2497. Acute Flaccid Paralysis: 17-Year’s Active Epidemiological Surveillance in a Pediatric Hospital in Argentina

Abstract

BackgroundArgentina, as the same of LATAM countries certifies the elimination of polio in 1990. Acute flaccid paralysis (AFP) surveillance is a key strategy for monitoring the progress of poliomyelitis eradication in the world. The aim of this study was to describe the epidemiological pattern of patients reported with AFP.MethodsA cross-sectional study was carried out from January 2000 to December 2016 at the “R. Gutierrez” Children`s Hospital. All children aged <15 years who met the WHO definition for AFP were included. Stool samples were sent to the national reference laboratory to be tested for enteroviruses (non-polio enterovirus, poliovirus, Sabin, Sabin-derived)in compliance with the AFP protocol.ResultsA total of 174 cases were included; median age 62 months (IQR: 29–108); 53.5% males. No seasonality pattern was observed; 137(79%) stool samples were tested and no wild poliovirus was isolated. The median time between the onset of the paralysis and the admission was 4 days (IQR 2–9); the most common prodromal symptoms were: fever(39%),respiratory infection (35%), digestive (31%), myalgia (34%) and meningeal (5%). Symmetric paralysis (78%) without progression was the most frequent clinical presentation. The median length of stay at the hospital was 9 days (IQR 1-17). None of the patients was diagnosed as having polio vaccine related paralysis. Guillain-Barre syndrome was the most frequent final diagnosis (n = 72) followed by transverse myelitis (n = 14), botulism (n = 12) and encephalitis (n = 6). Between years 2000 and 2016 a total of eight cases of non-polio enterovirus (NPEV) were found: 6 cases of acute myelitis (AFM) associated to D68 enterovirus, clustered in winter 2016. Five of them were detected by PCR in nasopharyngeal aspirates and only one in stool samples. All of them present motor sequels.ConclusionEpidemiological surveillance of AFP allows ruling out poliovirus infection and detect other flaccid paralysis etiologies. In 2016 D-68 enterovirus AFM outbreak was detected in Argentina when conducting AFP routine surveillance. Nasopharyngeal aspirates, in AFM suspected cases, must be part of the study AFP protocol.Disclosures All authors: No reported disclosures.