Problem
The emergence of Zika virus has challenged outbreak surveillance systems in many at-risk, low-resource countries. As the virus
has been linked with Guillain–Barré syndrome, routine data on the incidence of acute flaccid paralysis (AFP) may provide a useful early
warning system for the emergence of Zika virus.
Approach
We documented all Zika virus outbreaks and cases in 21 Pacific Islands and territories for the years 2007 to 2015. We extracted
data from the Global Polio Eradication Initiative database on the reported and expected annual incidence of AFP in children younger
than
15 years. Using a Poisson probability test, we tested the significance of unexpected increases in AFP in years correlating with Zika virus
emergence. Data were analysed separately for each Pacific Island country and territory.
Local setting
In most Pacific Island countries, early warning surveillance for acute public health threats such as Zika virus is hampered by
poor health infrastructure, insufficient human resources and geographical isolation.
Relevant changes
Only one example was found (Solomon Islands in 2015) of a significant increase in reported AFP cases correlating with
Zika virus emergence.
Lessons learnt
We found no conclusive evidence that routinely reported AFP incidence data in children were useful for detecting emergence
of Zika virus in this setting. More evidence may be needed from adult populations, who are more likely to be affected by Guillain–Barré
syndrome. Reporting of AFP may be deficient in regions certified as polio-free.
Muistiin 11. 1.2017
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