Letters to the Editor

Indian Pediatrics 2001; 38: 561-561  

Acute Flaccid Paralysis Surveillance Program

The medical records of all reported patients with a diagnosis of acute flaccid paralysis are evaluated by an Expert Group for Case Classification (constituted by the Ministry of Health and Family Welfare, Government of India) to consider whether a given case is "compatible with a diagnosis of poliomyelitis" or has convincing evidence of an alternative condition (usually Guillain Barre syndrome, traumatic neuropathy, transverse myelitis, infantile hemiplegia). In a majority of cases the child has received inpatient hospital care and has been examined by a pediatrician. Unfortunately, in a significant proportion of cases the documentation is incomplete and detailed observations are not recorded. For lack of such information many cases have to be called "compatible with polio", which label has obvious implications.

It is of utmost importance that pediatricians obtain a detailed history and carry out careful examination on every child with acute flaccid paralysis and document their findings. The clinical course and the outcome should be explicity mentioned. Whenever necessary a neurologist should be consulted and his opinion noted. It is very useful if CSF findings are available in patients with suspected Guillain Barre syndrome. Adequate stool specimens should invariably be obtained; if the child is constipated, rectal swabs can be taken. At 60-day follow up examination, the pattern of residual weakness and neurological abnomalities should be clearly recorded. Detailed documentation of such essential data will be of great help to the Expert Group for Case classification.

R.N. Srivastava,
Member,
Expert Group for Case Classification,
487, Mandakini Enclave,
New Delhi 110 019, India
E-mail: [email protected]