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Acute Flaccid Paralysis in Australian Children from 2007 to 2017
Junchao Bao1, Carlos Nunez1,2, Elizabeth Elliott1,2
1Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.
Insights
Acute flaccid paralysis (AFP) surveillance in Australian children revealed Guillain-Barre syndrome, transverse myelitis, and acute disseminated encephalomyelitis as primary causes. Ongoing vigilance is crucial due to emerging infectious disease threats like non-polio enterovirus.
Area of Science:
- Pediatric Neurology
- Infectious Disease Epidemiology
- Public Health Surveillance
Background:
- Global poliomyelitis eradication efforts rely on acute flaccid paralysis (AFP) surveillance.
- AFP surveillance in Australia involves multiple agencies to exclude poliovirus.
- Understanding childhood AFP epidemiology is vital for public health.
Purpose of the Study:
- To describe the epidemiology of AFP in Australian children over an 11-year period (2007-2017).
- To identify the primary causes and trends of AFP in children.
- To assess the impact of non-polio enterovirus on AFP incidence.
Main Methods:
- Prospective surveillance data from the Australian Paediatric Surveillance Unit (APSU), PAEDS network, and NERL were combined.
- Analysis included epidemiological trends, clinical features, and investigations for children aged 0-15 years with AFP.
- Datasets were analyzed for annual incidence, major diagnoses, and temporal patterns.
Main Results:
- A total of 590 AFP-compatible cases were identified, with an annual incidence of 1.3 per 100,000 children.
- Guillain-Barre syndrome (36%), transverse myelitis (17%), and acute disseminated encephalomyelitis (15%) were the most frequent diagnoses.
- Increased AFP frequency in 2013 and 2016 correlated with non-polio enterovirus detection.
Conclusions:
- Guillain-Barre syndrome, transverse myelitis, and ADEM are the leading causes of AFP in Australian children.
- AFP incidence remained stable between 2007 and 2017, with rates comparable to international data.
- Clustering of cases linked to non-polio enterovirus highlights the need for continued surveillance against emerging infectious threats.
Introduction:
Acute flaccid paralysis (AFP) surveillance continues globally as part of the World Health Organization's goal to eradicate poliomyelitis. The Australian Paediatric Surveillance Unit (APSU), Paediatric Active Enhanced Disease Surveillance (PAEDS) network, and National Enterovirus Reference Laboratory (NERL) collaborate in AFP surveillance in Australia, capturing and reviewing cases of AFP for all aetiologies in order to exclude poliovirus. We aimed to describe the AFP epidemiology in childhood over an 11 year period.
Methods:
Data were reported nationally by paediatricians via prospective APSU surveillance, PAEDS surveillance nurses at five tertiary paediatric hospitals and NERL from 2007 to 2017. Children aged 0-15 years with AFP were included. We combined APSU, PAEDS, and NERL datasets, analysed epidemiological trends, and described clinical features and investigations for major diagnoses.
Results:
Of 590 AFP-compatible cases, 49% were male; 47% were aged 0-4 years, 9% aged <1 year. Annual incidence of AFP was 1.3 cases per 100,000 children aged <15 years. Lower limb paralysis was the most frequent presenting symptom. The most frequent diagnoses were Guillain-Barre syndrome (GBS; 36%), transverse myelitis (TM; 17%), and acute disseminated encephalomyelitis (ADEM; 15%). No secular trend was seen in frequency of AFP cases nor amongst major diagnoses. Seasonality was observed with ADEM occurring more frequently in winter. We observed periods of increased AFP frequency in 2013 and 2016, coinciding with increased reporting of non-polio anterior horn cell disease (AHCD) and detection of non-polio enterovirus (NPEV).
Conclusions:
Estimated incidence of GBS, ADEM, and TM in Australian children was comparable with international rates. There was stable incidence of AFP in Australian children between 2007 and 2017. GBS, ADEM, and TM are the major causes of AFP. We observed clustering of cases associated with NPEV that emphasises a need for ongoing vigilance in surveillance given continue emerging infectious disease threats.
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