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

Current scenario of Polio

Cameroun

WORLD - WILD POLIO VIRUS CASES - 2010577 CASES IN 15 COUNTRIES

Pakistan

Afghanistan

CountriesWild 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

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

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 virus14 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

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

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

1735

397

139212

1487

203127

62

648

83 75 807

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

0

1

2

3

4

5

6

7

8

9

10

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

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

Area of m OPV1

mOPV1

tOPV

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

0

1

2

3

4

5

6

7

8

9

10

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

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

0

1

2

3

4

5

6

7

8

9

10

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

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

190

127

59

116

22 7 428

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

0

5

10

15

20

25

30

35

40

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

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

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

0

5

10

15

20

25

30

35

40

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

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

0

5

10

15

20

25

30

35

40

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

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

MAHARASHTRA – 2010Wild cases

MH-NSK-10-201 10/01/2010

P1 Wild Case

Idcode Donset

Spot map of AFP cases

Total Resident AFP cases - 1193

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ANG

SLR

PNA

NSK YTL

GDL

JLG AMT

STR

BED NDD

BLD

CPRABD

THN

NGP

JLN

KLP

SNGRTG

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 - 2010577 CASES IN 15 COUNTRIES

Pakistan

Afghanistan

CountriesWild 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

AFP Rate

Less than 0.69

2 & Above

0.70 to 0.99

1 to 1.99

No data MH– 5.57 %

ANG

SLR

PNA

NSK YTL

GDL

JLG AMT

STR

BED NDD

BLD

CPRABD

THN

NGP

JLN

KLP

SNGRTG

LTR

DHL

OBD

RGD

PBN

AKL

HIN

WDH

NDB

GNA

SDG

WSM

BND

BMC

* As of Week 29, 2010

POLIO ERADICATION MILESTONES

1988 WHA RESOLUTION

2000 STOP VIRUS

TRANSMISSION

2005 CERTIFY GLOBAL

ERADICATION

2005/10 STOP POLIO

IMMUNIZATION

1988

350 000 cases

125 countries

Areas with Active Polio Transmission

POLIO ERADICATION STRATEGIES

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 INCLUDES1. COLLECTION OF DATA2. ANALYSIS OF DATA3. INTERPRETATION OF DATA4. 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

Hospitals Clinics

Investigation

Non-Polio AFP Polio AFP

Community

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…..

Non-AFP cases

Polio cases

AFP cases

Borderline AFP cases

Surveillance sensitivity is

adequate enough to detect 90% polio 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

2005 = 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

STEPS FOR EACH AFP CASE1. CASE INVESTIGATION2. 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.

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.

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 andoutbreak response immunization

 

≤ 3 Days ≤ 24 Days

≤ 7 Days

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

Traditional Healer

MPW/ ANM

RH

PHC

Quack

DHO/MOH/SMO

State

WHO

Delhi

Data Flow

Reporting Units Districts

Districts State

States NPSU Delhi

Delhi WHO

Mondays

Tuesdays

Wednesdays

Thursday

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

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

7957

56

60

59

73 6365

67

71

68

64

61

74

82

7858

8175

6672

77

69 8349

54

5253

50

51

55

48

Total Reporting Unit - 39

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

15257

151

60

150

116 117115

67

71

68

180198

144

179

83184

182

116

181

173

183

114113

124

122

118

119

123121

120

200

199

185 201

202

132

205197

147

146

145

70148

196

167166

165

164

105

168195

174170 169

171177

178

Total Informers Unit - 141

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

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-02-013PMC 13

OTHER DISTRICTS

19

TOTAL CASES

32

MH-PNA-02-026

MH-PNA-02-038

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

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-04-507PMC 15

OTHER DISTRICTS

31

TOTAL CASES

46

MH-PNA-04-025

MH-PNA-04-005,217

MH-PNA-04-201

MH-PNA-04-216

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-05-119PMC 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

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-06-145PMC 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

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

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-08-136PMC 21

OTHER DISTRICTS

36

TOTAL CASES

57

MH-PNA-08-147

MH-PNA-08-107,109,157

MH-PNA-08-114

MH-PNA-08-104,105,138,144,146Dhankawadi 05 cases

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-09-129,139165,169

MH-PNA-09-101,115,

MH-PNA-09-132,

MH-PNA-09-124,125,130,151,157,176

MH-PNA-09-105,113162,168,172

PMC 31

OTHER DISTRICTS

45

TOTAL CASES

76MH-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,

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-10-112MH-SLR-10-108MH-PNA-10-133

MH-PNA-10-102

MH-PNA-10-114120,KA-BEL-10-

008

MH-PNA-10-118,

MH-PNA-10-105

MH-PNA-124

MH-PNA-10-137

Expectations from General Practioners

Routine Immunization

Services

AFP Surveillance

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)

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.

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

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

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 notpassed, 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

Thermal Characteristics of the Vaccine

   OPV, Measles. : Heat Sensitive

VaccineDPT, DT, TT. : Freeze Sensitive

VaccineBCG : Light Sensitive

Vaccine

   

Recommended 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/NursingHome 

+20 C to +80 C 1 Months

Transport  +20 C to +80 C 1 week

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