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

Paola Stefanelli, Stefania Bellino, Stefano Fiore, Stefano Fontana, Concetta Amato, Gabriele Buttinelli, Filippo Ansaldi, Sandro Binda, Laura Pellegrinelli, Guglielmo Bonaccorsi, Chiara Lorini, Silvio Brusaferro, Barbara Camilloni, Benita Capannolo, Cristiana Mancini, Valter Carraro, Paolo Castiglia, Antonella Arghittu, Marcello Mario D'Errico, Carlo De StefanoAlfredo Foca, CinziaGerminario [Unknown], Angela Larocca, Giovanni M. Giammanco, Simona De Grazia, Guido Maria Grasso, DanielaLombardi [Unknown], Francesca Russo, Giuseppina Napoletano, Francesca Zanella, Silvia Spertini, Licia Veronesi, Paola Affanni, Maria Triassi, Francesca Pennino, Francesco Vairo, Natl Surveillance Syst Acute

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Background Acute flaccid paralysis (AFP) surveillance has been adopted globally as a key strategy for monitoring the progress of the polio eradication initiative. Hereby, to evaluate the completeness of the ascertainment of AFP cases in Italy, a hospital-discharges based search was carried out. Methods AFP cases occurring between 2007 and 2016 among children under 15 years of age were searched in the Italian Hospital Discharge Records (HDR) database using specific ICD-9-CM diagnostic codes. AFP cases identified between 2015 and 2016 were then compared with those notified to the National Surveillance System (NSS). Results Over a 10-year period, 4163 hospital discharges with diagnosis of AFP were reported in Italy. Among these, 956 (23.0 were acute infective polyneuritis, 1803 (43.3 myopathy, and 1408 (33.8 encephalitis, myelitis and encephalomyelitis. During the study period, a decreasing trend was observed for all diagnoses and overall the annual incidence rate (IR) declined from 5.5 to 4.5 per 100,000 children. Comparing NSS with HDR data in 2015-2016, we found a remarkable underreporting, being AFP cases from NSS only 14 the acute infective polyneuritis cases reported to NSS accounted for 42.6 while only 0.93.1myelitis/encephalomyelitis cases have been notified to NSS. The highest AFP IRs per 100,000 children calculated on HDR data were identified in Liguria (17.4), Sicily (5.7), and Veneto (5.1) Regions; regarding the AFP notified to the NSS, 11 out of 21 Regions failed to reach the number of expected cases (based on 1/100,000 rate), and the highest discrepancies were observed in the Northern Regions. Overall, the national AFP rate was equal to 0.6, therefore did not reach the target value. Conclusions AFP surveillance data are the final measure of a country's progress towards polio eradication. The historical data obtained by the HDR have been useful to assess the completeness of the notification data and to identify the Regions with a low AFP ascertainment rate in order to improve the national surveillance system.
Original languageEnglish
JournalBMC Public Health
Issue number1
Publication statusPublished - Nov 15 2019


  • Acute flaccid paralysis
  • Hospital discharge records
  • National surveillance system
  • Polio

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