SURVEILLANCE OF ACUTE FLACCID PARALYSIS IN THE NETHERLANDS, 1992-94

Detection and investigation of all cases of acute flaccid paralysis (A FP) in children below 15 years of age are among the criteria for polio myelitis-free certification. In the absence of poliomyelitis the incid ence of AFP is around 1 per 100000 children aged < 15 years. In the Ne therlands, surveillance of AFP began in October 1992 under the supervi sion of the Dutch Paediatric Surveillance System (NSCK). Over 90% of c linically active paediatricians participated in the monthly reporting of new cases of AFP. From October 1992 to December 1994 (27 months), 5 2 cases of AFP were reported. The incidence was 0.7 per 100000 over th e period, and reported cases were evenly distributed throughout the co untry. The main cause of AFP was Guillain-Barre syndrome. The average time between onset of symptoms and visiting a doctor was less than 3 d ays. The median reporting delay was 29 days, although the system was n ot intended as surveillance for action. Virological examination of fae ces was carried out for only 40.4% of AFP patients. The start of the N SCK surveillance system coincided with the 1992-93 outbreak of poliomy elitis in the Netherlands, but only 7 of the 18 children with paralyti c poliomyelitis were reported through the AFP surveillance system. For certification purposes, the present AFP surveillance system in the Ne therlands needs to be improved with respect to coverage by including n eurologists, rapidity of reporting, and completeness of laboratory inv estigations.