Poliovirus (polio) is a highly contagious pathogen that may cause a life-threatening paralytic disease and polio-induced respiratory insufficiency requiring intubation and mechanical ventilation [
1]. Clinical sequaelae include abortive poliomyelitis, aseptic meningitis and paralytic disease, with a mortality rate of 5–15 % primarily due to acute paralytic polio [
2‐
4]. Failure to eradicate the virus may result in the re-emergence and potential outbreak of polio disease in otherwise polio-free areas. The Global Polio Eradication Initiative (GPEI) is a partnership of the World Health Organization (WHO), Rotary International, the US Centers for Disease control and Prevention (CDC), and the United Nations Children’s Fund (UNICEF) and has been successful in reducing the incidence of confirmed cases of polio by 99 % from 1988 to 2013 [
5]. As of 2015, wild poliovirus remains endemic in Pakistan, Afghanistan and Nigeria [
6]. The success of the GPEI can be attributed to successful vaccination initiatives, improved hygienic practices, training of health care professionals (HCP) to deliver quality immunization services and most importantly, establishing a disease surveillance to detect a possible outbreak. Outbreaks are managed using a live attenuated oral poliovirus vaccine (OPV). To mitigate the risks of re-importation and circulation of poliovirus, a sensitive surveillance system coupled with effective vaccination covering at-risk children are the two most effective methods to promptly contain an outbreak [
7]. Environmental sampling from sewage and genetic sequencing are used to distinguish between circulating vaccine-derived polio-virus (cVDPV) and wild poliovirus isolates [
8]. Surveillance of acute flaccid paralysis (AFP) cases characterized by acute onset of muscle paralysis in children less than 15 years of age is used as a sensitive indicator of polio infection in the community [
9]. Polio-free countries need to maintain a sensitive AFP surveillance and ensure a high OPV immunization coverage through strengthened routine immunization services as part of the polio end game plan of these countries. Therefore, countries are required to report any case of AFP in children aged 15 years and less, with an expected target of 1 case of AFP per 100,000 children under 15 years per year [
10]. Furthermore, all cases of AFP must be investigated within 14 days, followed by collection of two stool samples 24 h apart within 14 days after the onset of paralysis. The stool samples are tested in a WHO accredited laboratory to confirm the absence of poliovirus [
11]. A 60 day follow-up examination is also required to evaluate the residual paralysis [
12]. Papua New Guinea (PNG) is at significant risk of polio re-importation from polio-infected countries and circulation due to poor healthcare infrastructure, inadequate training of healthcare providers (HCP) and insufficient surveillance activities, especially in remote regions [
13]. The rate of AFP reporting in PNG has significantly declined in 2000 when PNG was declared polio-free as part of WHO Western Pacific Region (WPRO), failing to reach a target non-polio AFP rate of 1/100,000 children under 15 with poor stool adequacy [
14]. The non-polio AFP rate and stool adequacy in PNG between September 2011 and September 2012 was 0.14/100,000 children under 15 and 0.20/100,000 respectively (Data from National AFP Line list). Under-reporting from the provinces in PNG poses a risk to the global polio eradication program because of the difficulty in distinguishing between a failure to report and a true zero-report. In addition to insensitive AFP surveillance, the national routine immunization coverage of Oral Polio Virus 3 (OPV3) in 2011 was only 57 %, coupled with supplementary immunization activities (SIA) coverage of below 80 % in highly populated provinces. With declining AFP surveillance from 2008 to 2012 and suboptimal OPV coverage in routine immunization, the Polio Regional Certification Committee (RCC) of WHO WPRO highlighted PNG as one of the highest-risk countries of polio virus importation from polio-endemic countries [
15].
The role of the pediatrician in PNG is critical to the identification, investigation and follow-up of all AFP cases [
16]. Newly inducted pediatric medical officers are less sensitized towards reporting cases of AFP, with minimal involvement of Provincial Disease Control Officers (PDCO) in active surveillance and little feedback provided to reporting medical officers on test results, which were identified as critical factors to declining surveillance performance in PNG. Based on increased risk for polio virus importation due to recent economic activities and the success of mobile phone based syndromic surveillance systems in PNG [
17], the Polio National Certification Committee (NCC) recommended that the National Department of Health (NDoH) should pilot the use of mobile-phone based alert systems (SMS Alert) to improve the detection and reporting of AFP cases, to raise awareness of AFP surveillance among pediatricians and the PDCOs and to increase timely reporting with support from WHO-PNG. In this report, we demonstrate the results of the implementation of SMS messages to sensitize the pediatrician and the provincial disease control officers in reporting of AFP cases, which also indicates a cost-effective means to increase surveillance reporting of AFP and other communicable disease in the NSS in PNG.