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<%
on error resume next
Set db = Server.CreateObject("ADODB.Connection")
db.connectionstring = "Provider=Microsoft.Jet.OLEDB.4.0;Data Source=D:\who-shared-hosting\sites\polioeradication\htdocs\db\admin.mdb;Persist Security Info=False"
db.Open
thepage=request.servervariables("script_name")
referrer=request.servervariables("http_referer")
browser=request.servervariables("http_user_agent")
thelanguage=request.servervariables("http_accept_language")
theIP = request.servervariables("remote_addr")
sql = "INSERT INTO log (sitepage,referrer,browser,browserlanguage,IPaddress) VALUES ('" & thepage & "','" & referrer & "','" & browser & "','" & thelanguage & "','" & theIP & "')"
db.execute(sql)
set db=nothing
%>
<%
filename = lcase(Mid( request.servervariables("URL"), InStrRev( request.servervariables("URL"), "/" ) +1 ))
filename = left(filename,len(filename)-4) & " "
if filename = "default " then
elseif Instr("background disease vaccines risk strategies history partners ",filename) > 0 then
response.write " Home > Background"
elseif Instr("progress labnet nid future casecount ",filename) > 0 then
response.write " Home > Global Situation"
elseif Instr(filename, "opvc_") > 0 then
response.write " Home > Global Situation > The Future > Research & Products"
elseif Instr("opvcessation ", filename) > 0 then
response.write " Home > Global Situation > The Future > Research & Products"
elseif Instr("pressreleases factsheets positionstatements videoaudio featurestories events qa def_questions speeches mediacontact photogallery photoessay ",filename) > 0 then
response.write " Home > Press Centre"
elseif Instr("fundingbackground poliodonors donorstories howtocontribute ",filename) > 0 then
response.write " Home > Funding"
elseif Instr("latestdocs presentations reports polionews speechstatement ",filename) > 0 then
response.write " Home > Publications"
elseif filename = "whatsnew " then
response.write " Home"
else
response.write " Home"
end if
if filename <> "default " then
%>
<% end if %>
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The third part of the four-pronged eradication strategy is surveillance - the intelligence network that underpins the entire eradication initiative. Without this investigative framework, it would be impossible to pinpoint where and how wild poliovirus is still circulating or to verify when the wild virus has been eradicated. Surveillance allows new cases to be identified where none had been before - and can detect importations of wild poliovirus.
Effective polio surveillance requires an expert team of virologists, epidemiologists, doctors, and national immunization programme staff, backed up by a global network of laboratories. WHO, in collaboration with national governments, has established a network of 148 laboratories to provide virological surveillance: national laboratories, regional reference laboratories, and global specialized laboratories.
IDENTIFYING ACUTE FLACCID PARALYSIS (AFP) CASES:In the early stages, polio may be difficult to differentiate from other forms of acute flaccid paralysis, such as Guillain-Barré Syndrome, transverse myelitis, or traumatic neuritis. Surveillance for AFP is unusual because it does not target a specific disease (e.g. polio) but a symptom (acute flaccid paralysis).The first link in the surveillance chain are health workers in all health facilities, from district health centres to large hospitals. They must promptly report every case of acute flaccid (floppy) paralysis in any child under 15 years of age. In addition, public health staff make regular visits to hospitals and rehabilitation centres to search for AFP cases which may have been overlooked or were misdiagnosed. WHO emphasises that all AFP cases should be reported. The number of cases reported each year is used as an indicator of a country's ability to detect polio - even in countries where the disease no longer occurs. A country's surveillance system should be sensitive enough to detect at least 1 case of AFP for every 100 000 children under 15 -- even in the absence of polio. This means that AFP is a very rare condition - in a country of 20 million total population (~ 8 million children under 15) only about 80 cases (1 per 100.000 < 15s) per year are expected.
CLINICAL DIAGNOSIS OF POLIOBecause of the initial similarity with 'real' polio, all patients with the symptom of acute flaccid paralysis, regardless of the initial clinical impression, must be reported and subjected to virological examination, even if doctors are confident on clinical grounds that the case is not polio.To exclude the possibility of polio, faecal (stool) specimens have to be obtained and tested for the presence of poliovirus. Because shedding of the virus is variable, two specimens - taken 24-48 hours apart - are required for analysis. Speed is essential, since the highest concentrations of poliovirus in the stools of infected individuals are found during the first two weeks after onset of paralysis. Stool specimens have to be carefully sealed in containers and stored immediately inside a refrigerator or packed between frozen ice packs at 4-8EC in a cold box, ready for shipment to a laboratory. Undue delays or prolonged exposure to heat on the way to the laboratory may destroy the virus. Specimens should arrive at the laboratory within 72 hours of collection. Otherwise they must be frozen (at -200 C), and then shipped frozen, ideally packed with dry ice or cold packs. The procedure is known as the "reverse cold chain".
AT THE LABORATORYVirologists begin the task of isolating poliovirus and identifying which, if any, of the three types of wild virus is involved.
If poliovirus is isolated, the next step is to distinguish between wild (naturally occurring) and vaccine-related poliovirus. This is necessary because the oral vaccine in fact consists of attenuated live polioviruses, and resembles wild virus in the laboratory.
MAPPING THE VIRUSOnce wild poliovirus has been identified, further tests are carried out to determine where the strain may have originated. By determining the exact genetic make-up of the virus, wild viruses can then be compared to others, and classified into genetic families which cluster in defined geographical areas. The newly found poliovirus sequence is checked against a reference bank of known polioviruses, allowing inferences about the geographical origin of the newly found virus. When polio has been pinpointed to a precise geographical area, it is possible to identify the source of importation of poliovirus - both long-range and cross-border. Appropriate immunization strategies can thus be determined to avoid further spread of the poliovirus.
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