Letters to the Editor

Indian Pediatrics 2001; 38: 561-562  

Clinico-Virological Profile of Acute Flaccid Paralysis at a Referral Hospital

Acute Flaccid Paralysis (AFP) surveillance is an essential component of the strategy to eradicate poliomyelitis and is being imple-mented in India since 1997. This prospective hospital based observational study presents clinical and virological profile of cases referred for evaluation of AFP over 15 month period from April 1998 to June 1999. All cases of AFP below 15 years of age who presented between April ’98 to June ’99 were evaluated prospectively. Two stool samples, 24-48 hours apart were collected in 28 children and sent to Central Research Laboratory, Mumbai with due care for maintenance of reverse cold chain. Follow-up after 60 days was done in surviving children to look for residual paralysis.

Thirty children fulfilling the criteria of AFP were evaluated(1,2). About 2/3rd were <5 years of age. Almost 1/3rd had received intra-muscular injection prior to the onset of paralysis. Three or more doses of OPV were received by 76.6% children. In 3 children there was history of trauma preceeding the weakness. Wild polio virus was isolated in 2 cases (P1 in both), vaccine virus in 2 (P2 in one and P1 + P3 in another) and non-polio enteroviruses (NPEV) in 4. CSF showed albumino-cytological dissociation in 4 cases. Two children died. Eleven had residual paralysis on 60 days follow up.

Two children in whom wild polio virus was isolated did not have classicial clinical picture of polio at presentation(3) and did not have residual weakness at 60 days follow-up. It is possible that these two children had just infection with wild polio virus which did not produce the disease. Wild virus was not isolated in any of the 11 children with residual paralysis.

In conclusion, AFP can be caused by disease other then polio and residual paralysis at 60 days follow-up can be due to causes other than polio.

Authors wish to thank Dr. A.K. Gurha, Suveillance Officer, Jabalpur and staff of NPSP, Jabalpur for their help.

R. Kumar,
V.K. Bhardwaj,
M. Chansoria,
NSCB Medical College,
Jabalpur, MP, India.

1. Thacker N, Shendurnikar N. Polio Eradication: Operational Manual. Kutch Branch, Indian Academy of Pediatrics, Rajkot, Kitabghar Printer, 1997.

2. Thacker N, Shendurnikar N. Global Polio Eradication: Progress and Challenges. Kutch Branch, Indian Academy of Pediatrics, Rajkot, Kitabghar Printer, 1997.

3. Cherry JD. Enteroviruses. In: Nelson Textbook of Pediatrics, 13th edn. Eds. Behrman RE, Vaughan VC. Philadelphia, W.B. Saunders Company, 1987, pp 690-692.