Evaluation of Acute Flaccid Paralysis Surveillance System in Afghanistan during 2020: A Retrospective Secondary Data Analysis

Background: We aimed to evaluate the acute flaccid paralysis (AFP) surveillance system focusing on indicators reflecting the performance of the system in Afghanistan. Methods: This retrospective study was a secondary analysis of routinely collected AFP surveillance data during 2020 in Afghanistan. The standard WHO indicators were used to evaluate the AFP surveillance. Results: Afghanistan reported 3972 AFP cases during 2020; of them 2228 (56%) were male while 2835 (71%) were children aged under five years. Of all AFP-reported cases, 56 were wild polio cases and almost half (n= 28, 50%) of them were reported among children aged 12–24 months. Almost 348 (8.8%) had taken zero doses of the vaccine both in routine and supplementary immunization activities (SIA). Approximately 83% (n=3290) had fever at the onset of the disease while 50.4% (n=2001) had asymmetric paralysis. Two southern provinces, i.e., Kandahar and Helmand, reported 30 (54%) wild polio cases. In 2020, the non-polio AFP rate was 17/100,000 in children below 15 years of age. Meanwhile 42 (75%) of wild polio cases patients received zero oral polio vaccine (OPV) through routine immunization while 24 (43%) wild polio cases received zero OPV through NID campaigns. All other indicators met the expected target except that 851 (21.4%) specimens arrived at the laboratory within 3 days and 180 (41.3%) were followed up after onset of paralysis in 60 days. Conclusion: The AFP surveillance performed well in 2020. However, timely investigation of AFP cases and reaching the specimen to the lab should be improved.