An epidemiological analysis of acute flaccid paralysis in Khuzestan Province, southwest Iran, from 2006 to 2010

Abstract

OBJECTIVES:Investigations into the epidemiology of acute flaccid paralysis (AFP) are an essential strategic component of the Global Poliomyelitis Eradication Initiative of the World Health Organization (WHO), and are part of the certification process for polio eradication worldwide. This is an epidemiological report of AFP incidence in children less than 15 years old in southwest Iran.METHODS:This was a retrospective cohort study, carried out based on WHO guidelines, in which we reviewed non-polio AFP cases recorded from January 2006 to December 2010 in different regions of Khuzestan Province, southwest Iran. In this study, the records of all children under 15 years old with AFP were evaluated.RESULTS:During a 5-year period, 137 cases of AFP were reported (incidence rate, 2.21 per 100,000 children <15 years old). More than 50% (73 of 137) of the cases were boys, and 52.6% (72 of 137) were under 5 years of age, with a mean age of 5.39±3.98 years. The incidence of AFP was significantly higher in older children (p=0.001). The most common cause of paralysis was Guillain-Barré syndrome (117 of 137). None of the cases were diagnosed with acute poliomyelitis.CONCLUSIONS:In this study, we found that the incidence rate of AFP in the region was almost in agreement with the expected incidence of AFP in children less than 15 years old; therefore, the AFP surveillance program in Khuzestan Province is satisfactory in terms of reliability and effectiveness. Nevertheless, routine vaccination against polio and ensuring that patients with AFP receive follow-up are essential for eradicating polio.

Evaluation of the Acute Flaccid Paralysis Surveillance System in Polio-Free Jordan, 2012-2016: Retrospective Secondary Analysis

“…Almost half of the patients (49.7%) had fever, and approximately one-third of the patients had asymmetric paralysis. This finding is similar to that in Iran [10]. Odoom et al [13] reported that 84.2% of cases had fever and 64.8% had asymmetric paralysis, and another study in Turkey reported that 13.6% of the total cases had fever [15].…”

“…However, importation of poliovirus remains a potential threat; therefore, it is essential to continue AFP surveillance. The study reported that half of the reported cases were of patients below 5 years of age, which is consistent with findings of a study conducted in Iran [10] and another one in Bangladesh [11]. However, higher percentages were reported in countries such as Congo (85.2%) [12] and Ghana (74.4%) [13], and lower percentages were reported in other countries including Italy (37%) [14].…”

“…GBS was the most common cause of AFP and found in 35.1% cases in Jordan. A much higher rate (85.4%) was reported in a study in Iran [10]. In South Africa, in 2013, 42.7% of the AFP cases were caused by GBS [16].…”

Initial Response and Outcome of Critically Ill Children With Guillain Barre' Syndrome

“…The most common cause of acute flaccid paralysis worldwide is Guillain Barre Syndrome (2). While some cases can be severe, rapidly progressive and life threatening; prompt supportive treatment with immunotherapy can be effective (10).…”

“…Guillain–Barre' syndrome (GBS) is an acute inflammatory polyneuropathy, characterized by possibly progressive, essentially symmetric, weakness and areflexia; with possible sensory disturbance in a previously well child (1). With an incidence of 4 per 100,000 per year, it is the most common cause of acute flaccid paralysis worldwide since the eradication of poliomyelitis and can affect all age groups (2).…”