Epidemiological Surveillance of Poliomyelitis During the Military and Political Conflict in the Central African Republic, 2013 and 2014.

Background. Since December 2012, the Central African Republic (CAR) has been undergoing a severe military and political conflict. This situation has resulted in general insecurity and total disorganization of surveillance activities, including those for acute flaccid paralysis (AFP). In this study, we used laboratory data to evaluate surveillance of AFP in 2013 and 2014, the most critical period of the conflict. Methods. The laboratory data on AFP were analyzed retrospectively for the age, sex, vaccination status (oral poliovirus vaccines), and geographical origin of the samples. The.2 test was used, with P <.05 as the threshold for significance. Results. Decreased activity of AFP surveillance of 57% was registered in 2013 and 36% in 2014 compared with previous years. Only 37.3% and 49.7% of children with AFP were vaccinated in 2013 and 2014, respectively, but no wild poliovirus or vaccine-derived poliovirus (VDPV) was isolated. Laboratory performance concerning the timeliness of cell culture and intratypic differentiation/VDPV results was only 65.5% and 66.7% of the target in 2013 but reached 95.5% and 100% in 2014. Conclusions. All personnel involved in the monitoring of AFP must be mobilized to improve vaccination coverage and surveillance activities in the CAR.