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Everything You Should Know About Acute Flaccid Paralysis

Acute flaccid paralysis (AFP) is a severe medical condition characterized by rapid onset of muscle weakness or paralysis and mainly affects children. The group of symptoms and signs, not a single disease, often affects muscles involved in breathing or swallowing. The condition, which often affects one leg or arm and is not typically linked to injury, primarily affects children under 15.

AFP is associated with a variety of causes, including viral infections such as poliovirus, enterovirus and adenovirus, Campylobacter infections, as well as autoimmune diseases such as Guillain-Barré syndrome (a disorder where the immune system attacks the nerves) and transverse myelitis (inflammation of the spinal cord).

AFP case definition

  • any patient who under 15 years of age with acute flaccid paralysis, or 
  • A patient of any age in whom a clinician suspect polio  
Classic example of syndromic surveillance
     Several other conditions may look like clinical polio (Ex. Guillan-Barré Syndrome)
  • True polio cases may be misdiagnosed – reporting of 'clinical polio' is not sensitive 
  • Increase sensitivity to detect remaining polio by reporting a syndrome (AFP), which should include all polio cases 
  • Acute (rapid) Flaccid (floppy) Paralysis (weakness or loss of motion)
Transmission
  • The virus is transmitted from person-to-person, mainly through the fecal-oral route and, less frequently, by a common vehicle such as contaminated water or food. It multiplies in the intestine from where it can invade the nervous system and cause paralysis and death.
  • Causes: In addition to poliovirus, a highly infectious virus that primarily affects the nervous system and can lead to severe paralysis and muscle weakness, potential causes range from other viral infections to autoimmune diseases and conditions, including transverse myelitis and Guillain-Barré syndrome.
  • Poliovirus: A highly infectious virus that primarily affects the nervous system and can lead to severe paralysis and muscle weakness, has historically been a significant cause of AFP and acute flaccid myelitis (AFM). Many cases were reported annually until the widespread adoption of polio immunization programmes reduced incidence rates.
Symptoms
  • Weakness and loss of muscle tone: Sudden onset of weakness or paralysis, usually affecting an arm or leg, accompanied by reduced muscle tone not caused by injury.
  • Facial weakness: Facial drooping, difficulty moving the eyes and drooping eyelids.
  • Speech and swallowing difficulties: Slurred speech and difficulty swallowing.
  • Sensory symptoms: Tingling or numbness in the limbs, indicating nerve involvement.
  • Respiratory issues: In severe cases of AFP difficulty breathing can lead to respiratory failure.
  • Disruption of autonomic functions: Problems controlling vital bodily processes such as heart rate and blood pressure.
  • Fever and back pain may be present, suggesting that the condition could be affecting multiple systems in the body and is not localized to one area.
  • The sudden onset of uneven paralysis, along with fever or back pain, requires immediate medical consultation, especially if there are breathing difficulties.
  • Other common symptoms such as muscle wasting, fever, trouble breathing, tingling in the hands and feet, cramps, sensory loss and loss of bladder control should prompt immediate medical attention. It is necessary to urgently find the cause of these symptoms and begin treatment to prevent further nerve damage.
  • In cases of poliomyelitis, symptoms can include fever, neck stiffness, pain in the limbs, fatigue, headache, vomiting and stiffness. The illness can progress to flaccid paralysis with reduced deep tendon reflexes, often affecting the legs more than the arms. If the trunk and muscles of the chest and abdomen are involved, it can lead to paralysis in all four limbs. In the most severe cases, it causes difficulty swallowing and speaking. Patients do not lose sensation or experience changes in cognition.

Symptoms of AFP vary widely and may include:

Other signs and symptoms:




  • There is no cure for polio, only treatment to alleviate the symptoms
  • Heat and physical therapy is used to stimulate the muscles and antispasmodic drugs are given to relax the muscles
While this can improve mobility, it cannot reverse permanent polio paralysis
  • Weakness or paralysis that remains after 12 months after onset (which occurs in two-thirds of patients with paralysis) is usually permanent
This is why we must ensure that all our target age group children are vaccinated against poliovirus.

Treatment

  • For poliomyelitis, there is no single treatment. Management focuses on symptom relief, hydration and specific treatments based on the underlying disease.
  • Physical or occupational therapy can help with arm or leg weakness caused by polio and may improve long-term outcomes, especially if started early in the illness.
  • Continuous medical follow-up and rehabilitation are essential for persistent cases to minimize long-term impacts.
  • Maintaining high population-level polio vaccine uptake is essential to prevent poliovirus-related AFP

AFP prevention measures in communities

Safe food and water practices:

Ensure that food is properly cooked, and water is treated or boiled before consumption to prevent enterovirus (a virus affecting the intestines) and other infectious causes of AFP.

In areas with limited drinking water, use seawater or saline water for cleaning, toilet flushing and bathing to save drinking water. Inspect areas where seawater is collected to make sure it is safe to use. Seawater is not suitable for drinking.

Keeping safe while on the move: Constant moving makes following standard health practices challenging. Carry soap with you for hand cleaning if available and ensure safe water consumption to prevent diseases like AFP in transient living situations.

Prioritizing at-risk groups: Individuals with autoimmune disorders, weakened immune systems and those undergoing treatments that compromise immunity (e.g. chemotherapy), should be particularly careful about AFP exposure. Rigorous water and hygiene practices are essential for these groups to prevent infection. Whenever possible, ensure vaccination against diseases like poliovirus before exposure occurs.

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