title: Improved acute flaccid paralysis surveillance performance in the Democratic Republic of the Congo, 2010-2012.
abstract: BACKGROUND
  The Democratic Republic of the Congo (DRC) began polio eradication activities in 1996. By 2001, DRC was no longer polio endemic. However, wild poliovirus (WPV) transmission was reestablished in 2006 continuing through 2011 (last WPV case onset 20 December 2011), and vaccine-derived poliovirus type 2 (VDPV2) outbreaks occurred during 2004-2012 (last VDPV2 case onset 4 April 2012). Gaps in acute flaccid paralysis (AFP) surveillance have been consistently documented.
  
  
  METHODS
  AFP surveillance indicators were assessed at the national, provincial, and zone de santé (ZS) levels for 2010-2012. A spatiotemporal analysis of compatible, WPV type 1 (WPV1), and VDPV2 cases was performed.
  
  
  RESULTS
  During 2010-2012, AFP cases were reported from all provinces but not every ZS, particularly in Equateur province and Province Orientale. A spatiotemporal relationship between compatible, WPV1, and VDPV2 cases was noted. Nonpolio AFP rates met objectives at national and provincial levels but were sub-optimal in certain ZS. National and provincial trends in timely stool collection, stool condition, adequate stool, and 60-day follow-up exams improved.
  
  
  CONCLUSIONS
  DRC's AFP surveillance system is functional and improved during 2010-2012. Maintaining improvements and strengthening AFP case detection at the ZS level will provide further support for the apparent interruption of WPV and VDPV2 transmission.
authors.affiliation: Global Immunization Division.
authors.forename: Mary M
authors.initials: MM
authors.lastname: Alleman
authors.affiliation: Epidemic Intelligence Service Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Meyer
authors.affiliation: Expanded Programme on Immunization.
authors.forename: Audry
authors.initials: A
authors.lastname: Mulumba
authors.affiliation: Expanded Programme on Immunization.
authors.forename: Michel
authors.initials: M
authors.lastname: Nyembwe
authors.affiliation: Institut National de Recherche Biomédicale, Ministry of Public Health.
authors.forename: Yogolelo
authors.initials: Y
authors.lastname: Riziki
authors.affiliation: Immunization, Vaccines, and Emergencies Cluster, World Health Organization, Kinshasa, Democratic Republic of the Congo.
authors.forename: Albert
authors.initials: A
authors.lastname: Mbule
authors.affiliation: Immunization, Vaccines, and Emergencies Cluster, World Health Organization, Kinshasa, Democratic Republic of the Congo.
authors.forename: May
authors.initials: M
authors.lastname: Mayenga
authors.affiliation: Immunization, Vaccines, and Emergencies Cluster, World Health Organization, Kinshasa, Democratic Republic of the Congo.
authors.forename: Tiekoura
authors.initials: T
authors.lastname: Coulibaly
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D062665:Epidemiological Monitoring; D005243:Feces / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010243:Paralysis / Q000453:epidemiology* / Q000517:prevention & control*; D011051:Poliomyelitis / Q000453:epidemiology* / Q000517:prevention & control*; D017955:Poliovirus / Q000302:isolation & purification; D055815:Young Adult
keywords: Africa; Democratic Republic of the Congo; acute flaccid paralysis; polio eradication; surveillance; vaccine-derived poliovirus; wild poliovirus