77BC78DA-AcuteFlaccidParalysisSurveillance.pptx

Paralysis

1. ACUTE FLACCID PARALYSIS (AFP) SURVEILLANCE Dr Ahmad Zhafir bin Zulkfli@Zulkifli Unit Kesihatan Awam Hospital Shah Alam 23 February 2023

2. Content: 1. Poliovirus in a glance 2. cVDPV outbreak and recent case 3. AFP case definition, reporting and investigation 4. UKA as hospital liaison for PKD and JKN CDC 5. Q&A

3. Source: WHO Source: WHO Source: Centers for Disease Control

4. Four regions of the world are certified polio free - the Americas, Europe, South East Asia and the Western Pacific. By 2015, polio was believed to remain naturally spreading in only two countries, Pakistan and Afghanistan . Malaysia certified polio free since 29 October 2000 .

5. Mode of transmission Spread via faeco-oral route or oral-oral route through contaminated food or water. E.g. contact with faeces contaminated hands, faecal contaminated toys. Enters and binds to an immunoglobulin-like receptor, known as the poliovirus receptor or CD155, on the cell membrane. The virus then hijacks the host cell's own machinery, and begins to replicate. Transmission electron micrograph of poliovirus

6. Should we be concerned? Khairy said from Jan 1, 2019 to Sept 9, 2021, a total of 426 AFP cases had been reported nationwide, out of which four cases of confirmed polio were reported in Sabah. They were aged three months, three years, eight years and 11 years old respectively when they were confirmed to be infected with polio.

7. Should we be concerned? Testing has confirmed that the virus is genetically linked to poliovirus circulating in the Philippines (VDPV type 2)

8. WILAYAH ACHEH, SUMATERA, INDONESIA Recent case in neighbouring country!

9. Kes di Aceh, Sumatra, Indonesia 2022 Kanak- kanak lelaki berusia 7 tahun Tidak mempunyai sejarah imunisasi 6 Okt Demam , lemah pergerakan 18 Okt Admit Teuku Chik Ditiro Hospital 21 Okt Suspected Polio, sampel diambil 7 Nov RT-PCR confirmed poliovirus Lower limb paralysed 9 Okt 3 kanak-kanak sihat positif polio hasil survelens 24 Nov

10. Rationale for surveillance Poliomyelitis is targeted for eradication. Highly sensitive surveillance for AFP, including immediate case investigation, and specimen collection are critical for the detection of wild poliovirus circulation with the ultimate objective of polio eradication. AFP surveillance is also critical for documenting the absence of poliovirus circulation for polio-free certification .

11. Case definition “Any case of acute flaccid paralysis including Gullian-Barre Syndrome, in a child less than 15 years of age for which no other cause is apparent.” Case reporting Ensure 2 stool specimens for polio virus is sent to the lab (at least 24 hours interval between specimen) within 14 days of symptoms onset To complete AFP investigation form urgently and send to UKA. Form can be retrived from intranet or IMR website. Source: Pocket Handbook of AFP

12. Adequate stool specimen Item Details Specimen 5-8g of stool (one adult thumb size) Number Two specimens taken at least 24 hours apart When Within 14 days of onset Method Fresh voided stool (no rectal swab!) Transportation Transport at 4-8 celcius to IMR (cold chain) Specimen container must be labelled with date and time and accompanied with AFP Investigation Form!

13. Case Investigation Procedure at Hospital Level S t a r t AFP Cases Y es No S t op Notify the nearest DHO via phone/fax (fill AFP Investigation Form) Take 2 stool samples (**fulfil criteria) within 14 days of paralysis onset (24 hours apart) Send samples to IMR - Lab Request Form - Maintain cold chain during storage and transport S t op ** Criteria for adequate stool sample Two stool specimens Collected within 14 days of onset of paralysis In cases where sample could not be collected at 14 days, should be collected up to 60 days from onset of paralysis Both samples should be 24 hours apart Using a clean plastic screw cap container (not necessarily sterile) Source: Pocket Handbook of AFP

14. https://www.imr.gov.my/images/Services/Diagnostic_Service_Forms/Virology/AFP-Investigation-Form.xls Intranet HSAS > Borang > Direktorat Perkhidmatan Diagnostik dan Sokongan Klinikal > Unit Kesihatan Awam > Borang Penyiasatan AFP AFP Case Investigation Form Do not report AFP case as poliomyelitis in eNotifikasi!

15. Our response

16. Public Folder > Unit Kesihatan Awam > Acute Flaccid Paralysis > Pocket Book of AFP Case Investigation For Healthcare Personnel

17. Sources: Communicable Disease Control Unit, JKN Selangor Pocket Book of AFP Case Investigation for Healthcare Personnel, CDC MoH Malaysia Pathology Department, HSAS Boy confirmed to be first polio case in M’sia in 27 years https://www.thestar.com.my/news/nation/2019/12/09/boy-confirmed-to-be-first-polio-case-in-msia-in-27-years Khairy: WHO declares end of polio outbreak in Malaysia https://www.malaymail.com/news/malaysia/2021/09/11/khairy-who-declares-end-of-polio-outbreak-in-malaysia/2004797 Kronologi Penemuan Kasus Polio di Aceh hingga Jadi KLB h ttps://www.kompas.com/tren/read/2022/11/20/063000265/kronologi-penemuan-kasus-polio-di-aceh-hingga-jadi-klb Global Polio Eradication Initiative, World Health Organization, https://polioeradication.org World Health Organization (19 December 2022). Disease Outbreak News; Circulating vaccine-derived poliovirus type 2 (cVDPV2)-Indonesia. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON430

18. Take home message Be vigilance and report encounter case! Contact lab/liaison officer/UKA if not sure. Ensure two stool specimens sent! Q&A