Acute Flaccid Paralysis: 17-year‘s active epidemiological surveillance in a pediatric hospital in Buenos Aires

Abstract

Background: The surveillance of acute flaccid paralysis (AFP) is a key strategy for monitoring the progress of poliomyelitis eradication. The aim of this study was to describe the epidemiological pattern of patients reported with AFP. Methods & Materials: A 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. The 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. Results: A total of 174 cases were included; median age was 62 months (IQR: 29-108); 53.5% were males. No seasonality pattern was observed along the study period; 137 (79%) stool samples were tested and no 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 more 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 acute poliomyelitis or polio-compatible 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). During winter 2016 a cluster of 6 cases of acute myelitis associated to D68 enteroviruses was reported. Conclusion: Although poliovirus is no longer endemic in the Americas, there is still the possibility of having imported cases. Epidemiological surveillance of AFP allows ruling out poliovirus infection and quickly detecting other etiologies causing flaccid paralysis.