Acute Flaccid Paralysis in Australian Children from 2007 to 2017

Junchao Bao; Carlos Nunez; Elizabeth Elliott; Nicole Dinsmore; Jocelynne McRae; Anne Morris; Christropher C Blyth; Nigel Crawford; Anne Kynaston; Helen Marshall; Bruce Thorley; Peter McIntyre; Philip N Britton; PAEDS Investigators and APSU Contributors

doi:10.1159/000528293

Acute Flaccid Paralysis in Australian Children from 2007 to 2017

Neuroepidemiology. 2023;57(1):25-34. doi: 10.1159/000528293. Epub 2022 Dec 7.

Authors

Junchao Bao¹, Carlos Nunez^{1

2}, Elizabeth Elliott^{1

2}, Nicole Dinsmore³, Jocelynne McRae³, Anne Morris², Christropher C Blyth^{4

5}, Nigel Crawford^{6

7}, Anne Kynaston⁸, Helen Marshall^{9

10}, Bruce Thorley¹¹, Peter McIntyre^{2

3

12}, Philip N Britton^{1

3}; PAEDS Investigators and APSU Contributors

Affiliations

¹ Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.
² Australian Paediatric Surveillance Unit, Westmead, New South Wales, Australia.
³ Paediatric Active Enhanced Disease Surveillance Network, National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia.
⁴ Perth Children's Hospital, Perth, Washington, Australia.
⁵ Telethon Kids Institute and School of Medicine, University of Western, Perth, Washington, Australia.
⁶ Murdoch Children's Research Institute and Royal Children's Hospital, Melbourne, Victoria, Australia.
⁷ Department of Paediatrics,University of Melbourne, Parkville, Victoria, Australia.
⁸ Children's Health Queensland, Brisbane, Queensland, Australia.
⁹ Women's and Children's Health Network, North Adelaide, South Australia, Australia.
¹⁰ Robinson Research Institute and the Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
¹¹ National Enterovirus Reference Laboratory, Victoria Infectious Diseases Reference Laboratory, Melbourne, Victoria, Australia.
¹² Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.

PMID: 36477594
DOI: 10.1159/000528293

Abstract

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.

Keywords: Acute flaccid paralysis; Epidemiology; Surveillance.

MeSH terms

Australia / epidemiology
Central Nervous System Viral Diseases
Child
Female
Humans
Infant
Male
Myelitis
Neuromuscular Diseases
Paralysis / diagnosis
Paralysis / epidemiology
Paralysis / etiology
Poliomyelitis* / complications
Poliomyelitis* / epidemiology
Population Surveillance
Prospective Studies
alpha-Fetoproteins*

Substances

alpha-Fetoproteins

Supplementary concepts

acute flaccid myelitis