Summary Suspect Polio Surveillance and Specimen Collection Guidance Flowchart

Flowchart Text Description

IF a patient has:

Acute flaccid weakness, acute onset of flaccid paralysis or AFM:

• THEN collect stool and other specimens
  • Request the laboratory hold all specimens for submission to the NYSDOH Wadsworth Center
  • Immediately notify the local health department where the patient resides and contact the NYSDOH at AFM@health.ny.gov

Meningitis

• AND known or suspected to be unimmunized or under-immunized for polio
• AND resides, works, attends school, or has frequent social interaction in Rockland, Orange, Sullivan, or Nassau counties
• AND no other apparent cause of meningitis. Enterovirus testing of CSF may be positive, negative or not done.
  • THEN collect diagnostic stool specimen for enterovirus PCR testing and send to the clinical laboratory routinely used.
    • If a stool specimen cannot be obtained, an OP swab is acceptable. Stool is preferred.
    • Note the Rockland, Orange, Sullivan or Nassau County connection on the lab requisition.
    • An enterovirus-specific PCR test should be ordered; that is, point-of-care or other tests that return a "rhino/enterovirus" result are not acceptable.

Non-specific viral symptoms

• defined as:
  1. sore throat AND fever OR
  2. sore throat OR fever AND at least one: tiredness, headache, nausea, stomach pain
• AND known or suspected to be unimmunized or under-immunized for polio
• AND resides, works, attends school, or has frequent social interaction in Rockland, Orange, Sullivan, or Nassau counties
• AND patient tested for COVID-19, Influenza, Streptococcal Infection or other respiratory pathogens
  • IF NO, THEN collect diagnostic stool specimen for enterovirus PCR testing and send to the clinical laboratory routinely used.
    • If a stool specimen cannot be obtained, an OP swab is acceptable. Stool is preferred.
    • Note the Rockland, Orange, Sullivan or Nassau County connection on the lab requisition.
    • An enterovirus-specific PCR test should be ordered; that is, point-of-care or other tests that return a "rhino/enterovirus" result are not acceptable.
  • IF YES, confirm- are all tests negative? (or only enterovirus or "rhino-enterovirus positive.)
    • IF YES, THEN collect diagnostic stool specimen for enterovirus PCR testing and send to the clinical laboratory routinely used.
      • If a stool specimen cannot be obtained, an OP swab is acceptable. Stool is preferred.
      • Note the Rockland, Orange, Sullivan or Nassau County connection on the lab requisition.
      • An enterovirus-specific PCR test should be ordered; that is, point-of-care or other tests that return a "rhino/enterovirus" result are not acceptable.

NYSDOH has requested that clinical laboratories send specimens positive for enterovirus to the NYSDOH Wadsworth Center for poliovirus testing. For more information see: Laboratory Advisory: Submission of Positive Specimens and Isolates from Enterovirus Specific PCR Assays - July 26, 2023 (PDF)