POLIO ERADICATION AND ACUTE FLACCID PARALYSIS SURVEILLANCE

Although there has been no confirmed wild poliomyelitis case in Australia for many years, Australia, along with most countries of the World Health Organization's Western Pacific Region has agreed to carry out Acute Flaccid Paralysis (AFP) surveillance as part of the initiative to declare the world polio free by the year 2000.

A highly sensitive surveillance system for AFP will ensure that every possible case of poliomyelitis is detected, investigated and classified. This is critical for the successful eradication of polio.

A number of indicators have been established to monitor the performance of AFP surveillance systems. Most importantly, even in the absence of wild poliovirus circulation, surveillance systems should be capable of detecting at least one case of AFP per 100,000 population aged less than 15 years.

Several countries in the Western Pacific Region have moved from a clinical to a virological case definition for AFP cases. Before this can occur in Australia, adequate stool samples must be collected from at least 80% of all cases and cultured for poliovirus. "Adequate stool samples" have been defined by WHO as two samples of stool taken at least 24 hours apart, within 14 days of onset of paralysis and transported appropriately to the laboratory, with adequate documentation.

When we use a clinical case definition, many cases are mis-classified as "poliovirus compatible" because "residual paralysis" is found at the 60 day follow-up examination. If adequate stool samples had been found negative for wild poliovirus, these could have been discarded as "not polio".

The expected rate of notifications was achieved in the first year of the active AFP surveillance through the Australian Paediatric Surveillance Unit (APSU). However, the level of reporting declined to 0.7 cases per 100,000 in 1996. In addition, the proportion of adequate stool samples being taken within 14 days was only 26%.

If recommended reporting is not adhered to, WHO standards will not be met for certification. All cases with incomplete information (i.e. no clinical information received via questionnaires, or stool samples not tested adequately) will have to be considered "polio compatible" by the expert committee that reviews each notification.

Australia has a key role to play in the Western Pacific Region in contributing to protection from polio in the region, and in maintaining high public health standards. Therefore, for Australia to be certified polio free, it is requested of all medical personnel to phone in notifications of all cases of AFP and not only those where polio could be a possibility. Notifications should be directed to Dr Rennie D'Souza when a child is admitted to hospital, on telephone number 02-6289-8847. Secondly, please ensure that stool specimens are collected and forwarded to the National Polio Reference Laboratory, and that all cases of AFP are reported to the APSU and that completed questionnaires are returned.

National Certification Committee for Poliomyelitis Eradication
Professor John MacKenzie	Professor Charles Watson (Chair)	Dr Paul Darveniza
Virologist	President	Neurologist
Department of Microbiology University of Queensland	Faculty of Public Health Medicine c/o Curtin University of Technology	St Vincent's Clinic Sydney

Procedure for Notification of a Case of Acute Flaccid Paralysis

Identify an AFP CASE

Immediately phone Dr Rennie D'Souza at NCDC on 02 6289 8847 when a child is admitted to hospital.

Order 2 stool specimens 24 hours apart within 14 days of onset of illness and send it to your local laboratory.

Your laboratory will contact the National Polio Laboratory - Mrs Margery Kennett at 03 9280 2397 for information regarding collection, storage and transportation of stools in which poliovirus is isolated.

Monthly reporting AFP on APSU cards.

Keep a record of the case you have notified to APSU so that you can identify his/her record when NCDC sends you a questionnaire requesting clinical and laboratory information.

from Commonwealth Department of Health and Family Services