{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T06:29:35Z","timestamp":1783924175253,"version":"3.55.0"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,11,15]],"date-time":"2019-11-15T00:00:00Z","timestamp":1573776000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,11,15]],"date-time":"2019-11-15T00:00:00Z","timestamp":1573776000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health","award":["CCM Project"],"award-info":[{"award-number":["CCM Project"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>AFP cases occurring between 2007 and 2016 among children under 15\u2009years 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).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>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\u20132016, we found a remarkable underreporting, being AFP cases from NSS only 14% of those recorded in HDR. In particular, the acute infective polyneuritis cases reported to NSS accounted for 42.6% of those detected in HDR, while only 0.9% of myopathy cases and 13.1% of encephalitis\/myelitis\/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.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>AFP surveillance data are the final measure of a country\u2019s 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.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12889-019-7617-0","type":"journal-article","created":{"date-parts":[[2019,11,15]],"date-time":"2019-11-15T17:02:47Z","timestamp":1573837367000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Hospital discharges-based search of acute flaccid paralysis cases 2007\u20132016 in Italy and comparison with the National Surveillance System for monitoring the risk of polio reintroduction"],"prefix":"10.1186","volume":"19","author":[{"name":"the Regional Reference Centres of the National Surveillance System for Acute flaccid paralysis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Stefanelli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1149-3835","authenticated-orcid":false,"given":"Stefania","family":"Bellino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Fiore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Fontana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Concetta","family":"Amato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Buttinelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,11,15]]},"reference":[{"key":"7617_CR1","first-page":"113","volume":"16","author":"WHO","year":"1998","unstructured":"WHO. Acute Flaccid Paralysis Surveillance: the surveillance strategy for poliomyelitis eradication. Wkly Epidemiol Rec. 1998;16:113\u201320.","journal-title":"Wkly Epidemiol Rec"},{"key":"7617_CR2","first-page":"24","volume":"82","author":"J Smith","year":"2004","unstructured":"Smith J, Leke R, Adams A, Tangermann RH. Certification of polio eradication: process and lessons learned. Bull World Health Organ. 2004;82:24\u201330.","journal-title":"Bull World Health Organ"},{"key":"7617_CR3","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1186\/s12916-015-0363-y","volume":"13","author":"A Wilder-Smith","year":"2015","unstructured":"Wilder-Smith A, Leong WY, Fernandez Lopez L, Amaku M, Quam M, Khan K, et al. Potential for international spread of wild poliovirus via travelers. BMC Med. 2015;13:133.","journal-title":"BMC Med"},{"key":"7617_CR4","unstructured":"Istituto Superiore di Sanit\u00e0 [Italian National Institute of Health]. Scheda di segnalazione per la sorveglianza della paralisi flaccida acuta [Reporting sheet of the acute flaccid paralysis surveillance. Available from: http:\/\/www.salute.gov.it\/imgs\/C_17_pagineAree_820_listaFile_itemName_4_file.pdf. Accessed 24 Oct 2019."},{"key":"7617_CR5","unstructured":"La scheda di dimissione ospedaliera [Hospital discharge records]. Available from: http:\/\/www.salute.gov.it\/portale\/temi\/p2_6.jsp?lingua=italiano&id=1232&area=ricoveriOspedalieri&menu=vuoto. Accessed 24 Oct 2019."},{"issue":"1","key":"7617_CR6","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1111\/j.1467-842X.2002.tb00269.x","volume":"26","author":"RM D'souza","year":"2002","unstructured":"D'souza RM. Retrospective hospital-based searches for cases of acute flaccid paralysis. Aust N Z J Public Health. 2002;26(1):45\u20139.","journal-title":"Aust N Z J Public Health"},{"key":"7617_CR7","doi-asserted-by":"publisher","first-page":"346","DOI":"10.15585\/mmwr.mm6513a3","volume":"65","author":"CJ Snider","year":"2016","unstructured":"Snider CJ, Diop OM, Burns CC, Tangermann RH, Wassilak SGF. Surveillance systems to track progress toward polio eradication\u2014worldwide, 2014\u20132015. Morb Mortal Wkly Rep. 2016;65:346\u201351.","journal-title":"Morb Mortal Wkly Rep"},{"issue":"9","key":"7617_CR8","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1007\/s11908-018-0641-x","volume":"20","author":"A Bitnun","year":"2018","unstructured":"Bitnun A, Yeh EA. Acute flaccid paralysis and Enteroviral infections. Curr Infect Dis Rep. 2018;20(9):34.","journal-title":"Curr Infect Dis Rep"},{"key":"7617_CR9","doi-asserted-by":"publisher","first-page":"1952","DOI":"10.1099\/vir.0.043935-0","volume":"93","author":"R Tokarz","year":"2012","unstructured":"Tokarz R, Firth C, Madhi SA, Howie SR, Wu W, Sall AA, et al. Worldwide emergence of multiple clades of enterovirus 68. J Gen Virol. 2012;93:1952\u20138.","journal-title":"J Gen Virol"},{"key":"7617_CR10","doi-asserted-by":"crossref","unstructured":"Dyda A, Stelzer-Braid S, Adam D, Chughtai AA, MacIntyre CR. The association between acute flaccid myelitis (AFM) and Enterovirus D68 (EV-D68) - what is the evidence for causation?. Euro Surveill. 2018;23(3). Available at: https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29386095.","DOI":"10.2807\/1560-7917.ES.2018.23.3.17-00310"},{"key":"7617_CR11","doi-asserted-by":"crossref","unstructured":"The United Kingdom Acute Flaccid Paralysis Afp Task Force. An increase in reports of acute flaccid paralysis (AFP) in the United Kingdom, 1 January 2018-21 January 2019: early findings. Euro Surveill. 2019;24(6):1900093. Available at: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6373064\/.","DOI":"10.2807\/1560-7917.ES.2019.24.6.1900093"},{"key":"7617_CR12","unstructured":"Piano nazionale Prevenzione vaccinale 2017-2019 [National Vaccination Plan 2017\u20132019]. Available from: http:\/\/www.salute.gov.it\/imgs\/C_17_pubblicazioni_2571_allegato.pdf. Accessed 24 Oct 2019."},{"key":"7617_CR13","unstructured":"World Health Organization Regional Office for Europe. 32nd Meeting of the European Regional Commission for Certification of Poliomyelitis Eradication. Report 2018. Available from: http:\/\/www.euro.who.int\/en\/health-topics\/communicable-diseases\/poliomyelitis\/publications\/2018\/32nd-meeting-of-the-european-regional-commission-for-certification-of-poliomyelitis-eradication-rcc-report-2018. Accessed 24 Oct 2019."},{"key":"7617_CR14","volume-title":"Review of polio endemic countries","author":"WHO","year":"2018","unstructured":"WHO. Review of polio endemic countries. 2018. Available from: https:\/\/www.who.int\/immunization\/sage\/meetings\/2018\/october\/4_Review_Polio_Endemic_Countires_Report_IMB_Final_revised.pdf?ua=1."},{"key":"7617_CR15","doi-asserted-by":"crossref","unstructured":"Masa-Calles J, Torner N, L\u00f3pez-Perea N, de Viarce Torres de Mier M, Fern\u00e1ndez-Mart\u00ednez B, Cabrerizo M et al. Acute flaccid paralysis (AFP) surveillance: challenges and opportunities from 18 years\u2019 experience, Spain, 1998 to 2015. Euro Surveill. 2018;23(47). Available at: https:\/\/www.eurosurveillance.org\/content\/10.2807\/1560-7917.ES.2018.23.47.1700423.","DOI":"10.2807\/1560-7917.ES.2018.23.47.1700423"},{"issue":"suppl_1","key":"7617_CR16","doi-asserted-by":"publisher","first-page":"S293","DOI":"10.1093\/infdis\/jiw593","volume":"216","author":"SGF Wassilak","year":"2017","unstructured":"Wassilak SGF, Williams CL, Murrill CS, Dahl BA, Ohuabunwo C, Tangermann RH. Using Acute Flaccid Paralysis Surveillance as a Platform for Vaccine-Preventable Disease Surveillance. J Infect Dis. 2017;216(suppl_1):S293\u20138.","journal-title":"J Infect Dis"}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-019-7617-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12889-019-7617-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-019-7617-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,14]],"date-time":"2020-11-14T00:11:26Z","timestamp":1605312686000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpublichealth.biomedcentral.com\/articles\/10.1186\/s12889-019-7617-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,15]]},"references-count":16,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["7617"],"URL":"https:\/\/doi.org\/10.1186\/s12889-019-7617-0","relation":{},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,15]]},"assertion":[{"value":"12 March 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 September 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 November 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethics approval was not required as clinical isolates were collected, processed, and stored as part of routine clinical care by the collaborating hospital laboratories participating in the network. As our study did not involve interventions or additional clinical samples to be collected, no consent to participate was required. The surveillance activities are within the Global Polio Eradication Initiative (GPEI) of the WHO in the \u201cPolio Eradication & Endgame Strategic Plan 2013-2018\u201d, and by the Italian Ministry of Health (ref. 0004114\u201308\/02\/2018-DGPRE-DGPRE-P).","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable. Our manuscript does not contain any individual person\u2019s data in any form, including any individual details, images or videos.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1532"}}