{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T19:01:14Z","timestamp":1782846074557,"version":"3.54.5"},"reference-count":17,"publisher":"JMIR Publications Inc.","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Public Health Surveill"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>As part of the polio-eradication strategy, the World Health Organization (WHO) has established a global acute flaccid paralysis (AFP) surveillance system. AFP surveillance has successfully helped Jordan achieve polio-free certification. However, there is a substantial risk of polio importation from neighboring countries including Syria and Iraq.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to evaluate the AFP surveillance in Jordan and identify areas that need improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study is a secondary analysis of data that were routinely collected between 2012 and 2016 by Jordan\u2019s Expanded Program on Immunization. The WHO\u2019s minimum performance indicators were used to evaluate the AFP surveillance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Cumulatively, 328 AFP cases had been reported. Almost half (n=168, 51.3%) of the patients were aged 1-5 years, and 55.8% (n=183) were male. All cases were discarded (classified as a nonpolio case). The most common cause of AFP was Guillain-Barre Syndrome (n=115, 35.1%). The annualized nonpolio AFP rate increased from 1.4\/100,000 children below 15 years of age in 2012 to 4.3 in 2016. National and subnational sensitivities were not met in 2012 and 2013. Adequacy of stool specimens and timeliness of specimens arriving at and processed in the laboratory were constantly above the minimum target. Timeliness of the investigation met the expected target but with a decreasing trend. The nonpolio enterovirus isolation rate was below the target, except in 2016.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The AFP surveillance system in Jordan is performing well; however, additional efforts are needed to strengthen the subnational sensitivity. The cold chain from sample collection to laboratory testing has to be maintained to ensure the reliability of stool specimens required for isolation of the nonpolio enterovirus.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/14217","type":"journal-article","created":{"date-parts":[[2019,8,10]],"date-time":"2019-08-10T08:45:54Z","timestamp":1565426754000},"page":"e14217","source":"Crossref","is-referenced-by-count":9,"title":["Evaluation of the Acute Flaccid Paralysis Surveillance System in Polio-Free Jordan, 2012-2016: Retrospective Secondary Analysis"],"prefix":"10.2196","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6930-7527","authenticated-orcid":false,"given":"Fatima","family":"Zerriouh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7830-6857","authenticated-orcid":false,"given":"Yousef","family":"Khader","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8680-8796","authenticated-orcid":false,"given":"Nabil","family":"Qasem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6814-5113","authenticated-orcid":false,"given":"Kamel","family":"Abusal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8538-977X","authenticated-orcid":false,"given":"Ibrahim","family":"Iblan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1413-0095","authenticated-orcid":false,"given":"Layla","family":"Ghaffari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1848-7676","authenticated-orcid":false,"given":"Mohammed","family":"Abdallat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2019,9,27]]},"reference":[{"key":"ref1","unstructured":"World Health Organization20002019-03-31Global eradication of poliomyelitis by the year 2000 \n          https:\/\/www.who.int\/ihr\/polioresolution4128en.pdf"},{"key":"ref2","unstructured":"Wikipedia2019-03-31Polio eradication \n          https:\/\/en.wikipedia.org\/wiki\/Poliomyelitis_eradication"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1586\/erv.10.45"},{"key":"ref4","unstructured":"HamborskyJKrogerAWolfeCCenters for Disease Control and Prevention20152017-10-01Epidemiology and Prevention of Vaccine-Preventable Diseases \n          https:\/\/web.archive.org\/web\/20161230001534\/https:\/www.cdc.gov\/vaccines\/pubs\/pinkbook\/index.html"},{"key":"ref5","unstructured":"WHOWorld Health Organization20032019-08-26Recommended standards for surveillance of selected vaccine preventable diseases: Vaccines and Biologicals \n          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diseases"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.4178\/epih.e2016030"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.11648\/j.iji.20170501.13"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2016.24.154.8747"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-14-687"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-8-135"},{"issue":"3","key":"ref15","first-page":"283","volume":"55","author":"Sevencan, F","year":"2013","journal-title":"Turk J Pediatr"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2013.14.86.2032"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1111\/jpc.12492"}],"container-title":["JMIR Public Health and 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