SURVEILLANCE ACTIVITIES

IDENTIFY

CBS relies on community volunteers to actively search for AFP cases in the community using a simple case definition. For example, a case definition may be:

• Any person less than 15 years of age with sudden weakness or loss of movement in one or both legs or arms, not due to injury.

• Volunteers should search for AFP cases through rumors, home visits, or visits to traditional healers and religious leaders. In some CBS programs, volunteers may also keep records of vaccination status and basic demographic data for every family and child visited.

REPORT

If a case is identified, the case is reported to the relevant authority (such as a surveillance officer or focal point in the health facility) for follow-up. 

CONFIRM

The surveillance officer will follow up to confirm that the AFP case meets the case definition, initiate investigation and specimen collection, and notify the district health authority.

COLLECT

Using the approved protocol, stool specimens are collected from the reported case and transported to the lab.

FOLLOW UP

Finally, follow up with the case once results have been received. Regardless of whether the child has polio, community volunteers should be made aware of any local resources that can be offered to the family of a paralyzed child.

The surveillance system must operate quickly to ensure that cases that are identified are tested in a timely fashion. The GPSAP suggests targeting the 35-day timeline below for detection and response. See Annex F in the GPSAP for more information on the timeline and ways to reduce delays in surveillance activities.

It may be difficult for surveillance officers to conduct AFP case investigation quickly in inaccessible areas and among some special populations. In the event that the surveillance officer cannot complete the investigation in a timely manner, the community volunteer may need to interview the AFP case and collect and transport the stool specimen for testing. The community volunteers will require extensive training on the case investigation form and how to correctly collect a specimen, as well as specimen collection kids, access to an adequate cold chain, and a plan for specimen transport. Make sure all of these are in place before beginning the process. 

CBS can be resource intensive. Integration with other community-based disease surveillance programs can make it more sustainable and cost-effective. Integration leverages existing community structures. The communities themselves are well placed to detect and monitor health events in the communities, mobilize community action, and request assistance or resources, as needed.

If you would like to learn more about integration of poliovirus surveillance, review Annex H in the Global Polio Surveillance Action Plan and Integrated Disease Surveillance and Response in the African Region: A Guide for Establishing Community Based Surveillance in the resource section below.