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Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

August 15, 2019

DEPARTMENT ORDER
No. 2019 -_
0380
SUBJECT: Guidelines for the Intensified Acute Flaccid Paralysis (AFP) Case Finding
and Stool Specimen Collection

The Philippines was certified polio free in 2000, along with other countries in the
Western Pacific Region. However, in 2001, three (3) cases of circulating vaccine derived-
poliovirus (CVDPV) were detected in the country. Further in 2011, the country was identified at
high risk for polio virus re-introduction as AFP surveillance performance, OPV coverage and
OPV supplemental immunization activities continue to be a challenge. This is further
compounded by the fact that Philippines is at risk for importation of polioviruses from
neighboring countries like Indonesia, and Papua New Guinea — where there is an ongoing
transmission of cVDPV.

In response, DOH identified priority areas which need to strengthen preventive measures
against polio. Prioritization was based on three criteria: (1) OPV vaccination coverage routine in
vaccination; (2) AFP surveillance performance; and, (3) cordition of environmental sanitation.
Based on the National Certification Committee for Polio Progress Report 2018, identified
provinces and cities in the 17 regions categorized as HIGH RISK AREAS Poliovirus Re- for
infection in the Philippines.

Thus, to halt the threat of re-infection, immediate actions must be instituted. One
component that needs to be heightened is the active search (surveillance) of children below 15
years of age who have developed acute flaccid paralysis (AFP).

I. Target Areas
AFPactive surveillance should be established in communities and health facilities in areas
classified as high risk for polio re-infection. This will be done through supervision and
collaboration with the Regional and Local Epidemiology and Surveillance Units (ESU). Priority
will be given to high risk cities and municipalities:
Active Community-based Active Hospital Surveillance

Geographical Area Surveillance


(Human Resource for Health)
py pasar Peeve
Surveillance Officers)
Municipalities and Cities that are
categorized as HIGH RISK AREAS for Enhanced AFP
Poliovirus Re-infection House-to-house surveillance daily
rounds in
sentinel
based on the Assessment of
the National
Certification Committee for Polio
hospitals

eran as
Rest of municipalities and cities not
To be determined based on the AFP surveillance
results of the AFP Surveillance in
: . :

includedin hd igh risk areas daily rounds


in priority areas sentinel hospitals
Building 1, San Lazaro Compound, 1 Rizal Avenue, Sta. Cruz, 1003 Manila @ Trunk Line 651-7800 local 1113, 1108, 1135

Te
Direct Line: 711-9502; 711-9503 Fax: 743-1829 @ URL: http://www.doh.gov.ph; e-mail: ftduque@doh.gov.ph

Page 1 of 14
II. Implementation

A. Case Detection

1. AFP active surveillance will use the following AFP standard case definition:

An AFP case is
defined as a child < 15 years of age presenting with recent or sudden
of
onset floppy paralysis or muscle weakness of
the limb/s due to any cause,
OR
Any
person of any age with paralytic illness if poliomyelitis is suspected by a clinician

2. The following diseases will manifest acute flaccid paralysis (AFP):


Poliomyelitis
Guillain-Barre Syndrome (GBS)
Myelitis (i.e. Transverse myelitis)
Traumatic neuritis
Pott’s Disease
Other disease as long as AFP is manifested

B. Active AFP Case Finding

1. Community-based Surveillance (CBS) Active Case Finding


Priority should be given to areas with the following conditions:
1. Low OPV Coverage
2. Poor AFP surveillance (below target)
3. Poor environmental sanitation (e.g. poor sanitary toilet or percentage of open
defecation in the community and poor access tosafe water supply and poor waste
disposal system)
4. Areas with informal settlers and over crowding
_ Areas where polio virus isolate was detected in the environment through
environmental surveillance

a. Community-based active case finding:

Step 1: Local health authority with the EPI coordinator, sanitary inspector, and
development management officer (DMO) of DOH will assess the barangays
based on the above mentioned condition
Case finding.
to prioritize barangays for CBS-Active

2:
Step Once thelist of barangays is made, the local health authorities coordinate with
the local chief executives (municipal/city and barangay officials) the need to
heighten AFP surveillance in the area.
Step 3: Community preparation will be done by conducting AFP orientation for BHWs,
Barangay Nutrition Scholars, school authorities and officers of Parent-Teacher
Associations (PTAs). These group will be partners of the barangay health
facilities in identifying children that fits the description of AFP.

Page 2 of 14
ae ir
Step 4: Active AFP Surveillance case finding will commence in
the next three (3) days
after community orientation. Approach a household and ask if anyone in the
family is <15 years old. List this down in the AFP Community Survey Tool
(Annex A).
Step 5: If yes, ask further how many of the <15 years old children have sudden onset
or recent weakness/paralysis occurring within the last 2 months. Once a child
has been identified as an AFP case in the community, the child will be reported
to the health center. Information to be collected are the following: name of the
child, age, sex, complete address and date when weakness or paralysis developed
or noticed.

For those children with onset of AFP before 2 months and within the (6)six
months period, complete the Case Investigation Form only. It is important to
identify these children and classify them as “missed” case.

For a child whose condition occurred in the last two (2) months, complete the
CIF and collect stool specimens for
laboratory.

Step 6: When
together
a
child with AFP
with the human
is
reported to the health center, local health authorities
resources for health (HRH) will investigate using the
AFP CIF (Annex B). Collection of stool specimen will also be done. If stools
collected from the case are inadequate, identify three (3) to five (5) close contacts
and their names will be entered in the AFP Close Contact Form (Annex E).
Stool specimens will also be collected from close contacts. Stool samples
collected will be place in a stool specimen container (Section C, see table on
specimen collection).
Step 7: Submit accomplished forms to RESU. Label properly (name, age, address and
date of collection) stools specimens and place in the stool collection box (with
ice) and to be transported and received by RESU within 24 hours after collection.
Transport specimens to the National Reference Hospital a day after RESU
received the specimen.

b. Review of all consultations seen and managed by the health center:


Step 1: HRH will request access the record of consultations logbook in the health
center.
Step Review carefully all consultations for the last six (6) months and check for any
2:
chief complaint that fits the definition of AFP.
Step Any potential AFP case identified will be enrolled in the Retrospective Records
3:
Review Form (Annex C)
Step 4: Request for the medical record (if there is any) or family envelope of cases
enrolled in the Retrospective Records Review Form to verify and assess
if any patient fits the definition of an AFP. The following information must be
verified: Check the chief complaint, present medical history, physical
assessment, diagnosis, physician’s notes and nurse’s notes for any
documentation of “sudden onset of floppy paralysis”.
Step 5: If any of the retrieved case/s fit the AFP definition, check with RESU if
patient has been previously reported. If not reported, classify the child as a
the

“missed” case.
Step 6: If any of the missed case/s fit the AFP definition, with onset within the last 2
months, fill-out the AFP CIF.

Page 3 of 14

Step 7: For a child who developed AFP within the last two (2) months stool specimen
will be collected. If stools collected from the case were inadequate, identify
three (3) to five (5) close contacts and their names will be entered in the AFP
Close Contact Form (Annex E). Collect stool specimens also likewise be
collected from close contacts. Stool samples collected will be place in a stool
specimen container (Section C, see table on specimen collection).
Step 8: Submit accomplished forms to RESU. Label properly (name, age, address
and date of collection) stools specimens will be placed in the stool collection
box (with ice) and to be transported and received by RESU within 24 hours
after collection. Transport specimens
after RESU received the specimen.
had
to
the National Reference Hospital a day

Step 9: Secure a copy of the patient’s medical record and laboratory results. Send to
RESU for submission to the AFP Expert Panel Committee for classification.

2. Health Facility-based AFP Surveillance Active Case Finding


AFP Surveillance Officers (AFPSO), Disease Surveillance Officers (DSO) or
Disease Surveillance Coordinators (DSC) of the RESU, PESU, and CESU or of the
hospital will conduct regular surveillance through hospital ward visits and retrospective
medical records review

The following steps shall be taken:

A. Hospital Ward Surveillance

Step 1: Assign AFPSO/DSO to designated hospitals


Step 2: RESU Head coordinates with hospital authorities (medical Center Chief and
the hospital surveillance focal person) where assigned AFPSO will conduct the
AFP Surveillance.
Step 3: On the day of the hospital visit, AFPSO will make sure that he/she has the
needed surveillance materials.
Step 4: RESU Head will coordinate with the hospital surveillance focal person so
AFPSOwill be properly endorsedto the head nurse of the Pediatric Ward
Step 5: In the ward, AFPSO checks the logbook of admission and go through the list
of admissions, checking on any patient <15 years old who is currently admitted
with a chief complaints of “paralysis / weakness of extremity” or diagnosed an
admitted patient due to the AFP differential diagnosis.
Step 6: If admitted patient/s fit the AFP case definition, check with the hospital DSC
or with RESU if the patient has already been reported or a “missed” case.
Step 7: If case has not been reported, AFPSO/DSO/DSC investigates the case and
accomplish the AFP CIF (Annex B).
Step 8: For admitted patient, stool specimen will be collected. Give two stool
specimen containers and instruct the patient or the patient’s guardian to collect
two stool specimens 24 hours apart.
Step 9: Endorse to the nurse-on-duty of admitted patient that two stool specimens
must be collected.
Step 10: If stools collected from the case are inadequate (as in the case where the
patient was discharged and failed to give the 2 stool specimen), refer the case
to appropriate DMO for community follow-up. In the community, HRH
identify three (3) to five (5) close contacts and their names will be entered in
the AFP Close Contact Form (Annex E). Stool specimens will also be

Page 4 of 14
ae
collected from close contacts. Stool samples collected will be place in a stool
specimen container (Section C, see table on specimen collection).
Step 11: Submit accomplished forms to RESU. Label properly (name, age, address
and date of collection) stools specimens and place in the stool collection box
(with ice) and to be transported and received by the RESU within 24 hours
after collection. Transport specimens to the National Reference Hospital a day
after RESU had received the specimen.
Step 12: Secure a copy of the patient’s medical record and laboratory results. Send
these to RESU for submission to the Epidemiology Bureau (EB) for
classification.
Step 13: Consolidate findings for the day and immediately report any AFP case found
to RESU.

. Retrospective AFP Surveillance Records Review

Step 1: Assigned AFPSO/DSO visits the Hospital Records Section and borrow the
consultation / admission logbook.
Step 2: AFPSO/DSO will carefully review the all consultations / admissions for the
last six (6) months and check for any chief complaint that fits the definition of
an AFP.
Step 3: Any case identified, enroll in the Retrospective Records Review Form
(Annex C)
Step 4: Ask the records keeper to retrieve the medical charts of patients listed in the
Retrospective Records Review Form to verify and assess if the such condition
fits the definition of an AFP. The following information must be verified:
Check the chief complaint, present medical history, physical assessment,
diagnosis, physician’s notes and nurse’s notes for any documentation of
“sudden onset of floppy paralysis”.
Step 5: If any of the retrieved charts fit the AFP case definition, check with the
hospital DSO or with RESU if the patient has been previously reported or
“missed”.
Step 6: If any of the retrieved charts that fit the AFP case definition has been
“missed” and the onset of paralysis is within the last 2 months, fill-out the
AFP CIF.
Step 7: If the case is not yet reported; The DSO will investigate the missed case and
fill-out the AFP CIF (Annex B). Stool specimen collection will likewise be
done. If stools collected from the case were inadequate, identify three (3) to
five (5) close contacts and their names will be entered in the AFP Close
Contact Form (Annex E). Stool specimens will likewise be collected from
the close contacts. Stool samples collected will be place in a stool specimen
container (see table on specimen collection).
Step 8: Accomplished forms will be submitted to the RESU. Properly labelled
(name, age, address and date of collection) stools specimens will be placed in
the stool collection box (with ice) and will have to be transported to and
received by the RESU within 24 hours after collection. Specimens will have
to be received by the National Reference Hospital the day after RESU had
received the specimen.

Page 5 of 14
ies
Surveillance Unit (CESU) concerned for the follow-up investigation of the
AFP case in the field.

C. Stool Specimen Collection

1. From a child who developed AFP. Stool specimen will be collected two (2) adult thumb-
sized stool specimens at least 24 hours apart within 14 days from paralysis onset (adequate
stool specimen). Both the stool sample should be collected within 14 days. If the first
sample is collected in day 12 and second sample is collected on day 15, this will be
inadequate sampling. If only one stool sample is collected before 14days and second

2.
sampleis not collected, this is classified as inadequate sampling.
For AFP case with inadequate stool specimen, identify 3-5 close contacts, aged 14 years
old and below, regardless of symptoms. List them down in the AFP Close Contact Form
(Annex E).
3. One stool specimen will be collected once the close contact is
identified.
4. Each stool specimen shall be properly labeled with patient’s name, date and time of
collection and stool number.
5. After each stool collection, specimen shall be kept in refrigerator at temp of 2-§ °C. Do
not place the stool specimen inthe freezer.
6. All stool samples will be forwarded to the RESU. RESU shall transport specimens the to
Research Institute for Tropical Medicine (RITM) for testing within 3 days from the day of
stool collection.
7. RITM will provide RESU and EB with initial laboratory results within 14 days from receipt
of specimen (Annex F).
8. RESU shall provide feedback of laboratory results received from RITM to the reporting
DRU/LGU.
9. Laboratory results of stool specimens must be communicated by the RESU
health authority authorized to inform the family of the child with said result.
the local
to
The table below, summarizes the process in stool specimen collection:

Community and Hospital AFP surveillance

Child with AFP weakness or


paralysis
i
Child with AFP
310 5 close
eemkuees
Remarks

i
2 samples should be
Notified and collected and both
> senmins enilntend 38
Condition 1 Investigated within 14 Not needed samples should be
siiaas
days of paralysis onset
P
collected within 14 days
after the paralysis onset

oeroe
Notified and At least 3 close ibli
lsat
i

Condition 2
Investigated after 14 2 samples collected 24 contacts, 1 stool poled
days to 2 months after hours apart sample per contact i

the paralysis onset to be collected

Notified and foaes


Case Investigation form is
.

a
a
Investigated 2 months
Condition 3 Not needed Not needed completed as a missed
to within 6 months
after paralysis onset —

Page 6 of 14

es
D. Flow of Reporting

L Results of the community-based and health-facility-based active AFP case finding shall
be submitted to the RESU for consolidation and encoding (Annex D).
RESU shall validate and ensure
accuracy of information written in the CIF.
RESU shall maintain the database, analyze and geneiate a daily report for dissemination

to stakeholders.
RESU shall submit daily a
copy of the AFP database to EB every 5:00 PM, together with
a scanned copy of the patient’s CIF and medical records (if available).
EB
shall consolidate the CIF and medical records for submission to the National AFP
Expert Panel Committee for final classification of cases.
- EB
shall update the RESU and the submitted database with the AFP final classification.
EB shall analyze and generate a daily update for dissemination to DOH Executive
Committee Members and other stakeholders.

Il. Repealing Clause:

All other issuances inconsistent with this Order are hereby repealed/rescinded.

By Authority of the Secretary of Health:

RNA C. CABOTAJE, /MD,


MPH, CESO III
Undersecretary of Health
Public Health Services Team

Page 7 of 14
Annex A: AFP Community Survey Tool

AFP Community Survey Tool

Region: Muncity: Date:

Brgy/Area: Name of Surveillance Officer:

Household How many children are <15 years How many children had weakness/
old? paralysis within the last 2 months?
* Fill-out AFP CIF

Page 8 of 14
S
=
Annex B: AFP Case Investigation Form

Version 2019

OF
Tyee GRnu OCHO OGevitcapts! OF rete tmptet OCine

Vast

Tat
OGevt Laboratory OP irvate Laboratory §9=O¥urportiSeaport

Wats hare

ane
i i Age Dbays Civordite Years
MM OD YY

Corals
Cate Actewiied Seen Goneuil
prt = =
= = _ =

PRO
Date ot Pings | |
3S
late of teeatgater =

Pater
Mate
Piuerree cf lene migabor Contact Nx.

[is the come a amber of an inbgermus Group? OY OM Spamcty Pvt

li. CLINICAL DATA check (Put


in the appregelate Bex) |v |

Roden
Oeap
CRUOME. PARALYSIS STEORrLAcCO PARALYSIS SSeeY tendon
Refesss
Moers
Date onsat F , Agtam OY ON
foer OY OWN Prosar at orih? OY ON lisier OY ON
Cough: ¥ ON 2 Agpreveic?: OF ON
~~ OYOR
-

HISTORY
ee
PROGRESSION Lfttg OY ON
__

oY ON
wit
/

Pandyem tully dessicgped J — wees: OY OOM


4 NOTE Instructions of the graciog’
:
-

to days fom corset of fivem?


ON OY
oY ON Beck rramcioce or on adoring of Pah davisary Stata den
Meniges! sire facsimuedes OY OM Fiider veflaaes arid ister Status are
ov om Otnentben
af panciyote
Working D ‘
PnbSérited atid Back of page id
HL EPIDEMIOLOGIC DATA

Hemy of neciege taeda? TY CIM PES, apwcty cianeder _ -

the: peated tree! (= 1) ore, hor: howe!) one month ore to dine? CY OW
(Dun!

UYGS, spect
Otee AFP in
gece
cae pests
Oats wasted Foor,
commu) within G0 gaya of patents paceyem? CY ON
Te i

Does ive petert had soy Saory of wewre aed orrecto bee? OY ON rere

Jof
BYES, apecty pe ~

be there 20 Errroceects! Sarre tented powies tor Ww) WOR / Satria 2m ite wee? CY CN IF YES. Specthyte cate
1. IMMUNIZATION

dk —“
a
Total WIP seses received: Dele test dose A OPVEPWS ts die oe “Het coe? OY ON

a
V. LABORATORY DATA

see Commesed?
|!" YES. date] Cate went Datere- Specimen Condiaaa
Fit nae Ry

i
to RIT
. omen cotved (Ta
RITHM cam fon

it Ciwiry WY, Suber of packs:


Ma. bow
oY ON tte or Ore
oe
1 ? TiSasiretee Oty of low puck: CIPoaren
over
on
Cl Thawedbut ook
MG
oe 0 Warm

|
eaten 2
Cl Dype 2
Type of Gar
Owew ary Gap
2 oY OWN
eo eo ooo# Cl Sanrriee tee VOR
or Nassa.of Causar

a.
oview Spactty ~
e
Ose

PG
RECEIVED oY
OMPew we
3
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fh
Vi 0-DAY FOLLOW-UP
Gupacted dem ofteiewage:
Vea cee of
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Solwig-coriucted
Pepe OY ON] ne cement

if
© echum

PE ormetOoy Om Preis Onan Dow

Reus Cy On Oe?
0
peepee
Oe Spey PcckiFingge O Gea
Presene of Amopry? Oe ON
fa: RA CY ON tk OW OM

SOY ON we OW OM

Page 9 of 14
of
or
AcuteFlacoidParniysts

tec
‘Vil. CLASSIFICATION (TO BE FILLED UP BY THE EXPERT PANEL ONLY)

wd
PINAL CLASSIFICATION | CLASSIMCATION CRITERIA FINAL OIAGWOSIS

0 Conterred wilt pote © Laboostary

ris’
D Vecone-darwerl paralytic pobo (VDPY} © Lest to tofiw-igs
OD Vecons-ssnccmied paratytc polo (VAFT) OC Demith
Recpenri VAFPr Wh remetus! pareve
sci pees
OC OC

0 Contact VAP O Wethout


Po

ton:
© compatitte
© Decardedd as Noo-Fota ‘Was the case corasdecec
Deve came ‘
od NOT APP? OF ON

Siete
APP Cane Definition

‘Hot’
"high
An AFP cose Gefived we a cid bees then 15 years of age presenting avi recent or sutiden ores of floppy pacetyee of mureche

esnne
© @

‘weakracss of thw betbe due tc any couse Of

Motor
Case
. Ary parson of any age wih parwiyte finess @
polarrrpeltrs te supected by w chreces.

Nefese
Stetam.
Tandon
Sueding
© Acome thal @ comectered hiytty suspected for beng pobo based on chrecel Gut and with the folicwe presenting charwcter ims

Sermepey
— Less then 5 year of age
Lesa then 3 OPV dees

Deseription:
~

~ Fever a! onsel of paerstyas.


~ Aanyremainc parutpece
— Rapes progeessson of paradyure (aie 3 chapel
Farcice
~ Hee been in contect wih on eng m acse evth puuble oc recent! Polo vrua orcutslart

Osfin

Deep
Adequate Stoo!
e Pwo stool speceren (al weal acuél thuet som)
© Cofected aiften %4 days fom ore! of paratyes

© With a coffection intercal of af hems! 24 hours

& Senaory ststus Go


presented in percentage and categorised as follows

© S2o% = Abwert
© 225% bul 100% = Reduced
© 100% = Morred
B. Deep tendon refisess ae preseried in (r) aymbol and calegorued we fclices
®
nose or 0 = aboard
© + = seduced
© ++ = rooms!
oe
oer wiltvwihoul chews © mowssed of exjgeraied
GC. Moter Status ia prevented in frecton and celegonced an fodows:
© OS = steel o no movernerl
©
Sto 3S = vecuced mavemant jas mover! bul nol agers! reantmce of gravity |
© 49 Ww $9 norrad
«=
jmovernent with ful resadance and agams! gravity)

Page 10 of 14
Department of Health
xouuy

EPIDEMIOLOGY BUREAU
RETROSPECTIVE RECORDS REVIEW FORM 3a

Type:
CityMunicipality: Name of Surveillance Officer:
anSe IatIadso.1jay

Date of
Birth
(mmiddiyyyy)}
Complete Address
Date
Admit
|(mmiddiyyyy)
Admitting/
Discharge
Diagnosis
Chart
Available}
(YN)
Fits Case
Definition
(VINA)
ate
(RM)

Sp10ddy

MITAIY

oseg

WLIO

[]
JO
PI

Legend Y- Yas, N- No, /- insufficient R - Reported, M- Missed


Annex D: AFP Active Case-Finding Surveillance Flow: Community-based and Health
Facility-Based

Community Based Health Facility-Based

Communit Hospital Hospital


y/Househo ward Admission
ld Log Book
visits

{
HRH
ask household AFPSO DSO will look for AFPSO/ DSO
will review
admitted patients with chief log book for consultation or
members of
any child
complaint of “sudden admissions and look for
with “sudden
weakness or paralysis of patients with AFP
weakness or paralysis extremities” or diagnosed
of extremities” within differential diagnosis from
with AFP differential
the last 2 months diagnosis January 1, 2019 to present

v
case classification by EB,
Assess
(Case
if patient fits the AFP Case Definition
interview, medical charts review etc.)
Update
based on Expert Panel review
¥
Stool v if
Send CIF (and charts, available) to
Specimen
collection AFP Case Expert Panel for review upon receipt by
(Annex F) EB

v
AFP CIF Form (Annex B)
t
Filled out by HRH/ AFPSO / DSO Send mdb and update file with
corresponding CIF by RESU to EB
vy by 5PM
Daily Collection of AFP CIF Form by RESU
AFP cases
v v
seen from
facility-based AFP Merging, Data Analysis by EB at
surveillance
LT paiy Encoding of AFP CIF Forms in RESU 12 NN the next day al
and needs
community
follow-up for
stool collection
shall be RESU Data Analysis Daily Report
and Report Dissemination (Annex
referred to the Generation to D) signed by EB
CESU Stakeholders Director to
Stakeholders by 1PM
Pie
xouuy

Phdippine integrated Disease


Surveillance and Response
AFP Close Contact Form
aes
Wy

Name of AFP Case: dAV

Address:

f/f
980]
Total no.
of OPV/

fo
Name Sex Date of Birth Relationship to With paralysis/ Date of Last Dose
Date Stool
Results
Age
ia Gee ciaukbana? iA Cidee Taken

ee
Taken
39¥IUOD

__/
WLI04

es
osed
/ / / / / /

ft s
¢] 4
JO
PI
cee nestemeee ec cinccceech

ee
eeA
5
eee Aen!Gee (Te

a
Relationcnip. —Y¥
.

Codes /

— a Age Years
Mt - Male
menisdiyy 2ehootmate
Playmate
onentionem
if Yee,aceece ithe
cace fits the AFP
|oometrer’|
}

:
mmddyy mmidelyy

-
vorv
NEO

AFP Case Definiton:

Suspect Case
© ANAFP case is defined as a child less than 15 years of age presenting with recent or sudden onset of floppy paralysis or muscie weakness of the iimbs due to any cause. OR
© Any person of any age with paralytic liness pollomyelltis Is suspected by 3 cilnician.

AFP Close Contact:


© A close contact is 3 sibling, 3 Nousenhold member, a school-nate, a playmate and others with history of direct contact with the AFP case
Annex F: Stool Specimen Collection Flow

close contacts*
Identify 3-5
aged <15 years old; regardless of
Inadequate symptoms and register in the AFP
stool? Close Contact Form (Annex E)

v
HRH
or DSO
will collect stool specimen: HRH
or DSOspecimen:
will collect stool

- Two (2) adult thumb-size / 5ml_ stool specimen;


- Must be
collected at least 24 to 48 hours apart; - One (1) adult thumb-size / 5ml
- Within 14 days from paralysis onset*; stool specimen;
- Ensure proper labeling and packaging for the - Ensure proper labeling and
specimen and maintain reverse cold chain packaging for the specimen and
maintain reverse cold chain
*lf the onset is within the last 2 months, ASO can still collect specimen

y v
Samples will be forwarded to the RESU by DMOs or picked-up in the DRUs by
AFPSOs

v
Samples, together with a copy of the AFP CIF and Close Contact Form, will be sent to
RITM for confirmation by RESU

v
RITM
will test stool for presence of poliovirus thru:
Viral Isolation Testing
Intratypic Differentiation Testing

v
RITM will release transmittals to RESU and EB

f !
RESU will update database EB
will update Expert Panel and case
with laboratory-status classification based on laboratory result

Daily Report
RESU Data Dissemination (Annex D)
Analysis and signed by EB Director to
Report Generation Stakeholders by 1PM of
to Stakeholders the next dav

*4 close contact is a sibling, a household member, a school-mate, a playmate and others with history of direct
contact with the AFP case

Page 14 of 14
“ye