60-day
follow-up examination:
The
DIO or SMO re-visits selected AFP cases at least 60 days after
the onset of paralysis to confirm the presence or absence of
residual weakness. In the following cases the child undergoes
a 60-day follow-up exam: 1) cases with inadequate or no stool
specimens; 2) cases with isolation of vaccine virus from the
stool; 3) cases with isolation of wild poliovirus from the stool;
and 4) any case that the investigator thought was strongly suggestive
of poliomyelitis on initial examination (“hot case”).
On 60-day follow-up, the child is assessed for weakness, asymmetrical
skin folds, and difference in left/right mid-arm/mid-thigh circumference.
The child is considered to have residual weakness if any of
the above is present, even if minimal. The finding of residual
weakness on follow-up is suggestive that the case may actually
be polio, and this information is taken into account during
final case classification. 60-day follow-up of children from
whom wild poliovirus was isolated allows the investigator to
assess the community for evidence of ongoing wild virus transmission,
by searching for additional AFP cases.
Cross notification and tracking of cases:
AFP
cases are investigated anywhere in India, irrespective of where
the child lives. In the event that a child with AFP travels
from his/her resident district, the case is thoroughly investigated
by the DIO/SMO of the district to which the child has traveled.
An efficient communication system (telephone/fax/e-mail) has
been established to send information immediately to the DIO
of the resident district of the AFP case. The AFP case is constantly
tracked by the SMO so that the epidemiological investigation
and all necessary surveillance activities are completed, and
to ensure that no case is “lost.” Similar cross-notification
and reciprocal case investigation procedures exist with the
bordering countries of Bangladesh, Nepal and Pakistan.
