Background Ever since the 1988 poliomyelitis eradication global initiative, cases have been drastically decreasing; however, four countries remain polio reservoir sources for virus exportation. In Lebanon, the last two indigenous cases were reported in 1994. Acute flaccid paralysis (AFP) surveillance was adopted in Lebanon in 1998 to detect poliomyelitis cases, using syndromic approach.
Objective The objective of AFP surveillance is to early identify polio cases and achieve rapid response.
Methods According to Lebanese law, physicians immediately report any suspected polio case, using WHO case definition. Detection is enhanced by weekly hospital zero-reporting and active surveillance. Once case is reported, investigation is launched with data gathering and stool collection within 14 days of paralysis onset. Virological culture is performed at WHO accredited laboratory. Patients are reviewed by treating physicians or National Expert Group at day 60, assessing residual weakness. Accordingly, patients are classified as polio confirmed, compatible or discarded. Surveillance findings are posted at MOPH website.
Results Between 2000 and 2009, 154 patients were reported, on average 15 annually. No silent geographic areas were identified. 63% were males and 36% were under 5 years. Annual national AFP rate ranged from 0.79 to 2.34/100 000 under 15 y, with 72% specimen adequacy. Final diagnosis of most patients (75%) was attributed to Guillain Barre. One imported polio patient was confirmed in 2003 and another was classified as compatible in 2008.
Conclusion Enhancing AFP surveillance is of national priority because Lebanon is highly susceptible to polio importation due to ongoing Lebanese diaspora and foreign workers turnover.
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