Acute flaccid paralysis surveillance: A 6 years study, Isfahan, Iran

Naeini, Alireza Emami; Ghazavi, Mohamadreza; Moghim, Sharareh; Sabaghi, Amirhosein; Fadaei, Reza

Acute flaccid paralysis surveillance: A 6 years study, Isfahan, Iran

Authors

¹ Department of Infectious Diseases and Tropical Medicine, Infectious Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

² Department of Pediatrics, Isfahan University of Medical Sciences, Isfahan, Iran

³ Department of General Physician, Isfahan University of Medical Sciences, Isfahan, Iran

⁴ Department of Virology, Isfahan University of Medical Sciences, Isfahan, Iran

⁵ Infectious Diseases Specialist, Health Care Center, Isfahan, Iran

Abstract

Background: Poliomyelitis is still an endemic disease in many areas of the world including Africa and South Asia. Iran is polio free since 2001. However, due to endemicity of polio in neighboring countries of Iran, the risk of polio importation and re-emergence of wild polio virus is high. Case definition through surveillance system is a well-defined method for maintenance of polio eradication in polio free countries.
Methods: In a cross-sectional survey from 2007 to 2013, we reviewed all the records of under 15 years old patients reported to Acute Flaccid Paralysis Committee (AFPC) in Isfahan province, Iran. All cases were visited by members of the AFPC. Three stool samples were collected from each reported case within 2 weeks of onset of paralysis and sent to National Polio Laboratory in Tehran, Iran, for poliovirus isolation. Data were analyzed by SSPS software (version 22). Student's t-test and Chi-square was used to compare variables. Statistical significance level was set at P < 0.05.
Results: In this 6-year period 85 cases were analyzed, 54 patients were male (63.5%) and 31 were female (36.5%). The mean age of patients was 5.7 ± 3.9 years. The most common cause of paralysis among these patients was Guillian-Barrι syndrome (83.5%). We did not found any poliomyelitis caused by wild polio virus. Only one case of vaccine associated poliomyelitis was reported.
Conclusion: Since 1992, Iran has a routine and high percent coverage of polio vaccination program for infants (>94%), with six doses of oral polio vaccine (OPV). Accurate surveillance for poliomyelitis is essential for continuing eradication.

Keywords

References

1.	Alberta Health and Wellness. Public Health Notifiable Diseases Management Guidelines; August 2011.
2.	Kliegman RM, Stanton BF, Schor NF, St Geme JW, Behrman RE. Nelson Textbook of Pediatrics. 20 ^th ed., Vol. 241. Philadelphia: Elsevier Saunders; 2011. p. 1084-6.
3.	Zahraei SM, Sadrizadeh B, Gouya MM. Eradication of poliomyelitis in Iran, a historical perspective. Iran J Public Health 2010; 38:124.
4.	Global Polio Eradication Initiative. Available from: http://www.polioeradication. Org. [Last cited on 2010 Apr 13].
5.	Progress towards interrupting wild poliovirus transmission worldwide: January 2010-March 2011. Wkly Epidemiol Rec 2011; 86:199-204.
6.	Salk JE. Studies in human subjects on active immunization against poliomyelitis. I. A preliminary report of experiments in progress. J Am Med Assoc 1953; 151:1081-98.
7.	Mandell GL, Bennet JE, Dolin R. Principles and Practice of Infectious Diseases. 8 ^th ed., Vol. 171. Philadelphia: Elsevier Saunders; 2015. p. 2345-50.
8.	Cochi SL, Kew O. Polio today: Are we on the verge of global eradication? J Am Med Assoc 2008; 300:839.
9.	Acute Flaccid Paralysis Surveillance. HSE Health Protection Surveillance Centre. Available from: http://www.hpsc.ie.
10.	Yuki N, Hartung HP. Guillain-Barré syndrome. N Engl J Med 2012; 366:2294-304.
11.	Poropatich KO, Walker CL, Black RE. Quantifying the association between Campylobacter infection and Guillain-Barré syndrome: A systematic review. J Health Popul Nutr 2010; 28:545-52.
12.	Tam CC, O'Brien SJ, Petersen I, Islam A, Hayward A, Rodrigues LC. Guillain-Barré syndrome and preceding infection with campylobacter, influenza and Epstein-Barr virus in the general practice research database. PLoS One 2007; 2:e344.
13.	Kang JH, Sheu JJ, Lin HC. Increased risk of Guillain-Barré Syndrome following recent herpes zoster: A population-based study across Taiwan. Clin Infect Dis 2010; 51:525-30.
14.	Orlikowski D, Porcher R, Sivadon-Tardy V, Quincampoix JC, Raphaël JC, Durand MC, et al. Guillain-Barré syndrome following primary cytomegalovirus infection: A prospective cohort study. Clin Infect Dis 2011; 52:837-44.
15.	Goldschmidt B, Menonna J, Fortunato J, Dowling P, Cook S. Mycoplasma antibody in Guillain-Barré syndrome and other neurological disorders. Ann Neurol 1980; 7:108-12.
16.	Kaye EM, Van der Knaap MS. Disorders primarily of white matter. In: Swaiman KF, Ashwal S, Ferriero DM. Principle and Practice of Pediatric Neurology. 4 ^th ed., Vol. 60. Philadelphia: Elsevier Saunders; 2012. p. 1351-2.
17.	Candler PM, Dale RC. Three cases of central nervous system complications associated with Mycoplasma pneumonia. Pediatr Neurol 2004; 31:133-8.
18.	Wolf VL, Lupo PJ, Lotze TE. Pediatric acute transverse myelitis overview and differential diagnosis. J Child Neurol 2012; 27:1426-36.
19.	Lionnet F, Pulik M, Genet P, Petitdidier C, Davous P, Lebon P, et al. Myelitis due to varicella-zoster virus in two patients with AIDS: Successful treatment with acyclovir. Clin Infect Dis 1996; 22:138-40.
20.	U.S. National Library of Medicine, National Institute of Health. URL of this page. Available from: http//www.nlm.nih.gov.
21.	Newman PK, Terenty TR, Foster JB. Some observations on the pathogenesis of syringomyelia. J Neurol Neurosurg Psychiatry 1981; 44:964-9.
22.	Centers for Disease Control and Prevention (CDC). Wild poliovirus transmission in bordering areas of Iran, Iraq, Syria, and Turkey, 1997-June 1998. MMWR Morb Mortal Wkly Rep 1998; 47:588-92.
23.	Shahmahmoodi S, Mamishi S, Aghamohammadi A, Aghazadeh N, Tabatabaie H, Gooya MM, et al. Vaccine-associated paralytic poliomyelitis in immunodeficient children, Iran, 1995-2008. Emerg Infect Dis 2010; 16:1133-6.
24.	Martín J. Vaccine-derived poliovirus from long term excretors and the end game of polio eradication. Biologicals 2006; 34:117-22.

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