Skip to main content
Log in

Surveillance of acute flaccid paralysis in Italy: 1996–1997

  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

The last case of poliomyelitis due to transmission of indigenous wild poliovirus occurred in Italy in 1982. To achieve the certification of the eradication of poliomyelitis in Italy, an active surveillance of acute flaccid paralysis (AFP) in the population aged less than 15 years was set up following the World Health Organization (WHO) guidelines. The survey started in 1996 with a pilot study involving 4 out of 21 regions, and was gradually extended to a national level in 1997. The two-year survey identified five patients with diagnosis of vaccine associated paralytic poliomyelitis (VAPP). Polioviruses type 2 and 3 Sabin-like were isolated and characterized in three of them. In the remaining two cases, samples were collected late after the onset of symptoms, and poliovirus could not be isolated. No wild polioviruses were detected during the survey. The rate of non-polio AFP found in Italy in 1997 was 0.61 cases per 100,000, which is lower than the level of 1.0 case per 100,000 considered as acceptable by the WHO. This was mainly due to the delay in organizing the hospital network and starting the active search of AFP cases in the largest and most densely populated regions. Therefore, the overall rate of AFP found in Italy underestimates the global effectiveness of the program, which however will be better evaluated in the next few years. This study is the first systematic attempt to determine the rate of AFP in Italy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. World Health Assembly. Global eradication of poliomyelitis by the year 2000. Geneva: World Health Organization, 1988 (Resolution WHA 11.28).

    Google Scholar 

  2. Centers for Disease Control and Prevention. Certification of poliomyelitis eradication — the Americas, 1994. MMWR Morb Mort Wkly Rep 1994; 13: 720–722.

    Google Scholar 

  3. Hull HF, Ward NA, Hull BP, Milstien JB, de Quadros CA. Paralytic poliomyelitis: Seasoned strategies, dis-appearing disease. Lancet 1994; 343: 1331–1337.

    Google Scholar 

  4. Oblapenko G, Sutter RW. Status of poliomyelitis eradication in Europe and the Central Asian Republics of the former Soviet Union. J Infect Dis 1997; 175: S76–S81.

    Google Scholar 

  5. Tangermann RH, Bilous J, Maher C, Aylward RB, Schnur A, Sato Y, Omi S. Poliomyelitis eradication in the Western Pacific Region. J Infect Dis 1997; 175: S97–S104.

    Google Scholar 

  6. Ke-an W, Li-bi Z, Otten McW, Xing-lu Z, Chiba Y, Rong-zhen Z, Tao X, Xia L, Mu L, Qian-Le L, Jing-jin Y, Zhao W. Statuts of the eradication of Indigenous wild poliomyelitis in the People's Republic of China. J Infect Dis 1997; 175: S105–S112.

    Google Scholar 

  7. Andrus JK, Banerjee K, Hull BP, Smith JC, Mochny I. Polio eradication in the World Health Organization South-East Asia Region by the Year 2000: Midway assessment of progress and future challenges. J Infect Dis 1997; 175: S89–S96.

    Google Scholar 

  8. Hovi T, Cantell K, Houvilainen A, Kinnunen E, Kuronen T, Lapinleimu K, Poyry T, Roivanen M, Salama N, Stenvik M, Silander A, Thoden C-J, Salminen S, Weckstrom P. Outbreak of paralytic poliomyelitis in Finland: Widespread circulation of antigenically altered poliovirus type 3 in vaccinated population. Lancet 1986; 1: 1427–1432.

    Google Scholar 

  9. Oostvogel PM, van Wyngarden JK, van der Avoort HGAM, Mulders MN, Conyn van Spaedonck MAE, Rumke HC, van Steins G, van Loon AM. Poliomyelitis outbreak in unvaccinated community in the Netherlands, 1992–93. Lancet 1994; 344: 665–670.

    Google Scholar 

  10. Patriarca PA, Sutter RW, Oostvogel PM. Outbreaks of paralytic poliomyelitis, 1976–1995. J Infect Dis 175: S165–S172.

    Google Scholar 

  11. Fiore L, Genovese D, Diamanti E, Catone S, Ridolfi B, Ibrahimi B, Ikonomi R, van der Avoort HGAM, Hovi T, Crainic R, Simeoni P, Amato C. Antigenic and molecular characterization of wild type 1 poliovirus causing outbreaks of poliomyelitis in Albania and neighboring countries in 1996. J Clin Microbiol 1998; in press.

  12. Alcalà H, Olivé JM, de Quadros C. The diagnosis of polio and other acute flaccid paralysis: A neurological approach. Ninth Meeting of the Technical Advisory Group on Vaccine Preventable Diseases. Guatemala City, Guatemala 12–15 March 1991. N.EPI/TAG/91–10.

  13. EPI/PAHO. Strategies for the certification of the eradication of wild poliovirus transmission in the Americas. Bulletin of PAHO 1993; 27: 287–296.

    Google Scholar 

  14. Hull BP, Dowdle WR. Poliovirus surveillance: Building the Global Polio Laboratory Network. J Infect Dis 1997; 175: S113–116.

    Google Scholar 

  15. The Italian vaccine coverage survey working group. Childhood vaccination coverage in Italy; results of a seven-Regions survey. Bull WHO 1994; 72: 885–895.

    Google Scholar 

  16. Novello F, Lombardi F, Santoro R, Amato C, Fiore L, Grandolfo ME, Pasquini P. Paralytic poliomyelitis in Italy. 1981–85. Eur J Epidemiol 1987; 3: 54–60.

    Google Scholar 

  17. Fiore L, Novello F, Grandolfo ME. Eradicazione della poliomielite e sorveglianza delle paralisi flaccide in Italia. Rapporti ISTISAN 96/22.

  18. Prevots DR, Ciofi degli Atti ML, Sallabanda A. et al. Outbreak of paralytic poliomyelitis in Albania, 1996: High attack rate among adults and apparent interruption of transmission following nationwide mass vaccination. Clin Infect Dis 1998; 26: 419–425.

    Google Scholar 

  19. Squarcione S, Germinario C, Iandolo E, Lo Caputo S, Bergamini F, Profeta ML, Greco D, Quarto M, Barbuti S. Seroimmunity to poliomyelitis in an Albanian immigrant population. Vaccine 1992; 10: 853–856.

    Google Scholar 

  20. Aylward RB, Porta D, Fiore L, Ridolfi B, Chierchini P, Forastiere F. Unimmunized Gipsy population and implication for the eradication of poliomyelitis in Europe. J Infection Dis 1997; 175: S86–S88.

    Google Scholar 

  21. World Health Organization. Polio Lab Network. Quarterly Update. 1997; Vol.III; number 3: 1–2.

    Google Scholar 

  22. World Health Organization. Expanded programme on immunization. Manual for the Virological Investigation of Poliomyelitis. Geneva: WHO publication n. WHO/EPI/GEN/ 97.O1.

  23. Kew OM, Mulders MN, Lipskaya GY, Da Silva EE, Pallansch MA. Molecular epidemiology of poliovirus. Seminars in Virology 1995; 6: 401–414.

    Google Scholar 

  24. Van der Avoort HGAM, Hull B, Hovi T, Pallansch MA, Kew OM, Crainic R, Woods DJ, Mulders MN, van Loon AM. A comparative study of five methods for intratypic differentiation of polioviruses. J Clin Microbiol 1995; 33: 2562–2566.

    Google Scholar 

  25. Minor PD. The molecular biology of poliovaccines. J Gen Virol 1992; 73: 3065–3077.

    Google Scholar 

  26. Santoro R, Lombardi F, Novello F, Amato C, Ruggeri FM, Grandolfo ME, Annesi I, Cortellessa CM, Timperi F, Inglese R. Serum antibodies to poliomyelitis in Italy. Bull WHO 1984; 62: 591–595.

    Google Scholar 

  27. Caprioli A, Pezza C, Morelli R, Giammanco A, Arista S, Crotti D, Facchini M, Guglielmetti P, Piersimoni C, Luzzi I. Enterophatogens associated with childhood diarrhea in Italy. Pediatr Infect Dis J 1996; 15: 876–883.

    Google Scholar 

  28. Rautelin H, Kosunen TU. Campylobacter Etiology in human gastroenteritis demonstrated by antibodies to acid extract antigen. J Clin Microbiol 1987; 25: 1994–1951.

    Google Scholar 

  29. Strebel PM, Sutter RW, Cochi SL, Biellik RJ, Brink EW, Kew OM, Pallansch MA, Orenstein WA, Hinman AR. Epidemiology of poliomyelitis in the United States one decade after the last reported case of indigenous wild virus-associated disease. Clin Infect Dis 1992; 14: 568–579.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fiore, L., Novello, F., Simeoni, P. et al. Surveillance of acute flaccid paralysis in Italy: 1996–1997. Eur J Epidemiol 15, 757–763 (1999). https://doi.org/10.1023/A:1007697421114

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1007697421114

Navigation