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Combined performance indicators for the quality of acute flaccid paralysis surveillance in subnational areas of 28 priority countries -- World Health Organization African, Eastern Mediterranean, South-East Asia, and Western Pacific regions, 2023

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Abbreviations: AFP, acute flaccid paralysis; NPAFP, nonpolio acute flaccid paralysis; WHO, World Health Organization.

Notes:
(1) The number of NPAFP cases per 100,000 children younger than 15 years of age per year. NPAFP cases are cases of AFP determined not to be polio on further case investigation and stool testing. The threshold of two or more NPAFP cases indicating that AFP surveillance is sufficiently sensitive to detect circulating polio is based on a background rate of AFP due to etiologies other than polioviruses.

(2) Surveillance targets are two or more NPAFP cases per 100,000 persons younger than 15 years of age per year and 80% or more of persons with AFP having two stool specimens collected within 14 days of paralysis onset, 24 or more hours apart, and received in good condition (ie, without leakage or desiccation) by a WHO-accredited laboratory via reverse cold chain (storing and transporting samples at recommended temperatures from the point of collection to the laboratory).

(3) The 2023 priority countries include the following: African Region (21): Angola, Botswana, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Democratic Republic of the Congo, Ethiopia, Equatorial Guinea, Kenya, Madagascar, Malawi, Mali, Mozambique, Niger, Nigeria, South Sudan, Tanzania, Zambia, and Zimbabwe; Eastern Mediterranean Region (five): Afghanistan, Pakistan, Somalia, Sudan, and Yemen; South-East Asia Region (one): Indonesia; and Western Pacific Region (one): Papua New Guinea.

(4) NPAFP rate is difficult to interpret when the population younger than 15 years of age is below 100,000.

(5) Dotted and dashed lines on maps represent approximate border lines for which there might not yet be full agreement.

(Source: Kishore N, Krow-Lucal E, Diop OM, et al. Surveillance to track progress toward polio eradication - worldwide, 2022-2023. MMWR Morb Mortal Wkly Rep 2024;73[13]:278-85. Public domain.)