AFP surveillance for prevention from Polio , its need and importance .

1. “Building a fairer, healthier world”
Acute Flaccid Paralysis An Overview
including its surveillance
Dr Rishabh Kumar Rana , MBBS ,MD
Assistant Professor , Department of Community Medicine , SNMMCH Dhanbad
Jharkhand India .
https://www.drrishabhkumarrana.com

2. Keep India Polio- Free
Need optimum AFP Surveillance

4. AFP- Case Definition
Sudden onset weakness and
floppiness in any part of the
body in a child < 15 years of
age or paralysis in a person of
any age in which polio is
suspected.

5. Differential Diagnosis for AFP
» In general, in the absence of wild virus-induced
poliomyelitis, Guillain-Barré syndrome
accounts for 50% or more of the cases of AFP
in industrialized countries such as the United
Kingdom and Australia, and in developing
countries in
Plotkins 7th Ed Chapter 49 sec 2 p872

9. Left Leg
weakness Foot Drop

10. Right leg
weakness

11. Neck Flop Truncal weakness

12. Facial Palsy

13. All are AFP cases….
• GBS of any variety
• Transverse myelitis,
• Post - Diphtheric
polyneuritis,
• Isolated bulbar paralysis,
• Isolated neck paralysis
• Isolated lower motor
neuron type of Facial palsy
[Bells palsy]
• Nasal voice/regurgitation
• Viral neuritis,
• Traumatic neuritis,
• Post-injection
paralysis/paresis
• Flaccid
hemiplegia/paraplegia/Quad
riplegia of lower motor
neuron type
• Wrist/foot drop etc.
• Weakness arising because of
electrolyte imbalance

14. Response to an AFP case
• Information to SMO/DIO (Immediate notification)
• Case investigation
• Stool specimen collection
• Active case search in community
• Sensitize health facilities that missed the case (if
any)

15. Notification (Information) of the
case
• When: Immediate
• How: by the fastest means preferably telephonically or personal
messenger
• To: SMO/DIO/nodal person

16. Case Investigation
• Should happen for every case of AFP that
gets notified
• By designated Medical Officer
• CIF to be filled completely for all reported
cases: AFP or Rejected
• CIF to be sent to SMO/DIO within 24 hrs of
investigation (if case investigated by nodal
officer)

17. Stool specimen collection
• As soon as possible – should not wait for
case investigation
• Up to 2 months of onset of paralysis
• 2 specimens at least 24 hrs apart
• Maintain cold chain during storage/shipment
of stool samples

18. Support in Active case search in Medical college
• Authenticated report of VPD H003A by Nodal person through
Hard copy/mail by each Medical college on weekly basis

19. What should be done to ensure all completeness of AFP case reporting?
All cases of acute flaccid
paralysis should be
reported ‘irrespective of
diagnosis’ within 6
months of onset

22. What is needed
INFORMATION ON THE AFP CASE :
• Name of the Patient
• Age of the Patient (Date of Birth)
• Sex (M/F)
• Father’s Name & Grand Father’s Name
• Village, PO, PS, Block Name, District Name,
Nearest Landmark
• Date of Onset - Weakness Since When?
• Part(s) affected by Paralysis/ Weakness
WHO-, Patna Unit

23. Rukhsar Khatoon last case of WPV
detected in India (Jan 2011), her
mother Shabida Bibi in Shahapar
village, WB