Information about Acute Flaccid Paralysis surveillance for Polio Control in India

1. Surveillance
For
ACUTE FLACCID
PARALYSIS
--Rtn. P.P.Dr.Avinash Bhondwe

2. DEFINITION :
Sudden onset of
weakness of a limb or paralysis
over a period of 15 days
in a patient less 15 years of age .
A.F.P.

3. WHAT IS SURVEILLANCE ?
 IT IS A CONTINOUS SCRUTINY
 OF ALL ASPECTS OF OCCURRENCE & SPREAD
OF DISEASE
 THAT ARE PERTINENT TO EFFECTIVE
CONTROL.
 SURVEILLANCE 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

4. 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.

5. FOUR KEY STRATEGIES FOR POLIO
ERADICATION
 RI-PROGRAMME [ UIP ] - 1985
 MASS IMMUNIZATION(PPI) – 1995-96
CAMPAIGNS
 APF SURVEILLANCE - 1997
 MOPING UP IN FOCAL AREAS

6. 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 ]

7. 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.

8. 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.-----

9. 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

10. The AFP Surveillance System
Hospitals
Clinics
Investigation
Non-Polio AFP Polio AFP
Community

11. When to report AFP case
 Immediately ( Just one phone call)
9689931339 / 9822912062 /
24487700

12. 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

13. WHAT IS NOT AFP ?
 TRAUMA
 ISOLATED FACIAL NERVE PALSY
 HYPOKALAEMIA
 ACUTE RHEUMATIC FEVER
 CONGENITAL FLACCID PARALYSIS

14. CONDITIONS SOMETIMES
PRESENTING WITH AFP
 TUMOR
 ENCEPHALITIS
 HYPOKALEMIC PARALYSIS [ DUE TO LOW
SERUM POTASSIUM USUALLY REVERSIBLE ]
 POTT’s DISEASE
 TB MENINGITIS
 OSTEOMYELITIS