe the  distribution, epidemiological trend, and clinical characteristics of AFP cases. We analyzed secondary  data  of AFP cases in the Pujehun District for the period from 2011 to 2020. We collected data on key variables  such as age, sex, clinical  characteristics, outcome, non-AFP rate, stool adequacy, and non-Polio  enteroviruses. We analyzed data using Microsoft Excel 2013 and  Epi-Info 7 software. Results were reported  in tables, graphs, and maps. A total of 60 AFP cases were reported with a median age of 3  years (range 0.7- 14), with no confirmed poliomyelitis. Under-five Children accounted for 46 (76.7%), with 27 females and  33 males. Of the  sixty cases,17(28.3%) were hospitalized and 16(27%) were detected in the hospital. Ten  (16.7%) cases were classified as non-Polio  enteroviruses and 50 (83.3%) as negative. Sudden onset of  paralysis was reported in 57 (96.6%) cases, paralysis progressed within 3 days  in 44 (74.6%) cases, and  56 (94.6%) reported fever. Out of 33, the left legs 28 (84.9%) were the most affected sites. Majority of the  cases,  35(58.1%) had received five and more doses of the Oral Polio vaccine. The stool adequacy was  54(90%) and the non-AFP rate was above  2.0 except in 2017 when it was 1.8. Of the 14 chiefdoms,12 (86%)  met the minimum AFP reporting target (1/100,000 < 15 years’  population). None of the AFP cases were  confirmed as Poliovirus in Pujehun District. Case detection and reporting rate were high except  for two  chiefdoms. We recommended maintaining the AFP surveillance system in the district and replicate the  strategies used to other  districts.