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AFP surveillance

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

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

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    AFP surveillance AFP surveillance Presentation Transcript

    • AFP Surveillance
      Date : 20.08.2010
      Dr. Sunil A. ToreM.B.B.S., D.P.H.,D.H.A., M.I.P.H.A.
      Immunization Officer, Pune Municipal Corporation
    • Current scenario of Polio
    • WORLD - WILD POLIO VIRUS CASES - 2010
      577 CASES IN 15 COUNTRIES
      Tajikistan
      Mali
      Afghanistan
      Chad
      Pakistan
      Mauritania
      Niger
      Nepal
      Senegal
      Sierra Leone
      Nigeria
      India
      Cameroun
      Angola
      DRC
      Liberia
      * data as on 27th Jul 2010
    • Polio cases, India
      P1 wild
      P3 wild
      * data as on 30 Jul 2010
    • Location of poliovirus by type, 2010*
      Most recent virus
      14 June 2010
      Murshidabad, West Bengal
      * data as on 30 Jul 2010
    • Genetic linkages of WPV1 cases, 2010*
      Genetically related to an imported Sept 2009 strain in Ludhiana district of Punjab
      Genetically related to June 2009 strain in Saharsa district of Bihar
      Genetically related to June 2009 strain in Khagaria district of Bihar
      * data as on 3 July 2010
      * data as on 30 Jul 2010
    • Location of poliovirus by type, 2009
      ** One case reported mixture of P1 wild & P3 wild
    • Polio cases of type 1, India
      Year
      * data as on 30 Jul 2010
    • Weekly incidence of WPV1 cases, India, 2009 – 10
      Jan
      Feb
      Mar
      Apr
      May
      Jun
      Jul
      Aug
      Sep
      Oct
      Nov
      Dec
      Jan
      Feb
      Mar
      Apr
      May
      Jun
      2009
      2010*
      * data as on 30 Jul 2010
    • Area of m OPV1
      mOPV1
      tOPV
    • WPV1 Polio cases, India
      Jan 10
      Feb 10
      Mar 10
      N=2
      N=1
      N=0
      Apr 10
      May 10
      Jun 10
      N=1
      N=2
      N=1
      * data as on 30 Jul 2010
    • Weekly incidence of WPV1 cases, Uttar Pradesh, 2009 – 10
      Jan
      Feb
      Mar
      Apr
      May
      Jun
      Jul
      Aug
      Sep
      Oct
      Nov
      Dec
      Jan
      Feb
      Mar
      Apr
      May
      Jun
      2009
      2010*
      * data as on 30 Jul 2010
    • Weekly incidence of WPV1 cases, Bihar, 2009 – 10
      Jan
      Feb
      Mar
      Apr
      May
      Jun
      Jul
      Aug
      Sep
      Oct
      Nov
      Dec
      Jan
      Feb
      Mar
      Apr
      May
      Jun
      2009
      2010*
      * data as on 30 Jul 2010
    • Polio cases of type 3, India
      Year
      * data as on 30 Jul 2010
    • Weekly incidence of WPV3 cases, India, 2009 – 10
      Jan
      Feb
      Mar
      Apr
      May
      Jun
      Jul
      Aug
      Sep
      Oct
      Nov
      Dec
      Jan
      Feb
      Mar
      Apr
      May
      Jun
      2009
      2010*
      * data as on 30 Jul 2010
    • WPV3 Polio cases, India
      Jan 10
      Feb 10
      Mar 10
      N=14
      N=2
      N=0
      Apr 10
      May 10
      Jun 10
      N=1
      N=0
      N=1
      * data as on 30 Jul 2010
    • Weekly incidence of WPV3 cases, Uttar Pradesh, 2009 – 10
      Jan
      Feb
      Mar
      Apr
      May
      Jun
      Jul
      Aug
      Sep
      Oct
      Nov
      Dec
      Jan
      Feb
      Mar
      Apr
      May
      Jun
      2010*
      2009
      * data as on 30 Jul 2010
    • Weekly incidence of WPV3 cases, Bihar, 2009 – 10
      Jan
      Feb
      Mar
      Apr
      May
      Jun
      Jul
      Aug
      Sep
      Oct
      Nov
      Dec
      Jan
      Feb
      Mar
      Apr
      May
      Jun
      2009
      2010*
      * data as on 30 Jul 2010
    • MAHARASHTRA – 2010
      Wild cases
      P1 Wild Case
      Idcode Donset
      MH-NSK-10-201 10/01/2010
    • Spot map of AFP cases
      Total Resident AFP cases - 1193
      * As of Week 29, 2010
    • AFP Rate
      Less than 0.69
      0.70 to 0.99
      1 to 1.99
      2 & Above
      MH– 5.57 %
      No data
      * As of Week 29, 2010
    • POLIO ERADICATION MILESTONES
      1988 WHA RESOLUTION
      2000 STOP VIRUS
      TRANSMISSION
      2005 CERTIFY GLOBAL
      ERADICATION
      2005/10 STOP POLIO
      IMMUNIZATION
    • Areas with Active Polio Transmission
      1988
      350 000 cases
      125 countries
    • POLIO ERADICATIONSTRATEGIES
      BASED ON DISEASE KNOWLEDGE
      POTENT VACCINE .
      EFFECTIVE METHODS FOR THE CONTROL OF POLIO.
    • 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.
      .
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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
    • FOUR KEY STRATEGIES FOR POLIO ERADICATION
      RI-PROGRAMME [ UIP ] - 1985
      MASS IMMUNIZATION(PPI) – 1995-96 CAMPAIGNS
      APF SURVEILLANCE - 1997
      MOPING UP IN FOCAL AREAS
    • 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 .
    • WHAT IS SURVEILLANCE ?
      IT IS A CONTINOUS SCRUTINY OF ALL ASPECTS OF OCCURRENCE & SPREAD OF DISEASE THAT ARE PERTINENT TO EFFECTIVE CONTROL.
      IT INCLUDES
      COLLECTION OF DATA
      ANALYSIS OF DATA
      INTERPRETATION OF DATA
      DISTRIBUTION OF RELEVANT DATA SO THAT NECESSARY ACTION CAN BE TAKEN
    • 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 ]
    • 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.
    • 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.-----
    • 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
    • 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
    • The AFP Surveillance System
      Community
      Hospitals
      Clinics
      Investigation
      Polio AFP
      Non-Polio AFP
    • Causes of AFP
      Poliomyelitis
      Gullain Barre Syndrome
      Traumatic neuritis
      Transverse Myelitis
      Any other flaccid/lower motor presentation
    • 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
    • When too much polio is around…..
      Surveillance sensitivity is adequate enough to detect 90% polio cases
      AFP cases
      Polio cases
      Borderline AFP cases
      Non-AFP cases
    • Adequacy of surveillance
      Programme Monitoring indicators
      1. Non polio AFP rate
      2. Adequate stool specimen collection
    • 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
    • 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
    • Non Polio AFP Rate
      Non polio AFP rate = Reported AFP cases
      Expected AFP cases
      e.g. In PMC = 10
      10
      = 1
      = 23
      10
      = 2.3
      This rate should be more then 2.
    • 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
    • WHAT TO REPORT
      Any Case of Acute Flaccid Paralysis < 15 Yrs age
      It May be Monoplegia,Paraplegia,Hemiplegia,Facial Palsy,or Any Trasient weakness.
      Any case of Suspected Polio Clinically
      Irrespective of any age
    • AFP SURVEILLANCE
      STEPSFOR EACH AFP CASE
      CASE INVESTIGATION
      2 STOOL SPECIMENS,COLLECTED 24 HOURS APART,AND WITHIN 14 DAYS OF ONSET OF PARALYSIS
      SENT FOR CULTURES TO LAB TO ISOLATE POLIO VIRUS
      ORI ACTIVITY & SEARCH FOR MORE AFP CASES IN THE AREA
      60 DAYS FOLLOW-UP EXAMINATION AFTER ONSET.
    • 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
    • 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
    • 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
    • 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
    • 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.
    •  
      Appendix 5 :
      Flow diagram of case investigation,
      stool specimen collection and
      outbreak response immunization
      Onset of paralysis
      ≤ 7 Days
      Investigation of suspected case
      (≤48 hours of report)
      2 stool specimens collected (≤14 days since onset of paralysis)
      24 hours apart
      Poliovirus isolates send to regional reference laboratory for intratypic differentiation
      Specimens arrive at national laboratory
      Results reported from national laboratory
      ≤ 3 Days
      ≤ 24 Days
      Outbreak response immunization additional case finding
      Final classification of the case by the expert committee (≤ 12 weeks since onset of paralysis)
      60-day follow-up exam
    • WHAT IS NOT AFP ?
      TRAUMA
      ISOLATED FACIAL NERVE PALSY
      HYPOKALAEMIA
      ACUTE RHEUMATIC FEVER
      CONGENITAL FLACCID PARALYSIS
    • CONDITIONS SOMETIMES PRESENTING WITH AFP
      TUMOR
      ENCEPHALITIS
      HYPOKALEMIC PARALYSIS [ DUE TO LOW SERUM POTASSIUM USUALLY REVERSIBLE ]
      POTT’s DISEASE
      TB MENINGITIS
      OSTEOMYELITIS
    • AFP Reporting Network
      Gen. Pract.
      Paediatrician
      Neurologist
      Physician
      Dist. Hospital
      PHC
      RH
      DHO/MOH/SMO
      State
      MPW/ ANM
      Delhi
      Traditional Healer
      WHO
      Quack
    • Data Flow
      Mondays
      Reporting Units Districts
      Districts State
      States NPSU Delhi
      Delhi WHO
      Tuesdays
      Wednesdays
      Thursday
    • Reporting Units
      Reporting units – sending reports weekly regularly
      Informers – whenever AFP case - Informs by phone
    • AFP Reporting Unit - PMC
      Sangamwadi
      Lohgaon Airport
      71
      Yerawada
      67
      KC
      Aundh
      82
      65
      54
      53
      Dhole Patil
      73
      63
      48
      Ghole Rd
      52
      50
      61
      78
      77
      58
      49
      66
      56
      81
      69
      83
      75
      72
      80
      59
      55
      79
      Kasba peth
      PC
      Karve Rd
      57
      74
      70
      62
      60
      36
      76
      Warje Karve Nagar
      Bhavani peth
      Hadapsar
      V wada
      68
      90
      Tilak Road
      Bibweewadi
      64
      Sahakar nagar
      Total Reporting Unit - 39
      51
    • AFP Informer - PMC
      169
      Sangamwadi
      170
      174
      Lohgaon Airport
      168
      195
      71
      178
      Yerawada
      67
      113
      KC
      116
      114
      Aundh
      179
      115
      200
      202
      116
      117
      182
      183
      Dhole Patil
      Ghole Rd
      180
      198
      201
      132
      185
      184
      146
      181
      151
      83
      80
      150
      199
      152
      147
      Kasba peth
      PC
      Karve Rd
      57
      144
      70
      62
      70
      148
      60
      119
      197
      36
      205
      76
      Bhavani peth
      Hadapsar
      Warje Karve Nagar
      V wada
      68
      177
      145
      171
      90
      118
      Tilak Road
      120
      105
      Bibweewadi
      122
      165
      121
      Sahakar nagar
      123
      196
      124
      Total Informers Unit - 141
      173
      166
      167
      164
    • AFP CASES YEAR – 2001 - PMC
      MH-PNA-01-041,045
      Sangamwadi
      MH-PNA-01-025
      Lohgaon Airport
      Yerawada
      KC
      Aundh
      Dhole Patil
      Ghole Road
      MH-PNA-01-046,
      Kasba peth
      PC
      Karve Rd
      MH-PNA-01-029
      Hadapsar
      Bhavani peth
      Warje Karve Nagar
      V wada
      Tilak Road
      Bibweewadi
      Sahakar nagar
      MH-PNA-01-015
    • AFP CASES YEAR – 2002 - PMC
      MH-PNA-02-013
      Sangamwadi
      MH-PNA-02-038
      Lohgaon Airport
      Yerawada
      KC
      Aundh
      MH-PNA-02-004,012
      Dhole Patil
      Ghole Road
      MH-PNA-02-033,034,035,021,019
      Kasba peth
      PC
      Karve Rd
      Hadapsar
      Bhavani peth
      Warje Karve Nagar
      V wada
      MH-PNA-02-011
      Tilak Road
      Bibweewadi
      Sahakar nagar
      MH-PNA-02-026
      MH-Bmc-02-073,PNA-044
      t
    • AFP CASES YEAR – 2003 - PMC
      MH-PNA-03-026
      Sangamwadi
      Lohgaon Airport
      Yerawada
      KC
      Aundh
      Dhole Patil
      Ghole Road
      MH-PNA-03-027,031,034,007
      Kasba peth
      PC
      Karve Rd
      Hadapsar
      Bhavani peth
      Warje Karve Nagar
      V wada
      Tilak Road
      Bibweewadi
      MH-PNA-03-58
      Sahakar nagar
      MH-PNA-03-041
      Updated upto wk 38th
      MH-PNA-03-043,052
    • AFP CASES YEAR – 2004 - PMC
      MH-PNA-04-507
      MH-PNA-04-216
      Sangamwadi
      MH-PNA-04-005,217
      Lohgaon Airport
      Yerawada
      KC
      Aundh
      Dhole Patil
      MH-PNA-04-201
      Ghole Road
      MH-PNA-04-014,
      Kasba peth
      PC
      Karve Rd
      Hadapsar
      Bhavani peth
      Warje Karve Nagar
      V wada
      MH-PNA-04-008,009
      Tilak Road
      MH-PNA-04-016,213
      Bibweewadi
      Sahakar nagar
      MH-PNA-04-025
      MH-PNA-04-013,202,215
      MH-PNA-04-205
    • AFP CASES YEAR – 2005 - PMC
      MH-PNA-05-119
      MH-PNA-05-137
      Sangamwadi
      MH-PNA-05-107,108,146,153
      Lohgaon Airport
      MH-PNA-05-150
      Yerawada
      KC
      Aundh
      MH-PNA-05-117,128
      Dhole Patil
      Ghole Road
      MH-PNA-05-114,118
      Kasba peth
      MH-PNA-05-148
      PC
      Karve Rd
      Hadapsar
      Bhavani peth
      Warje Karve Nagar
      V wada
      MH-PNA-05-124,127,135
      Tilak Road
      MH-PNA-05-107,111,115
      Bibweewadi
      Sahakar nagar
      MH-PNA-05-109
      MH-PNA-05-149
      MH-PNA-05-105,131,134
    • AFP CASES YEAR – 2006 - PMC
      MH-PNA-06-145
      MH-PNA-06-108,155
      Sangamwadi
      MH-PNA-06-121,160,161
      Lohgaon Airport
      Yerawada
      KC
      Aundh
      MH-PNA-06-101,109,133,162
      Dhole Patil
      Ghole Road
      MH-PNA-06-137,141,143,144,149,150
      Kasba peth
      MH-PNA-06-118,126,127,146,153
      PC
      Karve Rd
      Hadapsar
      Bhavani peth
      Warje Karve Nagar
      V wada
      MH-PNA-06-007,122
      Tilak Road
      MH-PNA-06-136,151
      Bibweewadi
      Sahakar nagar
      MH-PNA-06-129
    • AFP CASES YEAR – 2007 - PMC
      MH-PNA-07-107,121,137
      Sangamwadi
      MH-PNA-07-129,211
      Lohgaon Airport
      MH-PNA-07-152,171
      Yerawada
      KC
      Aundh
      MH-PNA-07-109,114,117,160,172
      Dhole Patil
      Ghole Road
      MH-PNA-07-103,115,139,147
      Kasba peth
      PC
      Karve Rd
      Hadapsar
      Bhavani peth
      Warje Karve Nagar
      V wada
      MH-PNA-07-140
      Tilak Road
      Bibweewadi
      MH-PNA-07-111
      Sahakar nagar
      MH-PNA-113,135,151
      MH-PNA-07-134
      MH-PNA-07-123,,142
    • AFP CASES YEAR – 2008 - PMC
      MH-PNA-08-136
      MH-PNA-08-104,105,138,144,146
      Dhankawadi 05 cases
      Sangamwadi
      MH-PNA-08-107,109,157
      Lohgaon Airport
      Yerawada
      KC
      Aundh
      MH-PNA-08-111,118,153
      Dhole Patil
      Ghole Road
      MH-PNA-08-112,130,139
      Kasba peth
      PC
      Karve Rd
      MH-PNA-08-114
      Hadapsar
      Bhavani peth
      MH-PNA-08-122,142
      Warje Karve Nagar
      Dhan
      Tilak Road
      Bibweewadi
      MH-PNA-08-141
      Sahakar nagar
      MH-PNA-08-147
      MH-PNA-08-155
    • AFP CASES YEAR – 2009 – PMC
      MH-PNA-09-171
      Sangamwadi
      MH-PNA-09-102,107,146,133
      IND-BI-KTH-09-087
      Lohgaon Airport
      MH-PNA-09-103,160
      Yerawada
      KC
      Aundh
      Dhole Patil
      Ghole Road
      MH-PNA-09-129,139
      165,169
      MH-PNA-09-
      148,140
      MH-PNA-09-105,113
      162,168,172
      Kasba Vishram
      PC
      Karve Rd
      Hadapsar
      Bhavani peth
      MH-SLR-09-016,
      Warje Karve Nagar
      Dhan
      MH-PNA-09-132,
      Tilak Road
      MH-PNA-09-101,115,
      Bibweewadi
      MH-PNA-09-156
      Sahakar nagar
      MH-PNA-09-124,125,130,151,157,176
      MH-PNA-09-141
    • AFP CASES YEAR – 2010 – PMC UPTO 29TH WEEK
      MH-PNA-10-137
      Sangamwadi
      Lohgaon Airport
      MH-PNA-124
      MH-PNA-10-114
      120,KA-BEL-10-008
      Yerawada
      KC
      Aundh
      MH-PNA-10-112
      MH-SLR-10-108
      MH-PNA-10-133
      Dhole Patil
      Ghole Road
      MH-PNA-10-118,
      Kasba Vishram
      PC
      Karve Rd
      MH-PNA-10-102
      Hadapsar
      Bhavani peth
      Warje Karve Nagar
      Dhan
      MH-PNA-10-103
      Tilak Road
      MH-PNA-10-109,136,138
      Bibweewadi
      Sahakar nagar
      MH-PNA-10-105
      MH-PNA-10-001
    • Expectations from General Practioners
      Routine Immunization
      Services
      AFP Surveillance
    • Expectation from GP’s
      Immunization –
      Insist for Zero dose OPV
      Routine immunization
      Pulse polio immunization
      Observing VVM during all immunization activities
      (to train nursing staff – for VVM & cold chain)
    • Expectation from GP’s
      Surveillance –
      Report AFP case immediately – Just telephone – 9689931339 / 9822912062 / 24487700 Dr. Sunil A. Tore
      To give information of AFP case –whenever phone calls from WHO or PMC office
      An issue of reporting of referred case to neurologist for EMG/NCV in Pune.
    • 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
    • AFP Surveillance is in the end
      the only indicator for success
    • Cold Chain
    • 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
      Thermal Characteristics of the Vaccine
         
      OPV, Measles. : Heat Sensitive Vaccine
      DPT, DT, TT. : Freeze Sensitive Vaccine
      BCG : Light Sensitive Vaccine
      Recommended Temperature for Storage of
      OPV & Measles Vaccine
       
       
       
       
    • Routine immunization
      Plan of routine immunization for out reach areas
      Ward wise out reach sessions planned
      Provision of giving vaccine to private practitioner
    • 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
    • REPORT EVERY CASE OF AFP
      REPORT TO
      Dr.SUNIL TORE
      IMMUNIZATION OFFICER
      PUNE MUNICIPAL CORPORATION
      CONTACT NO.
      9689931339
      9822912062
      020-24487700
    • LET's work for the Community
      Thankyou