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Surveillance of Infectious diseases in Children by paediatricians and GP

The World Health Organization (WHO) identified a number of targets for vaccine preventable disease control. A goal of global eradication of poliomyelitis has been set and a strategic plan for eliminating measles and rubella infection exists for some of the WHO Regions. The European Region of WHO has been certified polio-free in June 2002 and elimination of measles and rubella in the Region is targeted by 2015. Prior to stopping polio immunization, it will be necessary to certify the absence of wild poliovirus circulation from every country in the world. For a region to be certified polio-free, each country needs to demonstrate the absence of wild poliovirus transmission for at least three consecutive years in the presence of excellent surveillance. In order to ensure that wild polioviruses do not circulate and any newly imported virus is rapidly detected, children with limb weakness of sudden onset are tested to rule out poliovirus in acute flaccid paralysis (AFP). Poliomyelitis is a mandatory reportable disease in Belgium, but up to 2002, there was no surveillance system for AFP. Surveillance of measles in Belgium occurred through a sentinel network of General Practitioners up to 2000. With incidence of measles decreasing to low levels, the sentinel network of GPs was considered inappropriate to assure further surveillance and surveillance of measles stopped.

In order to fulfil the criteria of the World Health Organisation for certification of polio-free status, and to implement WHO recommendations regarding measles elimination, a surveillance system of AFP and measles in Belgium was set up in October 2002. A steering committee with representatives from paediatric associations, the Communities and the WIV-ISP decides on the criteria and diseases being included in the surveillance system. Rubella surveillance was stopped in December 2004. In October 2005 Invasive pneumococcal disease (IPD) surveillance was added to monitor the impact of the pneumococcal conjugated vaccine. In January 2007 congenital rubella syndrome (CRS) was added assure further surveillance of rubella. Haemolytic Uremic Syndrome (HUS) was added in March 2009 to monitor incidence and cases associated with Enterohemorrhagic. From October 2009 until April 2010 surveillance of Pandemic H1N1 influenza was carried out. From November 2011 until October 2012 surveillance of varicella cases was carried out.

Following the success of the British Paediatric Surveillance Unit (BPSU) for surveillance of rare paediatric diseases, the same methodology has been adopted to set up a surveillance system in Belgium in October 2002, using a monthly reporting system of several rare paediatric conditions: AFP, measles, mumps and rubella. Surveillance is carried out by paediatricians covering the whole country. Since vaccine coverage for the first dose of measles vaccine in Brussels is the lowest in Belgium, general practitioners for the Brussels Capital Region have also been invited to participate in the surveillance. Reporting is done on a voluntary base, through an Internet website or by returning a form by mail in the first week of each month. Zero reporting is requested to assess cases that are not reported by omission. Doctors reporting a case receive a (web based) questionnaire to collect epidemiological data. Surveillance is completed by information on laboratory confirmed cases reported by a nationwide network of sentinel laboratories and the National Reference Centres and cases reported by the health inspectors of the communities.

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