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.