Integrated Program for the
Eradication of Poliomyelitis in Macau

Protocol 3

Other Program Components

Key Physician Reporting In Health Centers

All health care providers should be informed to urgently report/notify any AFP case, even when poliomyelitis is not suspected, and a nominal list of reporting key physicians at all health centers should be prepared. These key physicians should be the respective health center director or a permanently designated physician.

Should a case of AFP be detected, even when poliomyelitis is not suspected, key physicians should notify UTVE, by fax, and refer immediately the case to the CEP coordinator in CHCSJ. The first sheet of the bilingual standard infectious disease notification form (SSM-UTVE-MOD.100, Modelo1) should be send by fax to UTVE, and the cases reported as "AFP" or "suspected acute poliomyelitis".

As in hospitals, but on a weekly basis, key physicians in all health centers also should send reports stating "zero" AFP cases in the absence of cases (Cep2AFPform).

All the forms should be provided on a weekly or monthly basis to key physicians, which must be signed by the addresses and returned to UTVE. This unit follows-up on defaulters and files all returns. The completed forms will become part of the documentation of CEP.

Before the implementation of this key physician reporting system, information and educational sessions with audio-visual materials should be carried out in all health centers (as in hospitals). These sessions should focus on the main aspects related with the «active surveillance and investigation of AFP» and on general topics concerning the «prevention and eradication of poliomyelitis». Relevant bibliography should be distributed to the key physicians in all health centers.

Use Of The Poliovirus Laboratory Network

As virological surveillance for wild poliovirus is not performed in Macau, stool specimens of suspected AFP cases should be sent to the WHO-accredited Poliovirus Laboratory in Hong Kong (Queen Mary Hospital). A completely filled-up «AFP case laboratory request form» with all relevant clinical information, should be send together with each set of two stool samples (Cep3AFPform).

The stool samples should be sent under refrigerated conditions via jetfoil. The Pediatrics Unit of CHCSJ and the Public Health Laboratory will be responsible for all the necessary procedures, including contacts and transport of samples to the laboratory in Hong Kong, as well as the feedback of results to UTVE.

The criteria for "adequate" stool specimens are mentioned in the section of diagnostic aids and considers (1) two samples for each AFP case, (2) of at least eight grams per sample (3) collected 24-48 hours apart, (4) within fourteen days after onset of paralysis/weakness, and should arrive to the virology laboratory in Hong Kong (5) inside isothermal containers with ice or frozen ice-packs present, (6) without leakage, (7) with no desiccation, and (8) accompanied by the specific documentation (prepared by each CEP hospital coordinator).

Immunization

Routine immunization coverage for all antigens of the Macau Immunization Program has been sustained at very acceptable levels over the past years. In 1997, the territory coverage for OPV3 was reported at 87.7% in children less than one year of age (informatic system), although specific data for health centers at county level present higher coverage (90%). Mobile teams cover all schools for immunization and follow-up immunization defaulters (children 5-6 and 10-12 years old).

Routine immunization should be maintained at the highest level possible in all counties. Health care providers should be informed and requested to follow the 1997 updated normative and guidelines for the Macau Immunization Program, in order to reduce the missed opportunities of vaccination. However, the computer input of vaccination data should be improved In all health centers to address the present data discrepancies (due to inaccuracy and incompleteness).

Target populations should be regularly evaluated and compared with eligible populations to discover unregistered or 'floating' children. The system to discover and immediately follow-up immunization defaulters should be also reinforced.

Whenever necessary, special immunization activities should be conducted in those areas where floating population exists, or where unregistered children are likely to be found.

Outbreak response immunization with OPV should be carried out if any case of wild poliovirus associated poliomyelitis, imported or indigenous, is detected. The immunization strategies to adopt may be either high-risk or population based.

© Fernando Costa Silva, 1999