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Problem Little is known about the burden of influenza in sub-Saharan Africa. Routine influenza surveillance is key to getting a better understanding of the impact of acute respiratory infections on sub-Saharan African populations. Approach A project known as Strengthening Influenza Sentinel Surveillance in Africa (SISA) was launched in Angola, Cameroon, Ghana, Nigeria, Rwanda, Senegal, Sierra Leone and Zambia to help improve influenza sentinel surveillance, including both epidemiological and virological data collection, and to develop routine national, regional and international reporting mechanisms. These countries received technical support through remote supervision and onsite visits. Consultants worked closely with health ministries, the World Health Organization, national influenza laboratories and other stakeholders involved in influenza surveillance. Local setting Influenza surveillance systems in the target countries were in different stages of development when SISA was launched. Senegal, for instance, had conducted virological surveillance for years, whereas Sierra Leone had no surveillance activity at all. Relevant changes Working documents such as national surveillance protocols and procedures were developed or updated and training for sentinel site staff and data managers was organized. Lessons learnt: Targeted support to countries can help them strengthen national influenza surveillance, but long-term sustainability can only be achieved with external funding and strong national government leadership. INSETS: Box 1. World Health Organization (WHO) global influenza…;Box 2. Summary of main lessons learnt;Box 3. Influenza surveillance strengthening in Sierra Leone. [ABSTRACT FROM AUTHOR]

Background: The Enteric Cytopathic Human Orphan virus commonly referred to by the acronym ECHO virus has been known to cause acute flaccid paralysis (AFP). Zambia has since 1993 run a national AFP surveillance program to primarily detect and confirm poliomyelitis cases. Through this program other enteroviruses have been confirmed to be associated to the non-polio cases. We describe two patients with acute flaccid paralysis presenting like poliomyelitis and yet are non-polio cases associated with ECHO virus. Case reports: In March 1995, a 2 year old male from Misisi compound, presented at the UTH with muscle weakness and paralysis of sudden onset. Aside from the acute flaccid paralysis presenting in both legs and arms, the child had no other signs of symptoms of significance. Laboratory investigations using the WHO polio laboratory network standard protocols revealed the presence of ECHO 7 virus. In April 1995, a 4 year old girl from Kamwala South in Lusaka presented at the UTH with symptoms and signs of AFP of asymmetrical presentation affecting the Left upper and lower limbs, fever and sore throat. Two stool specimens collected for laboratory analysis revealed the presence of Echovirus untyped. Discussion: AFP is a neurological condition primarily suspected as a poliomyelitis commonly seen in children below 15 years defined by sudden onset of weakness and floppiness affecting usually one or more limbs. Laboratory analysis has revealed other viruses including the Echovirus being associated with acute flaccid paralysis. This case series reveals Echovirus 7 and Echovirus untyped as being associated with AFP cases that presented to the UTH initially suspected to be poliomyelitis. Conclusion: The clinical manifestations and laboratory results provide evidence of ECHO virus causing acute flaccid paralysis similar to that caused by polio virus. The last wild polio cases circulating in Zambia were in 2001. It is important that Zambia continues to investigate other causes of AFP for clinical decision making, scientific documentation and policy guidance. [ABSTRACT FROM AUTHOR]