Non-polio Acute Flaccid Paralysis Research Articles

Acute Flaccid Paralysis Surveillance in Central of Iran, 2003 To 2007: a Multicenter Study

Purpose: To examine the national program indicators for Acute flaccid paralysis (AFP) surveillance system in Isfahan and Markazi provinces of Iran. Methods: This is an evaluation study assessing indicators of acute flaccid paralysis surveillance system in Isfahan and Markazi provinces. All data registered for suspected AFP cases in departments of communicable diseases in health deputy of the mentioned provinces were reviewed. These documents included linear lists, patient records, national polio lab results, and classification committee reports. Demographic information and specific AFP surveillance indicators such as AFP number and non-polio AFP rate were obtained and calculated exactly, finally being compared with the available standards. Data analysis was performed by SPSS statistical software package. Results: Five-year mean values for all indicators (AFP number, non-polio AFP rate, AFP reported and tested within 48 hours of onset , AFP detected after 7 days, AFP with two stool specimens in 14 days, Stool specimens send to lab in 3 days , AFP cases followed up in 60 days) in both provinces were above the standard rate. Conclusion: Our study showed AFP surveillance system in central parts of Iran worked effectively and appropriately, however, it is necessary to regularly monitor ongoing process of this sensitive surveillance system.

Detecting Guillain-Barré syndrome caused by Zika virus using systems developed for polio surveillance.

Zika virus disease is caused by a ribonucleic acid (RNA) virus, which is transmitted to humans by mosquitoes of the Aedes aegypti species. Around 80% of infections are asymptomatic. (1) Symptomatic infections are characterized by mild fever lasting from four to seven days, associated with maculopapular rash, arthralgia, conjunctivitis, muscle pain and headache. Until recently, Zika virus disease has never been associated with deaths, intrauterine infections, or congenital anomalies. In 2013 and 2014, during an outbreak in French Polynesia, the disease was linked with GuillainBarre syndrome. (2) Zika infection can be established by detection of Zika virus RNA or specific viral antigens in human clinical samples. It is suspected that over 40 countries had autochthonous Zika virus transmission in 2015 and early 2016. (3,4) In some countries, there is a temporal association of Zika virus infections with severe clinical manifestations, particularly Guillain-Barre syndrome and congenital neurological malformations. (3,4) In December 2015, officials from the Brazilian Ministry of Health reported 76 patients diagnosed with neurological syndromes, of whom 42 (55%) were confirmed as having Guillain-Barre syndrome. (4) Similarly, between December 2015 and January 2016, Salvadorian health officials reported 46 patients with Guillain-Barre syndrome, more than 50% of whom had febrile illness lasting between seven to 15 days before onset of the syndrome. (4) A case-control study conducted in 2013 and 2014 in French Polynesia has shown evidence of Zika virus infections causing Guillain-Barre syndrome. (2) The French Polynesia study found, in most of the patients, neurological symptoms following Zika virus infections lasted a median of six days. (2) With increasing evidence of linkages between Guillain-Barre syndrome and Zika virus infection, (2-4) it is imperative to enhance Guillain-Barre syndrome surveillance. This can be done using existing surveillance systems like the one for acute flaccid paralysis (AFP) used by polio eradication programmes. (5) Scientists warn that in view of outbreaks that occurred in Africa, south-east Asia, the Pacific Islands, and the Americas, the disease now has pandemic potential. (6) In February 2016, the World Health Organization (WHO) declared that the reported clusters of microcephaly and other neurological disorders from the WHO Region of the Americas constituted a Public Health Emergency of International Concern and recommended to enhance surveillance for Zika virus infection. (7) The Aedes species of mosquitoes that transmits the Zika virus and other infections like dengue, chikungunya and yellow fever exists worldwide, posing a high risk for global transmission. (6) A 2016 modelling study looking at the potential for Zika virus spread predicted substantial international spread by travellers from Brazil to the rest of the world. (8) Many cases of microcephaly and Guillain-Barre syndrome are now being reported from countries affected by Zika. (2,4) Surveillance for timely detection and monitoring of Zika infection and screening for microcephaly and Guillain-Barre syndrome will be essential to guide the public health response. Governments and other stakeholders use existing AFP surveillance systems in countries to monitor progress towards a global polio eradication goal. (9) Currently, 91% (177 out of 194) of WHO Member States conduct AFP surveillance. Reporting of AFP in children younger than 15 years is followed by laboratory diagnosis of stool specimens to either confirm polio or identify nonpolio AFP cases. Guillain-Barre syndrome cases are classified as non-polio AFP cases. Guillain-Barre syndrome is the most common non-polio cause for AFP. Most countries achieve or surpass the global standard of an annual rate of at least one case of non-polio AFP per 100000 population of children younger than 15 years. In 2015, globally, 99 582 AFP cases among children younger than 15 years, including 72 laboratory-confirmed wild poliovirus cases, were reported. …

Profiling the immunity status of children with non-polio acute flaccid paralysis who had not received any doses of oral polio vaccine in the South–South region, Nigeria 2011–2014

ObjectivesTo demonstrate the immunity status of children with non-polio acute flaccid paralysis (NP AFP) reported through the AFP surveillance system in the South–South region of Nigeria. Study designA retrospective study was conducted using AFP surveillance data collected routinely between January 2011 and December 2014 by the Disease Surveillance Department of the regional health service and the World Health Organization (WHO)-accredited regional reference polio laboratory. All cases of AFP reported to the Disease Surveillance Network from all six zones during this period were included in the study. MethodsIn total, 5111 cases of AFP in children aged ≤15 years were reported between 2011 and 2014. These cases were investigated and verified by WHO surveillance officers using a standard questionnaire, which captured the number of doses of oral polio vaccine (OPV) received by the child. Two stool samples were collected for each case, 24–48 h apart, within 14 days of the onset of paralysis, and transported to the national polio laboratory under reverse cold chain storage. Data retrieved were stored in an AFP database hosted by the WHO server. EPIINFO software was used to query the database and extract the information required for analysis in this study. ResultsThe percentage of children who had received at least three doses of OPV (which serves as a threshold to measure immunity status) decreased from 87% in 2011 to 82% in 2014. The percentage of children who had not received any doses of OPV decreased from 2% in 2011 to 1% in 2014. Forty-eight percent of the children who had not received any doses of OPV were aged <1 year. ConclusionGiven the decrease in OPV immunity status, the region risks re-introduction of poliovirus. Swift steps should be taken to improve the immunization coverage, which would boost immunity status in Nigeria.

Faster Detection of Poliomyelitis Outbreaks to Support Polio Eradication.

As the global eradication of poliomyelitis approaches the final stages, prompt detection of new outbreaks is critical to enable a fast and effective outbreak response. Surveillance relies on reporting of acute flaccid paralysis (AFP) cases and laboratory confirmation through isolation of poliovirus from stool. However, delayed sample collection and testing can delay outbreak detection. We investigated whether weekly testing for clusters of AFP by location and time, using the Kulldorff scan statistic, could provide an early warning for outbreaks in 20 countries. A mixed-effects regression model was used to predict background rates of nonpolio AFP at the district level. In Tajikistan and Congo, testing for AFP clusters would have resulted in an outbreak warning 39 and 11 days, respectively, before official confirmation of large outbreaks. This method has relatively high specificity and could be integrated into the current polio information system to support rapid outbreak response activities.

A Critical Look at 2015 Acute Flaccid Paralysis (AFP) Surveillance Core Indicators of Bauchi State, Nigeria

<i>Background: </i>Poliomyelitis, a disease that predominantly affects children under the age of five years, is a highly infectious viral disease transmitted through the faeco-oral route. The disease could result in irreversible paralysis in 1:200 infections and has a case fatality rate of 5-10% especially when the respiratory muscles become immobilized. The Global Polio Eradication Initiatives (GPEI) is a partnership between international organizations and governments of countries and other stakeholders aimed at polio eradication across the globe through the use of strategies such as improved AFP surveillance, strengthening routine immunizations, and supplemental immunization activities. Importantly, the use of polio vaccine in multiple times on a child confers lifelong immunity against the disease. <i>Study Design: </i>Retrospective study <i>Methods: </i>Quantitative cross-sectional study of AFP cases reported across the 20 local government areas (LGA) of Bauchi State, northeastern Nigeria. The data was collected between 1^st January 2015 and 31^st December 2015. <i>Results: </i>Although all the 20(100%) LGAs met the non-polio AFP rate (NPAFP) of reporting at least 1 case per annum and stool adequacy, only 10(50%) LGAs met the minimum accepted NPENT rate of 10% with the remaining 10(50%) LGAs falling short of the minimum acceptable rate. Thus, the cumulative NPENT rate for Bauchi State stood at 10.3%. <i>Conclusion: </i>The 2015 AFP surveillance results from Bauchi State clearly support the remarkable progress made by Nigeria. However, there is need for future studies to establish reasons behind the remaining 10 (50%) of the LGAs in Bauchi failing short of meeting the minimum NPENT rate of 10.

Non-Polio Enteroviruses, the Neglected and Emerging Human Pathogens:Are we Waiting for the Sizzling Enterovirus Volcano to Erupt?

Enteroviruses consist of a lar ge group of pathogenic viruses, poliovirus being the notorious member . For the last several decades, all the attention and resources were directed towards control and eradication of poliomyelitis in India. There is very little research on non-polio enteroviruses (NPEVs), the cousins of poliovirus, which are associated with a wide range of diseases, especially in infants and young children. We have established an active research group on NPEVs during the last six years and showed that about 35% of non-polio acute flaccid paralysis (NP-AFP) children were positive for NPEV infections, and detected 66 serotypes in NP-AFP children, EV71 being more frequently detected followed by Echovirus 13 and CVB5. Long-term comparative epidemiological studies on NPEVs and rotavirus in acute diarrhoea revealed for the first time, that, NPEV association is as significant as that of rotavirus. A surprising observation was the contrasting seasonal prevalence between enterovus- and rotavirus-associated diarrhoea, the former predominating in non-winter months and the latter occurring primarily in the winter season. NPEVs were associated with epidemics-like outbreaks during which they were detected in up to 50% children with acute diarrhoea. In recent years, enterovirus has been identified to be associated with acute encephalitis cases in Uttar Pradesh. HFMD outbreaks have been reported in recent years, including a major outbreak in Bangalore in 2013. Since, no studies exist in India on the biology of EVs, including HFMD, we have recently initiated work on this emer ging disease. Our studies uncover an ur gent need for detailed studies on these “so far” neglected and emerging viruses for effective child health management in the country.

Serum IgG and IgA levels in polio and non-polio acute flaccid paralysis cases in western Uttar Pradesh, India.

IgG and IgA immunocompetence of children with wild poliovirus poliomyelitis and non-polio acute flaccid paralysis. 932 cases of acute flaccid paralysis, reported in 2008-2009, were tested for presence of polio and non-polio enteroviruses according to the WHO standards. Serum IgA and IgG levels were determined by sandwich ELISA. Mean (SD) IgA levels [0.87 (0.62)g/L; n=28] of virologically confirmed poliomyelitis cases were lower than those of virus negative [1.21 (0.83)g/L; n=612] and non-polio Enterovirus positive [1.22 (0.79)g/L; n=240] cases of acute flaccid paralysis. No significant difference was observed in the concentration of IgG among these groups. IgA plays an important role in protection against poliomyelitis.

Trends in Nonpolio Acute Flaccid Paralysis Incidence in India 2000 to 2013

Although the incidence of polio acute flaccid paralysis (AFP) has decreased in India, the nonpolio AFP (NPAFP) rate has increased. Nationwide, the NPAFP rate is 11.82 per 100 000 population, whereas the expected rate is 1 to 2 per 100 000 population. We examined the correlates of NPAFP to discern explanations for the increase. The incidence of polio AFP in India has decreased. However, the nonpolio AFP rate has increased since 2000. Follow-up of these cases of nonpolio AFP is not done routinely. However, one-fifth of these cases of …

Improved acute flaccid paralysis surveillance performance in the Democratic Republic of the Congo, 2010-2012.

The Democratic Republic of the Congo (DRC) began polio eradication activities in 1996. By 2001, DRC was no longer polio endemic. However, wild poliovirus (WPV) transmission was reestablished in 2006 continuing through 2011 (last WPV case onset 20 December 2011), and vaccine-derived poliovirus type 2 (VDPV2) outbreaks occurred during 2004-2012 (last VDPV2 case onset 4 April 2012). Gaps in acute flaccid paralysis (AFP) surveillance have been consistently documented. AFP surveillance indicators were assessed at the national, provincial, and zone de santé (ZS) levels for 2010-2012. A spatiotemporal analysis of compatible, WPV type 1 (WPV1), and VDPV2 cases was performed. During 2010-2012, AFP cases were reported from all provinces but not every ZS, particularly in Equateur province and Province Orientale. A spatiotemporal relationship between compatible, WPV1, and VDPV2 cases was noted. Nonpolio AFP rates met objectives at national and provincial levels but were sub-optimal in certain ZS. National and provincial trends in timely stool collection, stool condition, adequate stool, and 60-day follow-up exams improved. DRC's AFP surveillance system is functional and improved during 2010-2012. Maintaining improvements and strengthening AFP case detection at the ZS level will provide further support for the apparent interruption of WPV and VDPV2 transmission.

Effectiveness of Oral Polio Vaccination Against Paralytic Poliomyelitis: A Matched Case-Control Study in Somalia

After the last case of type 1 wild poliovirus (WPV1) was reported in 2007, Somalia experienced another outbreak of WPV1 (189 cases) in 2013. We conducted a retrospective, matched case-control study to evaluate the vaccine effectiveness (VE) of oral polio vaccine (OPV). We retrieved information from the Somalia Surveillance Database. A case was defined as any case of acute flaccid paralysis (AFP) with virological confirmation of WPV1. We selected two groups of controls for each case: non-polio AFP cases ("NPAFP controls") matched to WPV1 cases by age, date of onset of paralysis and region; and asymptomatic "neighborhood controls," matched by age. Using conditional logistic regression, we estimated the VE of OPV as (1-odds ratio)×100. We matched 99 WPV cases with 99 NPAFP controls and 134 WPV1 cases with 268 neighborhood controls. Using NPAFP controls, the overall VE was 70% (95% confidence interval [CI], 37-86), 59% (2-83) among 1-3 dose recipients, 77% (95% CI, 46-91) among ≥4 dose recipients. In neighborhood controls, the overall VE was 95% (95% CI, 84-98), 92% (72-98) among 1-3 dose recipients, and 97% (89-99) among ≥4 dose recipients. When the analysis was limited to cases and controls ≤24 months old, the overall VE in NPAFP and neighborhood controls was 95% (95% CI, 65-99) and 97% (95% CI, 76-100), respectively. Among individuals who were fully vaccinated with OPV, vaccination was effective at preventing WPV1 in Somalia.

Identification and characterization of unrecognized viruses in stool samples of non-polio acute flaccid paralysis children by simplified VIDISCA.

BackgroundThe use of sequence independent methods combined with next generation sequencing for identification purposes in clinical samples appears promising and exciting results have been achieved to understand unexplained infections. One sequence independent method, Virus Discovery based on cDNA Amplified Fragment Length Polymorphism (VIDISCA) is capable of identifying viruses that would have remained unidentified in standard diagnostics or cell cultures.MethodsVIDISCA is normally combined with next generation sequencing, however, we set up a simplified VIDISCA which can be used in case next generation sequencing is not possible. Stool samples of 10 patients with unexplained acute flaccid paralysis showing cytopathic effect in rhabdomyosarcoma cells and/or mouse cells were used to test the efficiency of this method. To further characterize the viruses, VIDISCA-positive samples were amplified and sequenced with gene specific primers.ResultsSimplified VIDISCA detected seven viruses (70%) and the proportion of eukaryotic viral sequences from each sample ranged from 8.3 to 45.8%. Human enterovirus EV-B97, EV-B100, echovirus-9 and echovirus-21, human parechovirus type-3, human astrovirus probably a type-3/5 recombinant, and tetnovirus-1 were identified. Phylogenetic analysis based on the VP1 region demonstrated that the human enteroviruses are more divergent isolates circulating in the community.ConclusionOur data support that a simplified VIDISCA protocol can efficiently identify unrecognized viruses grown in cell culture with low cost, limited time without need of advanced technical expertise. Also complex data interpretation is avoided thus the method can be used as a powerful diagnostic tool in limited resources. Redesigning the routine diagnostics might lead to additional detection of previously undiagnosed viruses in clinical samples of patients.Electronic supplementary materialThe online version of this article (doi:10.1186/1743-422X-11-146) contains supplementary material, which is available to authorized users.

Polio-like disease in the news: much ado about nothing?

Polio-like disease in the news: much ado about nothing?

Remaining alert for polio importations

It has been a quarter of a century since the World Health Organization endorsed the goal of poliomyelitis eradication, and progress has been substantial. The annual poliomyelitis incidence has been reduced by more than 99%, and only three countries (Nigeria, Pakistan and Afghanistan) have never interrupted indigenous poliovirus transmission. The Western Pacific region was declared polio-free on 29 October 2000, after the last indigenous case of polio occurred in a 15-month old girl, Mum Chanty, who was paralysed in Cambodia in March 1997.1 However, while poliovirus circulates anywhere in the world, all countries are at risk of importations. In 2007 poliovirus was imported into Australia when a Melbourne University student returned from a visit to Pakistan.2 More recently, a 2011 incursion of poliovirus from Pakistan into China, which had been polio-free since 1994, required an extensive response with five mass campaigns, 44 million doses of oral poliovirus vaccine administered and a direct cost of US$26 million in outbreak response activities.3 To maintain our polio-free status and ensure early detection of poliovirus importations, Australia and New Zealand must maintain high-quality surveillance for patients presenting with acute flaccid paralysis (AFP) and collect two early stool specimens to rule out poliovirus infection as the cause. Although Australia has consistently achieved the non-polio AFP surveillance detection target of one case per 100 000 children aged less than 15 years over the past 5 years, neither Australia nor New Zealand have collected the required two stool specimens for virology from 80% of cases classified as non-polio AFP.4 These specimens are also critical for detecting novel viruses,5 like the enterovirus 71 that caused cases of AFP in Australia during 2012/2013. Paediatricians are critical players in ensuring Australia and New Zealand remain on the alert for poliovirus importations and are encouraged to immediately contact the National Enterovirus Reference Laboratory in Melbourne when a child presents with acute flaccid paralysis or Guillain–Barré syndrome.

Evaluation of the Acute Flaccid Paralysis surveillance (AFP) system in Sierra Leone, 2012

Background: Poliomyelitis is a highly infectious viral disease that affects children below the age of 15 years which is transmitted via the fecal-oral route from person to person. One in every 200 infections leads to irreversible paralysis, usually in the legs. Polio is preventable by immunization and earmarked by the World Health Organization for eradication. Sierra Leone is working toward certification of Poliomyelitis-free status. A suspected case of Polio is any child under 15 years of age with acute flaccid paralysis (AFP) or any person of any age with paralytic illness which the clinician suspects poliomyelitis involvement and a confirmed case is any suspected case from which the wild polio virus is isolated. The AFP surveillance system in Sierra Leone was evaluated to determine if the system was meeting its set objectives and to assess the system's attributes. Methods & Materials: We used guidelines developed by Centres for Disease Control and Prevention, Atlanta. We reviewed surveillance records and analysed data sets on AFP from 2005 to 2012 from the National Surveillance Unit. We also interviewed stakeholders at all levels. Results: From 2005-2012, 8 wild polio virus case were identified in the country; in 2009 six wild polio cases were identified; Bo, Moyamba, Port-Loko and Western Area (Rural) had one case each whilst Kambia had 2. In 2010 and 2011; Western Area (Rural) identified a case. The non-polio AFP rate increased from 2.4 to 6.2 cases per100,000 children below 15 years from a target of 2 cases per 100,000 children below 15 years. The AFP surveillance system is integrated with other priority diseases and has a clear case definition and external laboratory support. The system is simple, flexible, sensitive, specific, stable and well represented. Incompleteness, poor data management and analysis at the district levels are the weaknesses. Vices are poor feedback, inadequate personnel and logistics. Conclusion: The AFP surveillance system meets set objectives but needs improvement in efficiency in logistics planning, data management, data quality including completeness and analysis. Feedback from national levels to the districts and below should be monitored including timely laboratory results.

Study of acute flaccid paralysis surveillance system in Kerman (Iran) for one decade

Background — During the past decade, polio eradication has stalled globally. Acute flaccid paralysis (AFP) surveillance is a key strategy for monitoring the progress of polio eradication. All AFP patients who referred to expert committee were evaluated about the causes. Methods — This case series study is the result of activities for one decade of expert AFP committee of Kerman University of Medical Sciences from 2002-2011, with coverage of more than 2,650,000 populations and 730,677 child with age of ≤15 years old. All patients have gone under diagnostic and therapeutic managements. Results — The total cases referred to Kerman expert committee of AFP for ten years were 147 cases. In our study the incidence of AFP was 2.016 per 100000 populations for one year.The most common causes of AFP were Guillain-Barre syndrome (GBS). Other causes of AFP were; stroke, synovitis, myelitis, seizures, cerebral palsy, viral infections, tumors, cerebellitis and non-polio AFP. The rate of GBS in our study was 0.96 per 100000 in children 15 years old or smaller, and more in male. In this study the incidence rate in cities with low mean temperature was higher than in cities with high mean temperature. Conclusion — We had no polio case in this period. The most common cause of AFPs was Guillain–Barre syndrome. The incidence of GBS was higher in areas with low mean temperature.

Enhanced surveillance of acute flaccid paralysis following importation of wild poliovirus in Xinjiang Uygur Autonomous Region, China

BackgroundAfter being polio free for more than 10 years, an outbreak occurred in China in 2011 in Xinjiang Uygur Autonomous Region (Xinjiang) following the importation of wild poliovirus (WPV) originating from neighboring Pakistan.MethodsTo strengthen acute flaccid paralysis (AFP) surveillance in Xinjiang, “zero case daily reporting” and retrospective searching of AFP cases were initiated after the confirmation of the WPV outbreak. To pinpoint all the polio cases in time, AFP surveillance system was expanded to include persons of all ages in the entire population in Xinjiang.ResultsTotally, 578 AFP cases were reported in 2011 in Xinjiang, including 21 WPV cases, 23 clinical compatible polio cases and 534 non-polio AFP cases. Of the 44 polio cases, 27 (61.4%) cases were reported among adults aged 15–53 years. Strengthening AFP surveillance resulted in an increase in the number of non-polio AFP cases in 2011 (148 children < 15 years) compared with 76 cases < 15 years in 2010. The AFP surveillance system in Xinjiang was sensitive enough to detect polio cases, with the AFP incidence of 3.28/100,000 among children < 15 years of age.ConclusionsIncorporating adult cases into the AFP surveillance system is of potential value to understand the overall characteristics of the epidemic and to guide emergency responses, especially in countries facing WPV outbreak following long-term polio free status. The AFP surveillance system in Xinjiang was satisfactory despite limitations in biological sample collection.

Fifteen years of acute flaccid paralysis surveillance in Hong Kong: Findings from 1997 to 2011

Acute flaccid paralysis (AFP) surveillance system was set up in Hong Kong in 1997 for World Health Organization's (WHO) certification of poliomyelitis eradication. This paper describes and reviews the demographic, clinical and virological characteristics of AFP cases reported to the system in its first 15 years. All patients aged under 15 years presented with acute onset of paralysis of any limbs reported to the Department of Health from January 1997 to December 2011 were reviewed. Data on demographic characteristics, vaccination history, clinical presentation and virological investigation on stool specimens collected during investigation were analysed with descriptive statistics. Of the 247 cases reported, about 45% were aged under five. All cases were classified as non-polio AFP according to WHO classification. About 60% were identified with neurological disorders, with Guillain-Barré syndrome (25.9%) and myelitis (13.4%) being the most common. Viruses were detected in 14.0% of the AFP cases, with non-polio enteroviruses (NPEV) (60.0%) and adenoviruses (31.4%) accounted for most of the positive detections. Most performance indicators set by the WHO were fulfilled. The AFP surveillance facilitated the clinical, virological and epidemiological examination of paediatric AFP cases. From 1997 to 2011, Guillain-Barré syndrome and myelitis were the most common among paediatric AFP cases in Hong Kong. NPEV and adenoviruses accounted for most of the positive viral detections. No wild poliovirus was detected, and all cases were classified as non-polio AFP.

Potential for the Australian and New Zealand paediatric intensive care registry to enhance acute flaccid paralysis surveillance in Australia: a data-linkage study

BackgroundAustralia uses acute flaccid paralysis (AFP) surveillance to monitor its polio-free status. The World Health Organization criterion for a sensitive AFP surveillance system is the annual detection of at least one non-polio AFP case per 100,000 children aged less than 15 years, a target Australia has not consistently achieved. Children exhibiting AFP are likely to be hospitalised and may be admitted to an intensive care unit. This provides a potential opportunity for active AFP surveillance.MethodsA data-linkage study for the period from 1 January 2005 to 31 December 2008 compared 165 non-polio AFP cases classified by the Polio Expert Panel with 880 acute neurological presentations potentially compatible with AFP documented in the Australian and New Zealand Paediatric Intensive Care (ANZPIC) Registry.ResultsForty-two (25%) AFP cases classified by the Polio Expert Panel were matched to case records in the ANZPIC Registry. Of these, nineteen (45%) cases were classified as Guillain-Barré syndrome on both registries. Ten additional Guillain-Barré syndrome cases recorded in the ANZPIC Registry were not notified to the national AFP surveillance system.ConclusionsThe identification of a further ten AFP cases supports inclusion of intensive care units in national AFP surveillance, particularly specialist paediatric intensive care units, to identify AFP cases that may not otherwise be reported to the national surveillance system.

Genetic diversity of cosaviruses in nonpolio acute flaccid paralysis cases of undefined etiology, Northern India, 2010–2011

BackgroundNo cases of wild poliovirus have been reported for more than one and a half years from India. Cases of acute flaccid paralysis (AFP) of undefined etiology continue to occur in the region. Despite the recent discovery of the human Cosavirus (HCoSV) in the feces of children from developing countries, there have been no studies of cosavirus infection in India. ObjectivesTo detect and characterize HCoSVs in stool specimens of nonpolio AFP cases by RT-PCR followed by sequencing. Study designA total of 387 fecal samples collected from AFP cases in Uttar Pradesh, India, between May 2010 and April 2011, tested negative on cell culture according to WHO algorithm, were subjected to 5′-UTR region specific RT-PCR followed by sequencing to detect HCoSV. Molecular characterization of HCoSV strains was done by sequencing followed by phylogenetic analysis. Result123 (32%) samples tested positive for cosaviruses and 87 (70.7%) were identified for genetic variants by sequencing a 316-nucleotide interval in the partial 5′-UTR region. Cosavirus strains were characterized as putative species HCoSV-A (n=70; 82%), HCoSV-B (n=7; 8%), HCoSV-C (n=1; 1.1) and HCoSV-D (n=4; 4.5%) while 5 (5%) strains remain uncharacterized. The cosavirus infection appeared highest (63.5%) in younger children, and showed a distinct seasonality, with a late summer peak and winter low. ConclusionThis study demonstrates a diversity of cosavirus strains in circulation, and reports the first investigation of HCoSV infection in children with nonpolio acute flaccid paralysis in India. Currently, this study provides baseline data for further studies of HCoSV infections in children with common enteric infections in India.

Genetic Variants of Echovirus 13, Northern India, 2010

Nonpolio acute flaccid paralysis is increasing in India. To determine viral causes, we conducted cell culture and molecular analysis identification of nonpolio human enteroviruses associated with acute flaccid paralysis during March–August 2010 in northern India. The predominant nonpolio enterovirus found was echovirus 13, a serotype rarely isolated in India.