Surveillance of acute flaccid paralysis in Italy: 1996-1997

The last case of poliomyelitis due to transmission of indigenous wild polio virus occurred in Italy in 1982. To achieve the certification of the eradic ation of poliomyelitis in Italy, an active surveillance of acute flaccid pa ralysis (AFP) in the population aged less than 15 years was set up followin g the World Health Organization (WHO) guidelines. The survey started in 199 6 with a pilot study involving 4 out of 21 regions, and was gradually exten ded to a national level in 1997. The two-year survey identified five patien ts with diagnosis of vaccine associated paralytic poliomyelitis (VAPP). Pol ioviruses 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 poliovirus es were detected during the survey. The rate of non-polio AFP found in Ital y 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 t o the delay in organizing the hospital network and starting the active sear ch of AFP cases in the largest and most densely populated regions. Therefor e, the overall rate of AFP found in Italy underestimates the global effecti veness of the program, which however will be better evaluated in the next f ew years. This study is the first systematic attempt to determine the rate of AFP in Italy.