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Frequently Asked Questions |
| 1 |
By when do we expect polio to
be eradicated from the world? |
| |
We are hoping that within the
next 6 months we will stop the spread of polio in the Indian
Subcontinent including Pakistan. This will depend to a large
extent on having a very good immunization campaign. We are
hoping that the world will be ready for certification as
polio-free by 2005. |
| 2 |
Why has not polio been
eradicated from Pakistan despite almost 7 years of polio
campaigns? |
| |
Pakistan has seen a great deal
of progress in the fight against polio since the campaigns
started in 1994. In 1999 we only saw a little more than 500
cases in the whole country. This year there are only 17.
This is in contrast to many thousands of cases seen every
year just a decade ago. To eradicate polio, we must
vaccinate every child in the country, even those who are
difficult to reach or whose parents do not take the
initiative to bring them to vaccination centers. |
| 3 |
If the child had already
received polio vaccine through routine immunization or in
previous NIDs, should this child be given the polio drops in
forthcoming NIDs too? |
| |
Yes, All children irrespective
of their previous immunization status should receive
additional polio drops during NIDs. Oral Polio Vaccine (OPV)
given during NIDs supplement and do not replace
immunization. |
| 4 |
What is the advantage of
giving frequent doses of polio drops to children? |
| |
Much research has gone into the
study of the effectiveness of polio vaccine in Pakistan and
it is evident that 3 doses of the oral vaccine do not
completely protect all children from the disease. Only
70-80% of children will be protected after the third dose.
This means that to be safe, children should receive every
single dose offered to them. In many children it requires 5
or 6 doses or even more to provide complete protection. |
| 5 |
Are there any risks in giving
so many doses of polio drops to children? |
| |
There is a very rare chance of
having complications from the vaccine. About one in 3
million children will develop problems after getting a dose.
This risk is very low as compared to the risk of developing
polio after being infected by the polio virus, which is
about one in 200 children. It is important to know that it
is the first dose that carries the greatest risk of
complications, The risk actually goes |
| 6 |
Why are the vaccination
rounds timed 4-8 weeks apart? |
| |
The reason that vaccination
rounds are timed 4-8 weeks apart is to try and suppress the
circulation of Polio virus from child to child in the
community. The vaccine strain of the virus, when given to
all of the children in a community, will actually replace
the disease causing strains of polio virus thereby reducing
the risk for the whole community. Spacing the rounds 4-8
weeks gives time for the disease causing strains to die out
in the area. |
| 7 |
What are standard operating
procedures? |
| |
SOPs are the list of guidelines
detailing the steps to follow in carrying out a specific
operation, procedures and functions. |
| 8 |
Why do we need SOPs? |
| |
Standard operating procedures
are needed to improve the quality. These are also needed to
have clear roles and responsibilities among the team to
avoid confusion and delays. |
| 9 |
What is acute flaccid
paralysis (AFP) case? |
| |
Any child under the age of 15
years with sudden onset of flaccid / floppy paralysis or
weakness or any person of any age in whom polio is
suspected. |
| 10 |
What is Surveillance? |
| |
Surveillance is collection of
data (information) for action. |
| 11 |
What is AFP Surveillance? |
| |
AFP identifies and documents the
presence of wild poliovirus in the country, its trends and
geographical distribution. To achieve this goal it is
necessary to find all cases of AFP and test two stool
specimens for each case in the laboratory for the presence
or absence of wild poliovirus. |
| 12 |
Why is surveillance needed
for AFP? |
| |
There are multiple causes of
AFP. Therefore apart from clinical diagnosis a sensitive
system is required to identify and report AFP cases so that
no such case is missed. It requires reporting of all AFP
cases less than 15 years of age and their stool specimen
tested in the laboratory for presence or absence of wild
poliovirus. |
| 13 |
How to identify an AFP case? |
| |
It is difficult to diagnose a
case of polio clinically therefore AFP cases are looked for
and reported. AFP is a symptom and not the disease. Patients
with different underlying problems may present with AFP. AFP
includes Poliomyelitis, GBS, Transverse mellitus, Traumatic
neuritis and many more conditions. After identification of
all AFP cases detailed history and laboratory investigation
are done to confirm the case if the onset of paralysis was
less then two months old. If the case meets the case
definition then it should be investigated and vice versa. |
| 14 |
How to notify AFP case to
Provincial EPI office? |
| |
All AFP cases should be
immediately notified to the Provincial EPI Offices through
TELEPHONE followed by written letter along with the
notification form. Telephone number and name of the focal
person should be available in the office. Date, time and
name of the person in the Provincial EPI Office receiving
the telephonic message should be recorded on a paper and put
in the case file. |
| 15 |
How and who will investigate
an AFP case? |
| |
After initial notification of an
AFP case investigation should proceed in the following
sequence. Team comprising of DSC, DSV and/or the vaccinator
should immediately (with in 48 hours of notification) visit
the case to confirm that the case is AFP. After confirmation
they will investigate the case immediately and DSC should
fill in the investigation form completely. |
| 16 |
What is an urgent case? |
| |
An Urgent case is that which is
less then 5 years of age, with fever at the onset of
paralysis, asymmetric paralysis, rapid progression to
installation of full paralysis with in 4 days, with OPV
doses less then 3 and belonging to high risk area i.e.,
areas where polio transmission present in the last year or
in current year and high risk population like Afghans and
others. |
| 17 |
How to do 60-day follow up? |
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60 days follow up of all cases
should be done. Objective is to find the presence of
residual paralysis or weakness. It is the responsibility of
DSC along with District Pediatrician to do the 60-day follow
up examination of the child. This should not be delayed more
than a week from due date. Alternative diagnosis should be
given if no poliovirus isolated. The sixty-day follow-up
form must be filled by the DSC and signed by the DSC and the
pediatrician. Completed and signed follow up form should
reach the provincial EPI office immediately. |
| 18 |
What is zero reporting? |
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Teaching hospitals/DHQs/THQs/RHCs/BHUs
and private sector hospitals should do it on weekly basis.
Health Facility In charge should fill in and send to EDO(H)
office. This should be compiled at EDO(H) office and copy
sent to provincial EPI cell. DSC will check that all are
reporting on time and correctly . Objective of Zero
reporting is to ensure that all the reporting sites are
aware of their responsibility for immediate notification of
AFP case, if attended by the health facility. Weekly Zero
report should be sent by all sites (health facilities,
hospitals in public and private sector) to the District
Health Office on the prescribed form whether or not an AFP
case is seen in that particular week. |
