WHY INTENSIFY

SURVEILLANCE FOR WE NEED YOUR HELP SURVEILLANCE OF

AFP CASES? ACUTE FLACCID
TO STOP POLIO PARALYSIS (AFP)
On 19 September 2019, the
Department of Health (DOH)
Identify and report ALL
confirmed the re-emergence AFP CASES immediately
of polio in the Philippines and facilitate the collection Guidance for
and declared a national polio
outbreak. As of February 2020, of stool specimens. Health Workers
there have been 17 confirmed
polio cases in the country and
several isolations of the virus in
sewage in Metro Manila and once
in a waterway in Davao. Contact your DSC/AFPSO:
Name:
AFP Surveillance needs to
be heightened to monitor
Phone No:
occurrence of the disease in the
country, as based on the WHO
recommendations.

Moreover, epidemiologic
investigation of confirmed polio
cases is necessary to provide
further information for response
and decision making. Epidemiology Bureau
Department of Health
San Lazaro Compound, Sta. Cruz, Manila
(02) 8651-7800 local 2925, 2926, 2950

 What is Acute Flaccid  WHAT IS MY ROLE AS PHYSICIAN
Paralysis (AFP)? OR NURSE IN THE STRENGTHENING
An AFP case1 is defined as a child < 15 OF AFP SURVEILLANCE?
years of age presenting with recent or
sudden onset of floppy paralysis or muscle
Physicians and nurses on duty shall actively
weakness of any part of the body due to any report any possible AFP case to the hospital
cause
Disease Surveillance Coordinator (DSC).
OR
All AFP cases2 should be immediately
reported so that measures to control the
Any person of any age with paralytic illness possible transmission of the poliovirus can • The DSC/AFPSO should complete
if poliomyelitis is suspected by a clinician. be immediately implemented.
 WHAT DISEASES MAY MANIFEST  WHAT SHOULD BE DONE AFTER • The DSC/AFPSO should report
WITH AFP? DETECTING AN AFP CASE?
• Poliomyelitis • The DSC or the AFP Surveillance Officer
• Guillain-Barre Syndrome (GBS) (AFPSO) should report the case to the
• Myelitis (i.e. Transverse Myelitis) Regional Epidemiology and Surveillance
• Traumatic Neuritis Unit [RESU] / local government unit
1
• Pott’s Disease within 24 hours of detection.
• TB Meningitis
2
• Encephalitis • The DSC, with support from the
• CNS Infection physician and doctor on duty, shall
• Muscle Hypotonia start the collection of stool samples as
• Acute Gastroenteritis with dehydration follows:
• Hypokalemia / Hypokalemic Periodic
Paralysis (HPP) • Collect two stool samples at least
• Other diseases, as long as AFP is 24 hours apart. The amount of stool
manifested should be the size of an adult’s
thumb (5 mL if watery stools)
• Store the samples at 4-8 °C.
• The two stool samples should
be collected within 14 days
of the onset of paralysis if
possible.
If the child comes to the hospital
> 14 days after paralysis onset,
collection of stool specimens from
the case will be the same, but the
DSC/AFPSO should also collect
1 stool specimen from 3 under
5-year-old contacts of the case.
the Case Investigation Form and
send a copy to the laboratory,
along with the stool samples.
weekly to the RESU the number of
AFP cases reported in the facility,
even if there are zero cases.
Updated case definition as of January 2020
An AFP hot case is a case that is
considered highly suspected for polio based
on clinical data and presenting with the
following characteristics:
• Less than 5 years old
• Received less than 3 OPV doses
• Had fever at onset of paralysis
• Has asymmetric paralysis
• Had rapid progression of paralysis
(within 3 days], and/or
• Has been in contact with or living
in area with possible or
recent polio virus
circulation