title: Acute flaccid paralysis surveillance indicators in the Democratic Republic of Congo during 2008-2014.
abstract: BACKGROUND
  The last wild poliovirus (WPV) case in Africa was reported in July 2014, thus underscoring the tremendous progress towards polio eradication worldwide. This study aimed to analyze the results of a seven-year surveillance of Acute Flaccid Paralysis (AFP) in the Democratic Republic of Congo (DRC) and to identify potential gaps that need to be addressed.
  
  
  METHODS
  Epidemiological and virological data obtained from AFP surveillance among AFP cases less than 15 years from January 2008 to December 2014 in DRC were retrospectively considered and analyzed in this study.
  
  
  RESULTS
  Of the 13,749 AFP cases investigated, 58.9% received at least three doses of oral polio vaccine (OPV), 7.3% never received OPV, while the status of 18.3% was unknown. Analysis of surveillance performances showed that all, but two, indicators were below the required WHO-specified targets. Non-polio enterovirus (NPEV) isolation rate was consistently below the minimum requirement at ≥10% and the proportions of stool specimens that reached the laboratory within 72 hours of being sent were always below 15% (WHO target is ≥80%). Virus isolation and differentiation showed that 1.5% of AFP cases were infected by WPVs, 5.5% by Sabin strains, 0.5% by vaccine-derived polioviruses (VDPVs) and 7.2% by NPEVs.
  
  
  CONCLUSIONS
  Our findings indicate that additional efforts are needed to address the timeliness of adequate stool specimens' arrival to the laboratory. It remains essential to maintain high polio vaccine coverage and high AFP surveillance standards to ensure rapid detection and containment of either WPV importation or VDPV re-emergence in DRC.
authors.affiliation: Institut National de Recherche Biomédicale (INRB), P.O Box 1197 Kinshasa 1, Kinshasa, Democratic Republic of Congo; Department of Disease Control, School of Veterinary Medicine, University of Zambia, P.O Box 32379, Lusaka, Zambia.
authors.forename: Hugo Kavunga
authors.initials: HK
authors.lastname: Membo
authors.affiliation: Department of Disease Control, School of Veterinary Medicine, University of Zambia, P.O Box 32379, Lusaka, Zambia.
authors.forename: Aaron
authors.initials: A
authors.lastname: Mweene
authors.affiliation: Service de Virologie, Centre Pasteur du Cameroun (CPC), rue Henri Dunant P.O Box 1274, Yaoundé, Cameroun.
authors.forename: Serge Alain
authors.initials: SA
authors.lastname: Sadeuh-Mba
authors.affiliation: Institut National de Recherche Biomédicale (INRB), P.O Box 1197 Kinshasa 1, Kinshasa, Democratic Republic of Congo.
authors.forename: Justin
authors.initials: J
authors.lastname: Masumu
authors.affiliation: Institut National de Recherche Biomédicale (INRB), P.O Box 1197 Kinshasa 1, Kinshasa, Democratic Republic of Congo.
authors.forename: Riziki
authors.initials: R
authors.lastname: Yogolelo
authors.affiliation: World Heath Organization (WHO), Central African Inter-country Bureau, Libreville, Gabon.
authors.forename: Norbert
authors.initials: N
authors.lastname: Ngendabanyikwa
authors.affiliation: World Heath Organization (WHO), Central African Inter-country Bureau, Libreville, Gabon.
authors.forename: Eddy
authors.initials: E
authors.lastname: Sokolua
authors.affiliation: Department of Disease Control, School of Veterinary Medicine, University of Zambia, P.O Box 32379, Lusaka, Zambia.
authors.forename: Fred
authors.initials: F
authors.lastname: Sagamiko
authors.affiliation: Department of Disease Control, School of Veterinary Medicine, University of Zambia, P.O Box 32379, Lusaka, Zambia.
authors.forename: Edgar
authors.initials: E
authors.lastname: Simulundu
authors.affiliation: Institut National de Recherche Biomédicale (INRB), P.O Box 1197 Kinshasa 1, Kinshasa, Democratic Republic of Congo.
authors.forename: Steve
authors.initials: S
authors.lastname: Ahuka
authors.affiliation: Institut National de Recherche Biomédicale (INRB), P.O Box 1197 Kinshasa 1, Kinshasa, Democratic Republic of Congo.
authors.forename: Jean Jacques
authors.initials: JJ
authors.lastname: Muyembe
mesh_terms: D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005243:Feces / Q000821:virology; D005260:Female; D006801:Humans; D008297:Male; D010243:Paralysis / Q000453:epidemiology* / Q000821:virology; D011051:Poliomyelitis / Q000453:epidemiology*; D017955:Poliovirus / Q000302:isolation & purification; D011055:Poliovirus Vaccine, Oral / Q000008:administration & dosage*; D011159:Population Surveillance; D012189:Retrospective Studies; D013048:Specimen Handling; D013997:Time Factors
chemical_list: D011055:Poliovirus Vaccine, Oral
keywords: Democratic Republic of Congo; Poliomyelitis; indicators; paralysis; poliovirus; surveillance