We acknowledge the contributions of the national polio program staff and the Village Polio Volunteers in Somalia to the success of this project. The mean duration from paralysis onset to notification was the same (4.5 days) for AFP cases reported by both VPVs and other reporting sources during 2014–2016. If the cause is poliomyelitis, this may result in permanent disability, and outcomes could sometimes be fatal [4, 5]. 1 Executive Summary The Pakistani government is engaged in a protracted conflict against armed militant groups within its borders and outside its borders, it is a key player in the global ‘war on terror’. In the near term, this improvement enhances the ability of the country’s polio program to detect and respond to new polio outbreaks, albeit limited by the reliance of AFP surveillance on the emergence of paralytic polio cases to determine the circulation of poliovirus in an area. Thank you for submitting a comment on this article. More than 500 VPVs are currently operational in all 4 geopolitical zones of Somalia (Central, Northeast, Northwest, and South). None of the AFP cases reported during 2011–2012 were due to WPV infection, although 10 cases of circulating vaccine-derived poliovirus were reported during both years. The Global Polio Eradication Initiative (GPEI) has made tremendous gains in the last 28 years, with over 99% reduction in wild poliovirus (WPV) [1,2,3].Poliomyelitis is characterized by sudden weakness or floppy paralysis of any of the limbs, most especially in children [4,5,6,7,8].Acute flaccid paralysis (AFP) surveillance is the gold standard for poliomyelitis control and prevention. To assess the impact of the VPV program on AFP surveillance, we determined case counts, case-reporting sources, and nonpolio AFP rates in the years before and after program introduction (ie, 2011–2016). The proportion of AFP cases detected by VPVs in these areas further increased to 52% in 2015 and 56% in 2016. In addition to AFP case counts and NPAFP rates, we evaluated the quality of surveillance activities undertaken by VPVs by examining 2 other key surveillance indicators: stool specimen adequacy rates and timeliness of reporting. Documents reviewed include program description documents outlining terms of reference for volunteers. No significant difference was found when comparing the timeliness of AFP cases reported within 7 days by VPVs (86.0%) and those reported by other sources (84.8%) during 2014–2016. ES was initiated in Pakistan in 2009 at sites within Karachi and Lahore .Sampling has since been expanded to many regions within Pakistan (Fig. Once collected, VPVs work closely with the district polio officer to ensure that the specimens are transported in a timely manner to the regional polio laboratory in Nairobi, Kenya, where testing is conducted. The subsequent occurrence of 2 large polio outbreaks during 2005–2007  and 2013–2014 [19, 20] underscores the continued vulnerability of the country to reintroduction of WPV. Of note, the last WPV case identified during the outbreak was reported by a VPV working in the Northeast zone of the country. Fifteenth meeting of the European Regional Certification Commission, Copenhagen, Weekly Poliovirus Surveillance Bulletin. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. The Village Polio Volunteers (VPV) program was established in 2013 in a bid to strengthen polio eradication activities in Somalia, including AFP surveillance, given the country’s vulnerability to polio outbreaks. Vaccines are among the greatest success stories in public health. Current scenario of Polio 3. The VPV program has contributed significantly to improved surveillance for AFP cases in Somalia. Notification speeds have since improved, with >80% of cases being reported within 7 days during 2014–2016. AFP case counts rose from 148 cases in 2012, the year before program introduction, to 279 cases in 2015, when VPVs accounted for 40% of reported cases. 9. The VPV program, a community-based program, was established to enhance polio eradication activities in Somalia by strengthening surveillance and improving vaccination coverage in local communities. Although we could not determine from our data whether AFP cases identified by VPVs could have otherwise been detected by other reporting sources, our findings strongly suggest that much of the improvement in surveillance has been driven by the activities of VPVs. Given the impact of the VPV program on improving AFP surveillance indicators in Somalia, similar community-based programs could play a crucial role in enhancing surveillance activities in countries with limited healthcare infrastructure. Surveillance for cases of acute flaccid paralysis (AFP) is a key strategy adopted by the Global Polio Eradication Initiative (GPEI) for the eradication of poliomyelitis [1–3]. Community-based surveillance programs, such as the VPV program, encourage a paradigm shift from passive reporting to active detection of diseases of public health significance. 92, 46 (pp. Approximately 90% of AFP cases were notified within 7 days of paralysis of onset during 2011–2012. Each case of AFP acts as a signal to the polio surveillance system where polio is circulating and who it is likely to affect. These traditional reporting sources accounted for the bulk of AFP cases reported from these areas over the next 2 years, with VPVs responsible for only 3% of AFP cases reported from districts with access limitations in 2013. Categories of reporting sources included VPVs, public healthcare facilities, private healthcare providers, staff of the polio program (other than VPVs), and other sources within the community. The programme conducts periodic stool surveys among children from high risk populations who may be carrying the poliovirus without any signs of paralysis, or wherein circulation has been difficult to detect through regular AFP surveillance. A crucial step in the investigation is the collection of 2 stool specimens from the case patients ≥24 hours apart. NPAFP rates decreased from levels during the outbreak to 4.8 and 5.3 cases per 100000 persons aged <15 years during 2015 and 2016, respectively, but remained significantly above preoutbreak reporting levels. Identification of ≥2 nonpolio AFP (NPAFP) cases per 100000 persons aged <15 years is recommended by the World Health Organization (WHO) as a benchmark for surveillance activities in regions with active poliovirus transmission or places at significant risk of outbreaks [8, 9]. They again accounted for the highest proportion of AFP cases reported in 2016 when compared with other reporting sources. Flanagan P, O’Lorcain P, Cotter S, et al. The patterns of reporting held in 2013, the first year of the polio outbreak, with public healthcare facilities again being the main reporting source for AFP cases. Acute flaccid paralysis (AFP) is defined as a sudden onset of paralysis/weakness in any part of the body of a child less than 15 years of age. However, despite the recession and eventual cessation of the outbreak in 2014, the NPAFP rate rose from levels in 2013, largely owing to the contributions of the newly introduced VPV program. All stool specimens collected from reported AFP cases are tested at the Regional Reference Laboratory (RRL) for polio eradication in Islamabad. The contributions of VPVs to case reporting further improved in the following years. Immunization Officer, Pune Municipal Corporation Date : 20.08.2010 2. This article focuses on the contributions of VPVs to strengthening poliovirus surveillance in Somalia by assessing the impact of their activities on key AFP surveillance indicators. Among AFP cases reported by VPVs, the mean duration from paralysis onset to notification improved from 5.4 (95% CI, 4.84–5.97) days in 2014 to 3.7 (3.32–4.14) days in 2016 (Table 1). In line with improvements in case detection, NPAFP rates rose considerably during the outbreak, increasing to 6.5 and 7.4 cases per 100000 persons aged <15 years during 2013 and 2014, respectively. In the years after program introduction, VPVs accounted for a high proportion of AFP cases reported in Somalia. 7. To determine the contributions of VPVs to AFP case detection, we calculated overall case counts and proportions during 2011–2016, categorized by reporting source. AFP surveillance in Pakistan collected data on 43,301 NPAFP cases between January 2003 and June 2016, with an average annual rate increasing from 4.3 to 11.4 NPAFP per 100,000 children under the age of 5 years from 2003 to 2016. The programme is able to identify where the polio virus is circulating through its highly sensitive surveillance activities. We also compared the stool specimen adequacy rates and timeliness of cases reported by VPVs to those reported by other sources. Chukwuma Mbaeyi, Abdinoor Mohamed, Brian Ogola Owino, Kumlachew F Mengistu, Derek Ehrhardt, Eltayeb Ahmed Elsayed, Strengthening Acute Flaccid Paralysis Surveillance Through the Village Polio Volunteers Program in Somalia, Clinical Infectious Diseases, Volume 67, Issue 6, 15 September 2018, Pages 941–946, https://doi.org/10.1093/cid/ciy180. Wassilak SG, Oberste MS, Tangermann RH, Diop OM, Jafari HS, Armstrong GL. This process helps determine the most appropriate immunization strategies to prevent further spread of the poliovirus. Duration from paralysis onset to notification, d, Copyright © 2021 Infectious Diseases Society of America. Volunteers involved in the program, commonly referred to as VPVs, were recruited from local communities in nearly all districts of the country, with early priority given to districts designated as high risk based on predefined criteria. We did this to establish a statistical metric of performance of the surveillance system before and after the introduction of the VPV program. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. 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