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

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. Current scenario of
Polio

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. 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. 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. 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. 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. 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. 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. Area of m OPV1
mOPV1
tOPV

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. 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. 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. 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. 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. 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. 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. 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. MAHARASHTRA – 2010
Wild cases
MH-NSK-10-201 10/01/2010
P1 Wild Case
Idcode Donset

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. 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. POLIO ERADICATION
MILESTONES
1988 WHA RESOLUTION
2000 STOP VIRUS
TRANSMISSION
2005 CERTIFY GLOBAL
ERADICATION
2005/10 STOP POLIO
IMMUNIZATION

23. 1988
350 000 cases
125 countries
Areas with Active Polio Transmission

24. POLIO ERADICATION STRATEGIES
 BASED ON DISEASE KNOWLEDGE
 POTENT VACCINE .
 EFFECTIVE METHODS FOR THE
CONTROL OF POLIO.

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

41. Causes of AFP
• Poliomyelitis
• Gullain Barre Syndrome
• Traumatic neuritis
• Transverse Myelitis
• Any other flaccid/lower motor
presentation

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. 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. Adequacy of surveillance
• Programme Monitoring indicators
1. Non polio AFP rate
2. Adequate stool specimen collection

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

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

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. Data Flow
Reporting Units Districts
Districts State
States NPSU Delh
Delhi WHO
Mondays
Tuesdays
Wednesdays
Thursday

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Expectations from General
Practioners
Routine
Immunization
Services
AFP
Surveillance

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. 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. 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. AFP Surveillance is in the end
the only indicator for success

79. Cold Chain

81. 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

82. 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

83. 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

84. Routine immunization
 Plan of routine immunization for out reach
areas
 Ward wise out reach sessions planned
 Provision of giving vaccine to private
practitioner

85. 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

86. REPORT EVERY CASE OF AFP
• REPORT TO
• Dr.SUNIL TORE
• IMMUNIZATION OFFICER
• PUNE MUNICIPAL CORPORATION
• CONTACT NO.
• 9689931339
• 9822912062
• 020-24487700