AFP surveillance

  • Definition: Acute flaccid paralysis (AFP) is defined as sudden onset of 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 whom polio is suspected.


  • Differential diagnosis:
    1. Polio
    2. Vaccine associated paralytic polio (VAPP)
    3. Guillain-Barre syndrome
    4. Transverse myelitis
    5. Traumatic neuritis.


  • Background rate of AFP:
    • In India, where the incidence of conditions such as traumatic neuritis and AFP caused by other non-polio enteroviruses is very high, the background non-polio AFP rate is undoubtedly much higher.
    • For this reason, the operational target of non-polio AFP case detection in India has been set to 2/1,00,000.


  • Sample collection:
    • Two stool specimens must be collected from every AFP case
    • Stool specimens must be collected within 14 days of onset of paralysis to maximize the chances of isolating poliovirus
    • In case samples cannot be collected within 14 days, the specimens should still be collected up to 60 days of onset of paralysis.


  • Outbreak response immunization (ORI):
    • After the AFP case investigation and stool specimen collection, ORI is organized in the community and performed as soon as possible
    • Usually 500 children below 5 years of age from the locality/village of the AFP case are covered under ORI.


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