NOTIFY TODAY AND SEND TWO STOOLS - DO THIS FIRST
Poliomyelitis - StatPearls (NCBI Bookshelf NBK558944) - https://www.ncbi.nlm.nih.gov/books/NBK558944/
Any child under 15 with new floppy weakness is a polio-surveillance case until proved otherwise, and the reporting clock is 24 hours. Notification and stool collection come before the diagnosis is settled, because the samples stop being useful after day 14 and the public-health response cannot start without them.
- REPORT WITHIN 24 HOURS - the WHO requires every country to report urgently, inside 24 hours, any case of acute flaccid paralysis in someone under 15, and anyone in whom polio is suspected. That is every country, so it is Egypt too. Telephone the district health office the same day; do not wait for a laboratory result, a specialist opinion, or the next working day.
- TWO STOOLS, 24 HOURS APART, WITHIN 14 DAYS. The CDC's requirement, as the article reports it, is 2 specimens with a minimum of 24 hours between them, both taken inside the first 14 days from the onset of the paralysis. The surveillance standard is stricter still: 2 samples, a day or more apart, inside 14 days of onset, and the cool chain unbroken all the way through transit. A late sample, or a warm one, is a missed case.
- STOOL IS THE SPECIMEN, NOT BLOOD AND NOT CSF - poliovirus is looked for by viral culture, or by detecting viral RNA, in stool, or in a throat swab or throat irrigation. Two negatives that mean nothing: finding the virus in cerebrospinal fluid is uncommon, so a negative CSF result does NOT exclude polio; and serology does not help, because anti-polio antibodies are so widespread from vaccination and from earlier symptomless infection.
- WHAT MAKES IT SUSPICIOUS - suspect polio where flaccid paralysis comes on acutely, the tendon reflexes are reduced or gone, and there is no sensory or cognitive deficit. A purely motor deficit appearing rapidly after a flu-like prodrome, with nothing sensory and nothing cognitive, points to paralytic polio. But not every patient reports a prodrome at all.
- A VACCINATED CHILD IS NOT EXCLUDED, AND NEITHER IS A CHILD IN A POLIO-FREE COUNTRY - vaccine-derived strains cause paralytic disease that cannot be told apart from wild-type polio, and they complicate eradication. Outbreaks still crop up now and then, including in countries that had been declared free of polio. Notify on the clinical picture, not on the vaccination card.
- MOST ACUTE FLACCID PARALYSIS IS NOT POLIO, AND THAT IS THE POINT - worldwide the rate is about 1 case in every 100,000 children under 15 each year, and other enteroviruses cause it more often than poliovirus does. Surveillance works by reporting all of them; a system that only reports the ones that look like polio finds nothing.
- REPORTING ROUTE - the cached article gives the United States route: "All suspected cases of poliomyelitis in the United States should be immediately reported to the United States Centers for Disease Control and Prevention (CDC)." The Egyptian equivalent is the Ministry of Health surveillance system through the district health office, and no cached document sets out that route, so the local telephone number is not printed here. Find it once and keep it by the telephone.