Acute Flaccid Paralysis (AFP) Surveillance

Introduction

• Cornerstone of Polio Eradication Programme under National Polio Surveillance Project (NPSP) / National Centre for Vector Borne Diseases Control (NCVBDC)
• Integrated with Integrated Disease Surveillance Programme (IDSP) and IHIP (Integrated Health Information Platform)
• India certified polio-free in March 2014 (last wild poliovirus case 2011)
• Continued high-sensitivity surveillance maintained to detect any re-introduction of Wild Poliovirus (WPV) or Vaccine-Derived Poliovirus (VDPV/cVDPV)
• Aligned with Global Polio Eradication Initiative (GPEI) and Global AFP Surveillance Guidelines 2026

Objectives

• Early detection of all cases of AFP to rule out or confirm poliovirus
• Rapid investigation and response to prevent outbreaks
• Maintain population immunity through supplementary immunization if needed
• Generate data for certification and maintenance of polio-free status
• Detect circulating vaccine-derived polioviruses (cVDPV)

Case Definition

Suspected AFP Case

• Any child <15 years of age with acute flaccid paralysis (sudden onset of weakness or paralysis of one or more limbs)
• OR any person of any age in whom a clinician suspects poliomyelitis

Surveillance Components

• Passive Surveillance: Reporting from all health facilities (public & private) through IHIP
• Active Surveillance: Regular visits by NPSP Surveillance Medical Officers (SMOs) to reporting units, schools, Anganwadis and community
• Zero Reporting: Mandatory weekly zero reports from all reporting sites
• Community-based Surveillance: Involvement of ASHA, Anganwadi Workers and private practitioners

Investigation & Response

• Notification: Immediate reporting of every suspected AFP case within 24 hours via IHIP
• Case Investigation: Detailed clinical & epidemiological investigation within 48 hours
• Stool Sample Collection: Two stool specimens (8–10 gm each) collected 24–48 hours apart, within 14 days of paralysis onset
• Transportation: Reverse cold chain (2–8°C) to accredited Polio Laboratory within 72 hours
• Contact Sampling: Stool from 3–5 household/neighbour contacts in high-risk areas
• Follow-up: 60-day follow-up examination for residual paralysis

Laboratory Surveillance

• Network of 8 National Polio Laboratories (including Kasauli)
• Tests: Virus isolation, Intratypic Differentiation (ITD), Sequencing
• Turnaround time: Results within 14–21 days

Key Performance Indicators (2026 Standards)

• Non-Polio AFP (NPAFP) rate: ≥2 per 1,00,000 children <15 years
• Stool adequacy rate: ≥80% (two specimens, 24–48 hrs apart, <14 days, good condition)
• Timely notification and investigation: ≥80%
• Completeness of reporting: ≥90%

Current Status (2026)

• India maintains one of the most sensitive AFP surveillance systems globally
• Gradual transition of NPSP network (from ~280 to lower units by 2027) while maintaining standards
• Strong integration with RBSK (for physical disability screening), IDSP and ABDM
• Continued focus on high-risk areas (Uttar Pradesh, Bihar, migrant populations, international borders)

Integration & Pediatrician’s Role

• Mandatory notification of every AFP case by pediatricians (private & public)
• Linkage with RBSK for follow-up of residual paralysis and rehabilitation
• Convergence with UIP/U-WIN for supplementary immunization activities (SIAs)
• Early clinical differentiation from Guillain-Barré Syndrome, transverse myelitis and traumatic neuritis