AFP surveillance

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An awareness Programme in Acute Flaccid Paralysis surveillance. for the doctors to End Polio

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AFP surveillance

  1. 1. AFP Surveillance Dr. Sunil A. Tore M.B.B.S., D.P.H.,D.H.A., M.I.P.H.A. Immunization Officer, Pune Municipal Corporation Date : 20.08.2010
  2. 2. Current scenario of Polio
  3. 3. Cameroun WORLD - WILD POLIO VIRUS CASES - 2010 577 CASES IN 15 COUNTRIES Pakistan Afghanistan Countries Wild cases 2010 India 25 Afghanistan 12 Angola 16 Pakistan 31 Tajikistan 437 Senegal 18 Sierra Leone 1 Mauritania 5 Mali 3 Nigeria 6 Niger 2 DRC 2 Nepal 4 Liberia 1 Chad 14 Total 577 India Senegal Nigeria Chad Mauritania Mali Angola Sierra Leone Nepal Tajikistan Liberia Niger * data as on 27th Jul 2010 DRC
  4. 4. 0 250 500 750 1000 1250 1500 1750 2000 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010* Polio cases, India P1 wild P3 wild * data as on 30 Jul 2010
  5. 5. State P1 P3 Total West Bengal 4 1 5 Jammu & Kashmir 1 0 1 Jharkhand 1 0 1 Maharashtra 1 0 1 Uttar Pradesh 0 10 10 Bihar 0 6 6 Haryana 0 1 1 Total 7 18 25 WPVs Location of poliovirus by type, 2010* Most recent virus 14 June 2010 Murshidabad, West Bengal * data as on 30 Jul 2010 State P1 P2 Total Uttar Pradesh 0 2 2 Tamil Nadu 0 1 1 Total 0 3 3 VDPVs
  6. 6. Genetic linkages of WPV1 cases, 2010* * data as on 3 July 2010 Genetically related to June 2009 strain in Saharsa district of Bihar Genetically related to June 2009 strain in Khagaria district of Bihar Genetically related to an imported Sept 2009 strain in Ludhiana district of Punjab * data as on 30 Jul 2010
  7. 7. State P1 P3 Total Bihar 38 79 117 Uttar Pradesh** 34 569 602 Delhi 3 1 4 Punjab 2 2 4 Jharkhand 2 0 2 Rajasthan 1 2 3 Haryana 0 4 4 Uttarakhand 0 4 4 Himachal Pradesh 0 1 1 Total 80 662 741 WPVs Location of poliovirus by type, 2009 State P1 P2 Total Assam 1 0 1 Bihar 0 3 3 Uttar Pradesh 1 16 17 Total 2 19 21 VDPVs ** One case reported mixture of P1 wild & P3 wild
  8. 8. 1735 397 139 212 1487 203 127 62 648 83 75 80 7 0 250 500 750 1000 1250 1500 1750 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010* Polio cases of type 1, India Year * data as on 30 Jul 2010
  9. 9. 0 1 2 3 4 5 6 7 8 9 10 Jan 2009 Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Weekly incidence of WPV1 cases, India, 2009 – 10 Jan 2010* Feb Mar Apr May Jun * data as on 30 Jul 2010
  10. 10. Area of m OPV1 mOPV1 tOPV
  11. 11. WPV1 Polio cases, India Jan 10 Feb 10 Mar 10 Apr 10 * data as on 30 Jul 2010 May 10 Jun 10 N=2 N=1 N=0 N=1N=2N=1
  12. 12. 0 1 2 3 4 5 6 7 8 9 10 Jan 2009 Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Weekly incidence of WPV1 cases, Uttar Pradesh, 2009 – 10 Jan 2010* Feb Mar Apr May Jun * data as on 30 Jul 2010
  13. 13. 0 1 2 3 4 5 6 7 8 9 10 Jan 2009 Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Weekly incidence of WPV1 cases, Bihar, 2009 – 10 2010* Jan Feb Mar Apr May Jun * data as on 30 Jul 2010
  14. 14. 190 127 59 116 22 7 4 28 794 484 662 18 730 0 100 200 300 400 500 600 700 800 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010* Polio cases of type 3, India Year * data as on 30 Jul 2010
  15. 15. 0 5 10 15 20 25 30 35 40 Weekly incidence of WPV3 cases, India, 2009 – 10 Jan 2009 Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan 2010* Feb Mar Apr May Jun * data as on 30 Jul 2010
  16. 16. WPV3 Polio cases, India Jan 10 Feb 10 Mar 10 Apr 10 * data as on 30 Jul 2010 May 10 Jun 10 N=14 N=2 N=0 N=1 N=0 N=1
  17. 17. 0 5 10 15 20 25 30 35 40 Weekly incidence of WPV3 cases, Uttar Pradesh, 2009 – 10 Jan 2009 Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan 2010* Feb Mar Apr May Jun * data as on 30 Jul 2010
  18. 18. 0 5 10 15 20 25 30 35 40 Jan 2009 Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Weekly incidence of WPV3 cases, Bihar, 2009 – 10 Jan 2010* Feb Mar Apr May Jun * data as on 30 Jul 2010
  19. 19. MAHARASHTRA – 2010 Wild cases MH-NSK-10-201 10/01/2010 P1 Wild Case Idcode Donset
  20. 20. Spot map of AFP cases Total Resident AFP cases - 1193 # # # # # ## S S S S S SS # # # # # # # # # # # # # S S S S S S S S S S S S S # # S S # # # # # # # S S S S S S S # ## # # # # # # # # # # # # # # # # # # # # # # # # S SS S S S S S S S S S S S S S S S S S S S S S S S S # # # # # # # S S S S S S S # # # # # # # # # # # S S S S S S S SS S S # # # # # # # # # # # # # # # # # S S S S S S S S S S S S S S S S S # # # # # # # # # # # # ## # # # # # # # # # ## # # # # # # # # # # # # # S S S S S S S S S S S S SS S S S S S S S S S S S S S S S S S S S S S S S S # ## ## # # # ## # # # # ## # # # # # ## # # # # # # # # # # # # # # # # # # # # # # # # # S SS SS S S S SS S S S S SS S S S S S SS S S S S S S S S S S S S S S S S S S S S S S S S S # # # # # ## # # # # # # # # # # # # # # # # # # # # # # # S S S S S SS S S S S S S S S S S S S S S S S S S S S S S S # # # # # # # # # # # # #### # # # ### # S S S S S S S S S S S S SSSS S S S SSS S # # # # # ## # # # # S S S S S SS S S S S # # # # # # S S S S S S ## # # # # # # # ## # # ## # # # # # # ### ## # # # # # # ### # ### # # # # # ## # #### # # # ## # # # # # # # # # # ## # ## ## # # # #### # # # # # # # ## ## ## # # # ## ## ### # # # ### # # ## ## # # ## ## # # # # # # # # # ## # # # # ## ### ## # # # # ## # # #### # # # # # #### # # ### ## # # # # ### # ## ## # # # # ### SS S S S S S S S SS S S SS S S S S S S SSS SS S S S S S S SSS S SSS S S SS S SS S SSSS S S S SS S S S S S S S S S S SS S SS SS S S S SSSS S S S S S S S SS SS SS S S S SS SS SSS S S S SSS S S SSSS S S SS SS S S S S S S S S S SS S S S S SS SSS SS S S S S S S S S SSSS S S S S S SSSS S S SSS SS S S S S SSS S SS SS S S S S SSS # # # ## # # # # # # # # # # # # # # # # # # # # # # # # # # ## # # # # # ## # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # ## # # # # # # ## # # # # # # # # # # # # # # # # # ## # # # # # # # # # # # # # ## # # # # # # # # # # # # ## # # # # # # # # # # # # # # # # # # # # # # # ## # # # # # # # # # # # # # # # # # # # S S S SS S S S S S S S S S S S S S S S S S S S S S S S S S S SS S S S S S SS S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S SS S S S S S S SS S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S SS S S S S S S S S S S S S SS S S S S S S S S S S S S S S S S S S S S S S S SS S S S S S S S S S S S S S S S S S S S # # # # # # # # # # # # # # # # ## # # # # # # # # # ## # # # # # # # # # # # # # # # # # # S S S S S S S S S S S S S S S S SS S S S S S S S S S SS S S S S S S S S S S S S S S S S S S # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S # ## # # # # ## ## # # # # # # # # # # # # # # # # # S SS S S S S SS SS S S S S S S S S S S S S S S S S S # # # # # ## # # # # # # # # S S S S S SS S S S S S S S S # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # ## # # # # # # # # # # # # # S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S SS S S S S S S S S S S S S S # # # # # # # # # # # # # # # # # # # S S S S S S S S S S S S S S S S S S S # # # ## # # # # # # # # # # # S S S SS S S S S S S S S S S S # # # # ## # # # # ## # # # # # # S S S S SS S S S S SS S S S S S S # # # # ## S S S S SS # # # # # # # # # # # # # # # # # S S S S S S S S S S S S S S S S S # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # ## # # # # # # # # # # # # # # S S S S S S S S S S S S S S S SS S S S S S S S S S S S S S S S S S S S S S S S SS S S S S S S S S S S S S S S # # # # # # # # # # # # # ## # # ## # # # # # # # # # # # # # # # # # # # # # # # # S S S S S S S S S S S S S SS S S SS S S S S S S S S S S S S S S S S S S S S S S S S # # # # # # # ### # # # # # # # S S S S S S S SS S S S S SS S S # # # # ## # # # # # # # # S S S S SS S S S S S S S S # # # # # # # # # # # S S S S S S S S S S S # # # # # # # # # # # # # # # # # # # # S S S S S S S S S S S S S S S S S SS S # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S SS S ANG SLR PNA NSK YTL GDL JLG AMT STR BED NDD BLD CPRABD THN NGP JLN KLP SNG RTG LTR DHL OBD RGD PBN AKL HIN WDH NDB GNA SDG WSM BND BMC * As of Week 29, 2010 Cameroun WORLD - WILD POLIO VIRUS CASES - 2010 577 CASES IN 15 COUNTRIES Pakistan Afghanistan Countries Wild cases 2010 India 25 Afghanistan 12 Angola 16 Pakistan 31 Tajikistan 437 Senegal 18 Sierra Leone 1 Mauritania 5 Mali 3 Nigeria 6 Niger 2 DRC 2 Nepal 4 Liberia 1 Chad 14 Total 577 India Senegal Nigeria Chad Mauritania Mali Angola Sierra Leone Nepal Tajikistan Liberia Niger * data as on 27th Jul 2010 DRC
  21. 21. AFP Rate Less than 0.69 2 & Above 0.70 to 0.99 1 to 1.99 No dataMH– 5.57 % ANG SLR PNA NSK YTL GDL JLG AMT STR BED NDD BLD CPRABD THN NGP JLN KLP SNG RTG LTR DHL OBD RGD PBN AKL HIN WDH NDB GNA SDG WSM BND BMC * As of Week 29, 2010
  22. 22. POLIO ERADICATION MILESTONES 1988 WHA RESOLUTION 2000 STOP VIRUS TRANSMISSION 2005 CERTIFY GLOBAL ERADICATION 2005/10 STOP POLIO IMMUNIZATION
  23. 23. 1988 350 000 cases 125 countries Areas with Active Polio Transmission
  24. 24. POLIO ERADICATION STRATEGIES  BASED ON DISEASE KNOWLEDGE  POTENT VACCINE .  EFFECTIVE METHODS FOR THE CONTROL OF POLIO.
  25. 25. The disease of poliomyelitis has a long history. The first example may even have been more than 3000 years ago. An Egyptian stele dating from the 18th Egyptian dynasty (1580 - 1350 BCE) shows a priest with a deformity of his leg characteristic of the flaccid paralysis typical of poliomyelitis. .
  26. 26. POLIO  MOST VOLUNERABLE GROUP IS < 5YRS.  HIGH TRANSMISSION-JULY TO SEPTEMBER.  ROUTE OF TRANSMISSION-FAECO- ORAL ROUTE.  OVER CROWDING,POOR SANITATION, SLUMS FAVOURABLE CONDITIONS  INCUBATION PERIOD- 1 TO 2 WEEKS.
  27. 27. POLIO DISEASE • IT IS A VIRAL INFECTION CAUSED BY AN ENTEROVIRUS –POLIO VIRUS • THREE TYPES • TYPE-1—EPEDEMICS • TYPE-2---THIS IS THE FIRST SERO TYPE TO DISAPPEAR. • TYPE-3--- PARALYSIS LESS FREQUENT.
  28. 28. In 1928, Philip Drinker and Louis Shaw at Harvard Medical School introduced the iron lung to help individuals suffering from acute poliomyelitis. Polio impaired patients' ability to breathe by paralyzing the diaphragm and intercostal muscles; the iron lung provided relief in the form of artificial respiration. It consisted of a sealed chamber in which air pressure is alternately reduced and increased. The patient was placed in the chamber with his/her head emerging from a port at one end. Each cycle of vacuum within the chamber allowed their lungs to be filled with atmospheric air; subsequent increase of pressure forced exhalation of air from the lungs.
  29. 29. POLIO DISEASE  IT IS A VIRAL INFECTION CAUSED BY AN ENTEROVIRUS –POLIO VIRUS  THREE TYPES  TYPE-1—EPEDEMICS  TYPE-2---THIS IS THE FIRST SERO TYPE TO DISAPPEAR.  TYPE-3--- PARALYSIS LESS FREQUENT.
  30. 30. WHY POLIO IS A CANDIDATE FOR ERADICATION ?  MAN IS THE ONLY RESERVIOR  NO LONG TERM CARRIER STATE  ROUTE OF TRANSMISSION IS FAECO- ORAL  HALF LIFE OF EXCRETED VIRUS IN SEWAGE SAMPLE IN TROPICAL CLIMATE LIKE INDIA IS 48 HOURS.  POTENT AND EFFECTIVE VACCINE.
  31. 31. WHY OPV ?  ALSO KNOWN AS SABIN VACCINE  POTENT LIVE VACCINE  GIVES GUT IMMUNITY  GIVES HERD IMMUNITY- INTERRUPT’s TRANSMISSION CYCLE  EASY TO ADMINISTER  COST EFFECTIVE
  32. 32. FOUR KEY STRATEGIES FOR POLIO ERADICATION  RI-PROGRAMME [ UIP ] - 1985  MASS IMMUNIZATION(PPI) – 1995-96 CAMPAIGNS  APF SURVEILLANCE - 1997  MOPING UP IN FOCAL AREAS
  33. 33. WHAT IS PULSE POLIO ? TO IMMUNIZE ALL THE KIDS< 5YRS NATION WIDE ON A SINGLE DAY IN THE SHORTEST POSSIBLE TIME WITH OPV & THAT THE ENVIRONMENT WILL GET SATURATED WITH THE VACCINE VIRUS SO THAT IT WILL REPLACE THE WILD VIRUS AND THUS INTERUPT THE TRANSMISSION OF WILD VIRUS .
  34. 34. WHAT IS SURVEILLANCE ? • IT IS A CONTINOUS SCRUTINY OF ALL ASPECTS OF OCCURRENCE & SPREAD OF DISEASE THAT ARE PERTINENT TO EFFECTIVE CONTROL. • IT INCLUDES 1. COLLECTION OF DATA 2. ANALYSIS OF DATA 3. INTERPRETATION OF DATA 4. DISTRIBUTION OF RELEVANT DATA SO THAT NECESSARY ACTION CAN BE TAKEN
  35. 35. AIM OF AFP SURVEILLANCE  TO DETECT POLIO TRANSMISSION & INTERRUPTION OF TRANSMISSION AFP CASE POLIO CASE RESERVOIR OF INFECTION [ 100 TO 1000 SUB CLINICAL CASES ] CONTAINMENT MEASURES [ O.R.I. / MOP UP ]
  36. 36. GOAL OF AFP SURVEILLANCE  IDENTIFICATION OF ALL RESERVOIRS OF CIRCULATING WILD POLIO VIRUS  ( THAT COULD BE POLIO ) BY DOCUMENTING ALL SUCH CASES,IT IS POSSIBLE TO SHOW THAT NONE OF THESE “POLIO-LIKE” CASES WERE CAUSED BY THE POLIO VIRUS,AND THAT POLIO IS NO LONGER PRESENT OR EXISTING.
  37. 37. WHY AFP SURVEILLANCE INSTEAD OF POLIO SURVEILLANCE ?  SURVEILLANCE OF A POLIO CASE ALONE IS NOT SUFFICIENT BECAUSE IT IS IMPOSSIBLEE TO PRECISELY IDENTIFY ALL CASES OF POLIO CLINICALLY DUE TO CONFUSING AND AMBIGUOUS CLINICAL SIGNS AND VARIABLE CLINICAL KNOWLEDGE & SKILLS OF DOCTOR.  CLINICALLY POLIO IN ACUTE STAGE, IS DIFFICULT TO DISTINGUISH FROM OTHER CAUSES OF ACUTE ONSET OF FLACCID PARALYSIS.-----
  38. 38. SURVEILLANCE OF ACUTE FLACCID PARALYSIS  STARTED IN 1997 OCTOBER  ACHIEVED GLOBAL BENCHMARKS IN MAY 1998  MAPPING OF POLIO CASES MADE POSSIBLE  LABS PROVIDING > 80% RESULTS ON TIME  GENETIC SEQUENCING CAPACITY EXPANDED
  39. 39. WHAT IS AFP ? OLD DEFINITION ANY CHILD AGE < 15 YRS HAVING ACUTE ONSET OF FLACCID PARALYSIS FOR WHICH NO OBVIOUS CAUSE SUCH AS SEVERE TRAUMA OR ELECTROLYTE IMBALANCE IS FOUND IT INCLUDES-GBS,TM,TN,POLIOMYELITIS
  40. 40. The AFP Surveillance System Hospitals Clinics Investigation Non-Polio AFP Polio AFP Community
  41. 41. Causes of AFP • Poliomyelitis • Gullain Barre Syndrome • Traumatic neuritis • Transverse Myelitis • Any other flaccid/lower motor presentation
  42. 42. AFP case definition broadened Consequences of missing the case of polio are more serious then occasionally including and “ambiguous’’ case, specially during the final stage of polio eradication. Includes every case with • current flaccid paralysis • History of flaccid paralysis in the current illness • Boarder line and ambiguous case • Transient weakness / paralysis
  43. 43. When too much polio is around….. Non-AFP cases Polio cases AFP cases Borderline AFP cases Surveillance sensitivity is adequate enough to detect 90% polio cases
  44. 44. Adequacy of surveillance • Programme Monitoring indicators 1. Non polio AFP rate 2. Adequate stool specimen collection
  45. 45. Non Polio AFP Rate Proportion of Non Polio AFP cases – is the indicator of quality of surveillance. More the no. of AFP cases reported – better the quality of surveillance
  46. 46. Non Polio AFP Rate 1 Non Polio AFP case in 1 Lakh children (0 to 15 Years) . Pune District – 27 lakh (0 to 15 years) – 27 non Polio AFP cases expected PMC - 10 Lakh (0-15 years) – 10 non Polio AFP cases expected This is the lowest limit of this indicator – applicable to western countries
  47. 47. Non Polio AFP Rate Non polio AFP rate = Reported AFP cases Expected AFP cases e.g. In PMC = 10 10 = 1 2005 = 23 10 = 2.3 This rate should be more then 2.
  48. 48. When to report AFP case  Immediately ( Just one phone call)  9689931339 / 9822912062 / 24487700  So that stool samples are collected within 14 days from onset of paralysis  Stool can be collected up to 2 months  Case can be reported up to 6 month of onset
  49. 49. WHAT TO REPORT  Any Case of Acute Flaccid Paralysis < 15 Yrs age  It May be Monoplegia,Paraplegia,Hemiplegia,Fa cial Palsy,or Any Trasient weakness.  Any case of Suspected Polio Clinically Irrespective of any age
  50. 50. AFP SURVEILLANCE STEPS FOR EACH AFP CASE 1. CASE INVESTIGATION 2. 2 STOOL SPECIMENS,COLLECTED 24 HOURS APART,AND WITHIN 14 DAYS OF ONSET OF PARALYSIS 3. SENT FOR CULTURES TO LAB TO ISOLATE POLIO VIRUS 4. ORI ACTIVITY & SEARCH FOR MORE AFP CASES IN THE AREA 5. 60 DAYS FOLLOW-UP EXAMINATION AFTER ONSET.
  51. 51. STOOL COLLECTION  2 STOOL SAMPLES, COLLECTED 24 HOURS APART  COLLECTED WITHIN 14 DAYS OF ONSET  APPROXIMATELY 8 gms OR ADULT’s THUMB SIZE  KEPT IN REFRIGERATOR( DO NOT FREEZ)  SEND IN REVERSE COLD CHAIN TO LAB WITH PROPER DOCUMENTATION
  52. 52. ADEQUATE SPECIMENS  TWO SPECIMENS - COLLECTED 24 TO 48 HOURS APART - WITHIN 14 DAYS OF PARALYSIS ONSET  SPECIMENS ARRIVING @ LAB - GOOD CONDITION - NO LEAKAGE - NO DESICCATION - IN COLD CHAIN - WITH APPROPRIATE DOCUMENTATION
  53. 53. OUTBREAK RESPONSE IMMUNIZATION TARGET AGE- 0- 59 MONTH OLD CHILDREN AFTER COLLECTION OF SPECIMENS ONE ROUND OF H-T-H WHOLE VILLAGE / URBAN WARD IMMEDIATELY FOLLOWING AN AFP CASE
  54. 54. WHY ORI ?  CONTROL OF OUTBREAK ESPECIALLY IN UPSURGE OF EPIDEMIC CURVE  AVOID NEGATIVE CONSEQUENCES OF COMPLACENCY  TO PROTECT AGAINST OTHER POLIO VIRUS TYPES  INFORMATION FOR ACTION- MOTIVATES REPORTING SITES,OPPORTUNITY FOR ACTIVE CASE SEARCH
  55. 55. 60 DAYS FOLLOW UP  EACH AFP CASE MUST BE FOLLOWED-UP AFTER 60 DAYS AFTER ONSET OF PARALYSIS TO DETERMINE IF THERE IS STILL A RESIDUAL PARALYSIS  FOR FOLLOW-UP, EXACT PERMANENT ADDRESS OF THE PATIENT SHOULD BE WRITTEN ON THE CIF @ THE TIME OF INITIAL INVESTIGATION.
  56. 56. Onset of paralysis Investigation of suspected case (≤48 hours of report) 2 stool specimens collected (≤14 days since onset of paralysis) 24 hours apart Outbreak response immunization additional case finding 60-day follow-up exam Specimens arrive at national laboratory Results reported from national laboratory Poliovirus isolates send to regional reference laboratory for intratypic differentiation Final classification of the case by the expert committee (≤ 12 weeks since onset of paralysis) Appendix 5 : Flow diagram of case investigation, stool specimen collection and outbreak response immunization ≤ 3 Days ≤ 24 Days ≤ 7 Days
  57. 57. WHAT IS NOT AFP ?  TRAUMA  ISOLATED FACIAL NERVE PALSY  HYPOKALAEMIA  ACUTE RHEUMATIC FEVER  CONGENITAL FLACCID PARALYSIS
  58. 58. CONDITIONS SOMETIMES PRESENTING WITH AFP  TUMOR  ENCEPHALITIS  HYPOKALEMIC PARALYSIS [ DUE TO LOW SERUM POTASSIUM USUALLY REVERSIBLE ]  POTT’s DISEASE  TB MENINGITIS  OSTEOMYELITIS
  59. 59. AFP Reporting Network Gen. Pract.Paediatrician Neurologist Physician Dist. Hospital Traditional Healer MPW/ ANM RH PHC Quack DHO/ MOH/ SMO State WHO Delhi
  60. 60. Data Flow Reporting Units Districts Districts State States NPSU Delh Delhi WHO Mondays Tuesdays Wednesdays Thursday
  61. 61. Reporting Units Reporting Units Informers PMC 39 141 PCMC 18 7 PUNE RURAL 43 139 Pune Dist 100 287 Reporting units – sending reports weekly regularly Informers – whenever AFP case - Informs by phone
  62. 62. Aundh Kasba peth PC Hadapsar Sangamwadi Yerawada Ghole Rd Bibweewadi Warje Karve Nagar Karve Rd Tilak Road Sahakar nagar Lohgaon Airport KC Bhavani peth AFP Reporting Unit - PMC Dhole Patil V wada 76 62 90 80 36 70 79 57 56 60 59 73 63 65 67 71 68 64 61 74 82 78 58 81 75 66 72 77 69 83 49 54 52 53 50 51 55 48 Total Reporting Unit - 39
  63. 63. Aundh Kasba peth PC Hadapsar Sangamwadi Yerawada Ghole Rd Bibweewadi Warje Karve Nagar Karve Rd Tilak Road Sahakar nagar Lohgaon Airport KC Bhavani peth AFP Informer - PMC Dhole Patil V wada 76 62 90 80 36 70 152 57 151 60 150 116 117 115 67 71 68 180 198 144 179 83 184 182 116 181 173 183 114 113 124 122 118 119 123 121 120 200 199 185 201 202 132 205 197 147 146 145 70148 196 167 166 165 164 105 168 195 174 170 169 171 177 178 Total Informers Unit - 141
  64. 64. Aundh Kasba peth PC Hadapsar Sangamwadi Yerawada Ghole Road Bibweewadi Warje Karve Nagar Karve Rd Tilak Road Sahakar nagar Lohgaon Airport KC Bhavani peth AFP CASES YEAR – 2001 - PMC Dhole Patil V wada AFP Case 06 Compatible Case 00 Hot Case 00 Wild Case 00 MH-PNA- 01-029 MH-PNA-01-046, MH-PNA-01- 041,045 PMC 06 OTHER DISTRICTS 14 TOTAL CASES 20 MH-PNA-01-015 MH-PNA-01-025
  65. 65. Aundh Kasba peth PC Hadapsar Sangamwadi Yerawada Ghole Road Bibweewadi Warje Karve Nagar Karve Rd Tilak Road Sahakar nagar Lohgaon Airport KC Bhavani peth AFP CASES YEAR – 2002 - PMC Dhole Patil V wada AFP Case 13 Compatible Case 00 Hot Case 00 Wild Case 00 MH-PNA-02-004,012 t MH-PNA-02-011 MH-Bmc-02-073,PNA-044 MH-PNA-02- 033,034,035,021,019 MH-PNA-02-013 PMC 13 OTHER DISTRICTS 19 TOTAL CASES 32 MH-PNA-02-026 MH-PNA-02-038
  66. 66. Aundh Kasba peth PC Hadapsar Sangamwadi Yerawada Ghole Road Bibweewadi Warje Karve Nagar Karve Rd Tilak Road Sahakar nagar Lohgaon Airport KC Bhavani peth AFP CASES YEAR – 2003 - PMC Dhole Patil V wada AFP Case 09 Compatible Case 00 Hot Case 00 Wild Case 00 MH-PNA-03-043,052Updated upto wk 38th MH-PNA- 03-58 MH-PNA-03- 027,031,034,007 MH-PNA-03-026 PMC 09 OTHER DISTRICTS 30 TOTAL CASES 39 MH-PNA-03-041
  67. 67. Aundh Kasba peth PC Hadapsar Sangamwadi Yerawada Ghole Road Bibweewadi Warje Karve Nagar Karve Rd Tilak Road Sahakar nagar Lohgaon Airport KC Bhavani peth AFP CASES YEAR – 2004 - PMC Dhole Patil V wada AFP Case 15 Compatible Case 00 Hot Case 00 Wild Case 00 MH-PNA-04-205 MH-PNA-04- 016,213 MH-PNA-04-008,009 MH-PNA-04-013,202,215 MH-PNA-04-014, MH-PNA-04-507 PMC 15 OTHER DISTRICTS 31 TOTAL CASES 46 MH-PNA-04-025 MH-PNA-04-005,217 MH-PNA-04-201 MH-PNA-04-216
  68. 68. Aundh Kasba peth PC Hadapsar Sangamwadi Yerawada Ghole Road Bibweewadi Warje Karve Nagar Karve Rd Tilak Road Sahakar nagar Lohgaon Airport KC Bhavani peth AFP CASES YEAR – 2005 - PMC Dhole Patil V wada AFP Case 23 Compatible Case 00 Hot Case 00 Wild Case 00 MH-PNA-05-117,128 MH-PNA-05-105,131,134 MH-PNA-05- 107,111,115 MH-PNA-05-124,127,135 MH-PNA-05-149 MH-PNA-05-114,118 MH-PNA-05-119 PMC 23 OTHER DISTRICTS 32 TOTAL PUNE 55 MH-PNA-05-109 MH-PNA-05-107,108,146,153 MH-PNA-05-150 MH-PNA-05- 148 MH-PNA-05- 137
  69. 69. Aundh Kasba peth PC Hadapsar Sangamwadi Yerawada Ghole Road Bibweewadi Warje Karve Nagar Karve Rd Tilak Road Sahakar nagar Lohgaon Airport KC Bhavani peth AFP CASES YEAR – 2006 - PMC Dhole Patil V wada AFP Case 26 Compatible Case 00 Hot Case 00 Wild Case 00 MH-PNA-06- 101,109,133,162 MH-PNA-06-129 MH-PNA-06- 136,151 MH-PNA-06-007,122 MH-PNA-06- 137,141,143,144,149,150 MH-PNA-06-145 PMC 26 OTHER DISTRICTS 39 TOTAL PUNE 65 MH-PNA-06-121,160,161 MH-PNA-06- 118,126,127,146, 153 MH-PNA-06- 108,155
  70. 70. Aundh Kasba peth PC Hadapsar Sangamwadi Yerawada Ghole Road Bibweewadi Warje Karve Nagar Karve Rd Tilak Road Sahakar nagar Lohgaon Airport KC Bhavani peth AFP CASES YEAR – 2007 - PMC Dhole Patil V wada AFP Cases 24 Compatible Case 00 Hot Case 00 Wild Case 00 MH-PNA-07- 109,114,117,160,172 MH-PNA-07-123,,142 MH-PNA- 07-111 MH-PNA-07-140 MH-PNA-07-134 MH-PNA-07- 103,115,139,147 MH-PNA-07- 107,121,137 PMC 24 OTHER DISTRICTS 49 TOTAL CASES 73 MH-PNA-113,135,151 MH-PNA-07-129,211 MH-PNA-07- 152,171
  71. 71. Aundh Kasba peth PC Hadapsar Sangamwadi Yerawada Ghole Road Bibweewadi Warje Karve Nagar Karve Rd Tilak Road Sahakar nagar Lohgaon Airport KC Bhavani peth AFP CASES YEAR – 2008 - PMC Dhole Patil Dhan AFP Cases 21 Compatible Case 00 Hot Case 00 Wild Case 00 MH-PNA-08- 111,118,153 MH-PNA-08-155 MH-PNA- 08-141 MH-PNA-08- 122,142 MH-PNA-08- 112,130,139 MH-PNA-08-136 PMC 21 OTHER DISTRICTS 36 TOTAL CASES 57 MH-PNA-08-147 MH-PNA-08- 107,109,157 MH-PNA- 08-114 MH-PNA-08-104,105,138,144,146 Dhankawadi 05 cases
  72. 72. Aundh Kasba Vishram PC Hadapsar Sangamwadi Yerawada Ghole Road Bibweewadi Warje Karve Nagar Karve Rd Tilak Road Sahakar nagar Lohgaon Airport KC Bhavani peth AFP CASES YEAR – 2009 – PMC Dhole Patil Dhan AFP Cases 76 Compatible Case 00 Hot Case 00 Wild Case 00 MH-PNA-09-129,139 165,169 MH-PNA-09- 101,115, MH-PNA-09-132, MH-PNA-09- 124,125,130,151,157,176 MH-PNA-09-105,113 162,168,172 PMC 31 OTHER DISTRICTS 45 TOTAL CASES 76 MH-PNA-09-102,107,146,133 IND-BI-KTH-09-087 MH-PNA-09-103,160 MH-PNA-09- 148,140 MH-PNA-09-156 MH-PNA-09-141 MH-PNA-09-171 MH-SLR- 09-016,
  73. 73. Aundh Kasba Vishram PC Hadapsar Sangamwadi Yerawada Ghole Road Bibweewadi Warje Karve Nagar Karve Rd Tilak Road Sahakar nagar Lohgaon Airport KC Bhavani peth AFP CASES YEAR – 2010 – PMC UPTO 29TH WEEK Dhole Patil Dhan AFP Cases 38 Compatible Case 00 Hot Case 01 Wild Case 00 MH-PNA-10-103 MH-PNA- 10-001 PMC 11+3 =15 OTHER DISTRICTS 23 TOTAL CASES 38 MH-PNA-10- 109,136,138 MH-PNA-10-112 MH-SLR-10-108 MH-PNA-10-133 MH-PNA-10-102 MH-PNA-10-114 120,KA-BEL-10- 008 MH-PNA-10- 118, MH-PNA-10-105 MH-PNA-124 MH-PNA-10-137
  74. 74. Expectations from General Practioners Routine Immunization Services AFP Surveillance
  75. 75. Expectation from GP’s • Immunization – 1. Insist for Zero dose OPV 2. Routine immunization 3. Pulse polio immunization 4. Observing VVM during all immunization activities (to train nursing staff – for VVM & cold chain)
  76. 76. Expectation from GP’s  Surveillance – 1. Report AFP case immediately – Just telephone – 9689931339 / 9822912062 / 24487700 Dr. Sunil A. Tore 2. To give information of AFP case – whenever phone calls from WHO or PMC office 3. An issue of reporting of referred case to neurologist for EMG/NCV in Pune.
  77. 77. Expectation from Paediatrians An issue of reporting of referred case to neurologist for EMG/NCV in Pune Should neurologist & EMG / NCV Labs also report this cases to PMC An ethical issue
  78. 78. AFP Surveillance is in the end the only indicator for success
  79. 79. Cold Chain
  80. 80. OPV: unstable, but more stable than before and it can be monitored Vaccine Vial Monitor (VVM) 1 = good OPV 2 = good OPV 3 = bad OPV 4 = bad OPV
  81. 81. Vaccine Vial Monitor (VVM) The square is lighter than the circle. If the expiry date is not passed, use the vaccine The square colour changes but lighter than the outer circle. If the expiry date is not passed, use the vaccine The square matches the circle. Do not use the vaccine. Inform your supervisor The square is darker than the circle. Do not use the vaccine. Inform your supervisor
  82. 82. Thermal Characteristics of the Vaccine OPV, Measles. : Heat Sensitive Vaccine DPT, DT, TT. : Freeze Sensitive Vaccine BCG : Light Sensitive VaccineRecommended Temperature for Storage of OPV & Measles Vaccine Level Temperature Storage Time Central Storage -200 C (-150 C to –250 C) 8 Months State/ District Storage -200 C (-150 C to –250 C) 3 months PHC/Dispensary/Nursing Home +20 C to +80 C 1 Months Transport +20 C to +80 C 1 week
  83. 83. Routine immunization  Plan of routine immunization for out reach areas  Ward wise out reach sessions planned  Provision of giving vaccine to private practitioner
  84. 84. mOPV1 Effects • Humoral immunity: – Circulating antibodies will prevent paralytic disease (individual protection) • Mucosal immunity: – Secretory antibodies will prevent replication and excretion (community barrier to transmission) • Rationale for mOPV1 effectiveness: – No interference from Sabin types 2 & 3 – In tOPV, type 2 most immunogenic, will outgrow types 1+3
  85. 85. REPORT EVERY CASE OF AFP • REPORT TO • Dr.SUNIL TORE • IMMUNIZATION OFFICER • PUNE MUNICIPAL CORPORATION • CONTACT NO. • 9689931339 • 9822912062 • 020-24487700

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