Acute Flaccid Paralysis in Children: Active Surveillance for Poliomyelitis ♦ 880

Abstract

Objective: To determine the epidemiologic, clinical and etiologic factors associated with acute flaccid paralysis(AFP) in children and their relationship to concurrent childhood immunizations. Background: No cases of wild-type poliovirus disease have occured in the Western Hemisphere since 1991. While poliomyelitis continues to occur in some areas of the world, the world-wide incidence of poliomyelitis has dramatically decreased in the past decade as a result of the global poliomyelitis eradication initiative of the World Health Organization. Active surveillance of cases of AFP is required to confirm regions remain free of poliomyelitis. Design/Methods: Eleven pediatric tertiary care hospitals across Canada participating in the Immunization Monitoring Program, ACTive (IMPACT), of the Canadian Pediatric Society, conducted active surveillance for cases of AFP. Children with AFP admitted to any of the centres from 1991 to 1996 were identified by intensive case surveillance on the wards, and thorough searches through hospital records and coded discharge summaries. Outcome measures included age, clinical features, immunization history, diagnostic investigations, treatment, and final etiologic diagnosis. Results: The total number of cases of AFP was 122 children with a mean of 2.6 cases per hospital per year. Age distribution was random. Most children (94%) had no previous neurological history, but the majority (75%) had a preceding non-neurological illness. Immunization history was complete for 88 (72%) children. The majority, 94(77%) cases of AFP, were diagnosed with Guillan-Barre syndrome. An etiological diagnosis for AFP was established in 31 (25%) children. There were no cases of vaccine-associated paralysis and no cases of poliomyelitis. Conclusions: A five year multicentre hospital-based study reveals that the most frequent cause of childhood AFP is Guillain-Barre syndrome followed by transverse myelitis. There were no cases of AFP associated with poliomyelitis or vaccination. Active surveillance should continue until global eradication of poliomyelitis is acheived.