Reorganization of Active Surveillance of Acute Flaccid Paralysis (AFP) in Emilia-Romagna, Italy: a two-step Public Health intervention

Main Article Content

Lucia Palandri
Mariana Morgado
Maria Eugenia Colucci
Paola Affanni
Roberta Zoni
Sandra Mezzetta
Assunta Bizzarro
Licia Veronesi


Poliomyelitis; Poliovirus; Public Health Practice; Disease Notification; Active Surveillance; Disease Eradication; Acute flaccid paralysis.


Background and aim of the work: The International Health Regulations Emergency Committee declared in 2014 that poliovirus circulation is a public health emergency of international concern. In 2017 and 2018 Italy was classified at intermediate risk of poliovirus reintroduction based on suboptimal poliovirus surveillance. Acute flaccid paralysis active surveillance is the gold standard in the polio eradication process. The aims of this study were to investigate the causes of reduced acute flaccid paralysis case reporting in Emilia-Romagna in the last few years (step 1) and to study a public health intervention to restore an adequate level of acute flaccid paralysis surveillance in that region (step 2). Methods: In the first step a context analysis was performed by analysing the 2015-2017 Hospital Discharge Registers in Emilia-Romagna with the ICD-9-CM differential diagnosis codes for acute flaccid paralysis. Data from context analysis was then used to plan a new regional collaborative network of acute flaccid paralysis active surveillance. Results: The active surveillance network was, at the end of the study, composed by 49 doctors from both hospital administrations and clinical wards from 4 University Hospitals and 7 Local Health Authorities throughout the Region. In 15 months, 7 acute flaccid paralysis cases have been reported; 85,7% received a full clinical and virological investigation and 83,3% completed the 60 day’s follow-up. The mean response to each e-mail was 48,5% (SD 7,5%). Conclusions: In 2019, the Emilia-Romagna’s active surveillance system reached the sensitivity, completeness of case investigation and follow-up required to achieve the minimum levels for certification standard surveillance.


Download data is not yet available.
Abstract 249 | PDF Downloads 64


1. World Health Organization Global Polio Eradication Initiative. Weekly GPEI Polio Analyses WPV. 2020. Last accessed February 7, 2020
2. World Health Organization Global Polio Eradication Initiative. Fact sheet: vaccine-derived poliovirus. 2019. Last accessed February 7, 2020
3. Stefanelli P, Buttinelli G, Rezza G. Poliomyelitis: residual hurdles to global eradication. Ann Ist Super Sanita. 2016. 52(4):469–71.
4. European Centre for Disease Prevention and Control. Communicable disease threats report, week 5, 28 January-3 February 2018. 2018. Last accessed February 7, 2020
5. World Health Organization. Statement of the Sixteenth IHR Emergency Committee Regarding the International Spread of Poliovirus. 2018
6. World Health Organization. Acute Flaccid Paralysis Surveillance: the surveillance strategy for poliomyelitis eradication. Wkly Epidemiol Rec. 1998. 16:113–20.
7. Smith J, Leke R, Adams A, Tangermann RH. Certification of polio eradication: process and lessons learned. Bull World Health Organ. 2004. 82:24–30.
8. Stefanelli P, Bellino S, Fiore S, et al. Hospital discharges-based search of acute flaccid paralysis cases 2007–2016 in Italy and comparison with the National Surveillance System for monitoring the risk of polio reintroduction. BMC Public Health. 2019. 15;19(1):1532.
9. Kliegman RM, F SB, Schor NF, Geme JW, Behrman RE. Pediatria di Nelson. XIX. Elsevier; 2013.
10. Pellegrinelli L, Primache V, Fiore L, et al. Surveillance of acute flaccid paralysis (AFP) in Lombardy, Northern Italy, from 1997 to 2011 in the context of the national AFP surveillance system. Hum Vaccines Immunother. 2014 28. 11(1):277–81.
11. Pellegrinelli L, Bubba L, Primache V, et al. Surveillance of poliomyelitis in Northern Italy: Results of acute flaccid paralysis surveillance and environmental surveillance, 2012-2015. Hum Vaccines Immunother. 2017. 13(2):332–8
12. World Health Organization Global Polio Eradication Initiative. Last accessed 7 February 2020.
13. Des Jarlais DC, Lyles C, Crepaz N, and the TREND Group. Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: The TREND statement. Am J Public Health. 2004. 94:361-366.
14. Campbell M, Katikireddi SV, Hoffmann T, Armstrong R, Waters E and Craig P. TIDieR-PHP: a reporting guideline for population health and policy interventions, explanation and elaboration. BMJ 2018. 360: k1079
15. Colucci ME, Affanni P, Caruso L, et al. Influenza vaccine effectiveness in children: the eight season post pandemic study with trivalent inactivate vaccine. Acta Biomed 2020. XX;XX(XX):XX-XX.
16. Ianiro G, Recanatini C, D'Errico M.M, et al. Uncommon G9P[4] group A rotavirus strains causing dehydrating diarrhea in young children in Italy. Infect Gen Evol 2018; 64: 57-64.
17. Ianiro G, Micolano R, Di Bartolo I, Scavia G, Monini M; RotaNet-Italy Study Group. . -Group A rotavirus surveillance before vaccine introduction in Italy, September 2014 to August 2017.
Euro Surveill. 2019; 24(15). doi: 10.2807/1560-7917.ES.2019.24.15.1800418.
18. Chiapponi C, Ebranati E, Pariani E, Faccini S, Luppi, A, Baioni L, et al. Genetic analysis of human and swine influenza A viruses isolated in Northern Italy during 2010-2015. Zoonoses Public Health. 2018 Feb;65(1):114-123. doi: 10.1111/zph.12378.
19. Veronesi L, Colucci ME, Capobianco E, et al. Immunity status against poliomyelitis in young migrants: a seroprevalence study. Acta Biomed. 2019. 13;90(9-S):28-34.
20. Zoni R, Mezzetta S, Affanni P, et al. Poliovirus and non-polio-enterovirus environmental surveillance in Parma within the Global Polio Eradication Program (GPEI). Acta Biomed. 2019. 13;90(9-S):95-97.
21. Fontana S, Fiore S, Buttinelli G, et al. Molecular Characterization of Coxsackievirus B5 Isolates from Sewage, Italy 2016-2017. Food Environ Virol. 2019.11(4):440–5.
22. Delogu R, Battistone A, Buttinelli G, et al. Poliovirus and Other Enteroviruses from Environmental Surveillance in Italy, 2009-2015. Food Environ Virol. 2018; 10(4): 333-42.
23. Veronesi L, Affanni P, Verrotti di Pianella C, Colucci M.E, Tanzi M.L. Immunity status against poliomyelitis in childbearing women in a province of northern Italy. A cross-sectional analysis. Ann Ig 2013. 25: 427-433
24. Cesari C, Colucci ME, Veronesi L, et al. Detection of Enteroviruses from urban sewage in Parma. Acta Biomed 2010;81(1): 40-46.

Most read articles by the same author(s)

<< < 1 2 3 > >>