To stop polio transmission in the Philippines, there is a need to strengthen acute flaccid paralysis (AFP) surveillance. There are two approaches to find polio through passive and active surveillance. Passive surveillance involves health workers routinely reporting AFP cases as they find them in sentinel sites like hospitals and health facilities.
However, during an outbreak and when there is a higher concern of polio in high risk provinces identified as those with low vaccination coverage, active surveillance needs to be conducted. The Department of Health (DOH) has deployed surveillance officers to hospitals, health facilities, and even the community to search out AFP cases.
As Philippines has a highly mobile population, health workers need to remain vigilant of possible spread to their provinces, and to intensify efforts to monitor AFP cases. DOH and WHO staff visited the San Antonio rural health unit (RHU) in Nueva Ecija to sensitize the surveillance officers and volunteers, to activate community surveillance, and report when they identify children with polio symptoms.
Active case finding
The team visited the San Antonio Hospital for active case findings, they searched the medical register to identify cases which have presented polio-like symptoms.
Dr Sukadeo Neupane from WHO (right) and Nixson Cao from DOH Center for Health Development III (left) at San Antonio Hospital. Photo: WHO/I. Tan
The team review recent cases, sensitize doctors on AFP surveillance, and advise on sample collection. Photo: WHO/I. Tan
Community surveillance with volunteers
San Antonio rural health unit (RHU) and their volunteers were also briefed on active community surveillance. Together with health staff, they visited families with children under five to collect stool samples.
DOH briefs local officials at a barangay before meeting with the community volunteers. Photo: WHO/I. Tan
The information will be reported back in real-time to national and regional authorities, to enable rapid decision making and action, and an investigative team will be dispatched if needed. If an informant identifies a child with polio-like symptoms, they will inform the RHU immediately.
Data-driven evidence-based decision making
Data collection and sharing are critical to stop the transmission of polio. Data should be standardized, of good quality, and available in a timely manner to allow for analysis and decision making, to track current situation, and improve surveillance.Surveillance and monitoring
A strong surveillance system is needed to swiftly address outbreaks along with optimal hospital and health facility-based AFP surveillance. Active community surveillance will take place, where stool specimens are collected to see if poliovirus is present.Surveillance officers and community volunteers from San Antonio were briefed on the polio outbreak, and mobilized to monitor for children who present AFP like symptoms in their community, and support contact tracing and collection of samples if necessary.
Surveillance officers and community volunteers visit house-to-house to find children under five for community healthy children stool survey. Photo: WHO/I. Tan
Health workers record the child’s information and provide instruction on sample collection. Photo: WHO/I. Tan
Advocacy and social mobilization
Health staff and volunteers were briefed on how to explain polio, its risk to children, and the benefits of vaccination. At the same time, they were oriented on the risk of spread and importation from other provinces, given the mobility of the population. Poor hygiene and sanitation, low routine immunization coverage, can increase the risk of polio. Parents with young children should ensure that their child receive the routine vaccination.While we worked on surveillance to stem the spread of polio, it remains vital to strengthen routine immunization, as vaccination is the best protection to stop polio.