title: Faster Detection of Poliomyelitis Outbreaks to Support Polio Eradication.
abstract: As the global eradication of poliomyelitis approaches the final stages, prompt detection of new outbreaks is critical to enable a fast and effective outbreak response. Surveillance relies on reporting of acute flaccid paralysis (AFP) cases and laboratory confirmation through isolation of poliovirus from stool. However, delayed sample collection and testing can delay outbreak detection. We investigated whether weekly testing for clusters of AFP by location and time, using the Kulldorff scan statistic, could provide an early warning for outbreaks in 20 countries. A mixed-effects regression model was used to predict background rates of nonpolio AFP at the district level. In Tajikistan and Congo, testing for AFP clusters would have resulted in an outbreak warning 39 and 11 days, respectively, before official confirmation of large outbreaks. This method has relatively high specificity and could be integrated into the current polio information system to support rapid outbreak response activities.
authors.forename: Isobel M
authors.initials: IM
authors.lastname: Blake
authors.forename: Paul
authors.initials: P
authors.lastname: Chenoweth
authors.forename: Hiro
authors.initials: H
authors.lastname: Okayasu
authors.forename: Christl A
authors.initials: CA
authors.lastname: Donnelly
authors.forename: R Bruce
authors.initials: RB
authors.lastname: Aylward
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Grassly
mesh_terms: D016000:Cluster Analysis; D003223:Congo; D060740:Disease Eradication; D004196:Disease Outbreaks / Q000517:prevention & control*; D042241:Early Diagnosis; D062665:Epidemiological Monitoring; D006801:Humans; D009123:Muscle Hypotonia / Q000175:diagnosis / Q000209:etiology; D010243:Paralysis / Q000175:diagnosis* / Q000209:etiology; D011051:Poliomyelitis / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D012998:Somalia; D013620:Tajikistan; D013997:Time Factors
keywords: INLA; acute flaccid paralysis; eradication; integrated nested Laplace approximation; outbreak detection; polio; poliomyelitis; response activities; spatiotemporal regression; spatiotemporal scan statistic; viruses