1. A non-Polio AFP rate of 1/100,000 should be adopted as the benchmark for adequacy of AFP surveillance in India as per Kerala data, a State, which has been free of Polio for more than three years.

2. Active community-based surveillance should be considered. Involvement of community should be solicited by rewards for reporting a new unreported case of AFP.

3. State and Centre level Technical Expert Committee be set up to oversee the process of AFP surveillance. This committee should have an IAP representative on it.

4. The scope of AFP surveillance should be expanded progressively to include contact surveys and environmental surveys.

5. The IAP and IMA should be actively involved in the process of AFP surveillance. The information regarding what, where and to whom to report and what to expect after reporting a case should be disseminated to all IAP and IMA members.

6. Special efforts must be made to ensure coverage of children between the age of 12 and 15 who may not be reporting to the Department of Pediatrics of various reporting units.

7. Intra-typing differentiation of all cases of AFP must be provided to clinicians reporting the index cases.

8. Clinicians must follow all cases of AFP for a minimum of 60 days and correlate with virus intra-typing.

9. Every case or AFP-which do not have a wild virus, must be scrutinized by a technical expert committee which has an IAP representative on it, to begin with, such expert committees may be constituted at State level, and gradually such committees may be constituted in each district.

IAP Recommendations for Vaccine-Associated Paralytic Polio

Discussion of VAPP should be restricted to only academic circles.

Definition: – At present, there is no accepted definition – we will follow the working definitions. Recipient VAPP – Paralytic polio in which onset of illness occurs within 7-30 days after administration of OPV. Contact VAPP – Paralytic polio which has contact with a vaccinee and the onset of paralysis within 7-60 days after the vaccinee received the OPV or the patient lived in an area where an OPV campaign was conducted within 7-60 days before the illness started without a contract. In these patients following data to be documented. History – OPV exposure evidence – Absence of epidemiological links. Physical Exam. – Paralytic poliomyelitis Laboratory – Stools negative for wild polio-virus.

In NPSP – AFP With Vaccine virus are discarded as non-polio. The program should recognize VAPP and follow them up.

There must be a felt need to plan a new strategy, which can minimize the occurrence of VAPP.