Acute flaccid paralysis indicators during the COVID-19 pandemic in Mozambique 2019 - 2020

Introduction: During the state of emergency posed by the COVID-19 pandemic, one of the primary communications for the public health control and prevention measures was "stay at home". However, what happens to the indicators of diseases aimed at eradication when people stay at home? We aimed to evaluate the Acute Flaccid Paralysis (AFP) surveillance indicators and determine the polio vaccine coverage in Mozambique, 2019-2020. Methods: We conducted a cross-sectional study using secondary data extracted from the AFP surveillance system and the monthly vaccination summaries for January to June 2019 and January to June 2020 for these five Mozambique provinces: Cabo Delgado, Nampula, Niassa, Tete, and Zambezia. The surveillance indicators were compared based on the target group for AFP surveillance and considered adequate when the sample rate was ≥80%, detection rate ≥3 / 100,000 among those <15 years old, surveillance index ≥1.6, and ≥80 % of districts had one or more cases under investigation. Polio vaccine coverage was analyzed among those <15 years. Results: A total of 133 suspected AFP cases were reported in 2019 and 74 in 2020. Tete province reported the highest number of cases, with 86.6% (13/15) in 2019 and in 2020 (73.3%, 11/15). All areas reached the ≥80% sample rate in 2019 and 2020, except Cabo Delgado with 57% in 2019 and 100% in 2020. Tete province was the only one to reach the target detection rate of 4.9 in 2019 and 3.9 in 2020. Also for the surveillance index, the same province was above the target 4.9 in 2019 and 3.9 in 2020. The province of Cabo Delgado registered, in April 2019, a 118% coverage rate in the 3rd dose of polio and 61% in April 2020. In Nampula province, the vaccination coverage rate in April 2019 was 103% compared to 76% in 2020. Conclusion: The COVID-19 pandemic may have negatively influenced AFP surveillance and vaccination coverage in Mozambique, demonstrating the need to reinforce the AFP surveillance during the COVID-19 state of emergency.