{ "schema_version": 1, "kind": "condition", "id": "acute-flaccid-paralysis", "name": "Acute flaccid paralysis (polio surveillance)", "category": "emergency", "sources": "Poliomyelitis - StatPearls (NCBI Bookshelf NBK558944) - https://www.ncbi.nlm.nih.gov/books/NBK558944/ · Acute Flaccid Myelitis - StatPearls (NCBI Bookshelf NBK606127) - https://www.ncbi.nlm.nih.gov/books/NBK606127/ · Acute flaccid paralysis - disease-level clinical article (acute-flaccid-paralysis-full.txt) · Acute flaccid paralysis - disease-level clinical article (acute-flaccid-paralysis-clinical.txt) · No dose - referral pathway, no medicine given in primary care", "review_status": "reviewed", "verified_against": "Poliomyelitis - StatPearls (NCBI Bookshelf NBK558944) - https://www.ncbi.nlm.nih.gov/books/NBK558944/ · Acute Flaccid Myelitis - StatPearls (NCBI Bookshelf NBK606127) - https://www.ncbi.nlm.nih.gov/books/NBK606127/ · Acute flaccid paralysis - disease-level clinical article (acute-flaccid-paralysis-full.txt) · Acute flaccid paralysis - disease-level clinical article (acute-flaccid-paralysis-clinical.txt) · No dose - referral pathway, no medicine given in primary care", "verified_date": "2026-08", "treatments": [ { "id": 51, "generic": "NOTIFY TODAY and send two stools - do this first", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Poliomyelitis - StatPearls (NCBI Bookshelf NBK558944) - https://www.ncbi.nlm.nih.gov/books/NBK558944/", "rationale": "Any child under 15 with new floppy weakness is a polio-surveillance case until proved otherwise, and the reporting clock is 24 hours. Notification and stool collection come before the diagnosis is settled, because the samples stop being useful after day 14 and the public-health response cannot start without them.", "cautions": [ "REPORT WITHIN 24 HOURS - the WHO requires every country to report urgently, inside 24 hours, any case of acute flaccid paralysis in someone under 15, and anyone in whom polio is suspected. That is every country, so it is Egypt too. Telephone the district health office the same day; do not wait for a laboratory result, a specialist opinion, or the next working day.", "TWO STOOLS, 24 HOURS APART, WITHIN 14 DAYS. The CDC's requirement, as the article reports it, is 2 specimens with a minimum of 24 hours between them, both taken inside the first 14 days from the onset of the paralysis. The surveillance standard is stricter still: 2 samples, a day or more apart, inside 14 days of onset, and the cool chain unbroken all the way through transit. A late sample, or a warm one, is a missed case.", "STOOL IS THE SPECIMEN, NOT BLOOD AND NOT CSF - poliovirus is looked for by viral culture, or by detecting viral RNA, in stool, or in a throat swab or throat irrigation. Two negatives that mean nothing: finding the virus in cerebrospinal fluid is uncommon, so a negative CSF result does NOT exclude polio; and serology does not help, because anti-polio antibodies are so widespread from vaccination and from earlier symptomless infection.", "WHAT MAKES IT SUSPICIOUS - suspect polio where flaccid paralysis comes on acutely, the tendon reflexes are reduced or gone, and there is no sensory or cognitive deficit. A purely motor deficit appearing rapidly after a flu-like prodrome, with nothing sensory and nothing cognitive, points to paralytic polio. But not every patient reports a prodrome at all.", "A VACCINATED CHILD IS NOT EXCLUDED, AND NEITHER IS A CHILD IN A POLIO-FREE COUNTRY - vaccine-derived strains cause paralytic disease that cannot be told apart from wild-type polio, and they complicate eradication. Outbreaks still crop up now and then, including in countries that had been declared free of polio. Notify on the clinical picture, not on the vaccination card.", "MOST ACUTE FLACCID PARALYSIS IS NOT POLIO, AND THAT IS THE POINT - worldwide the rate is about 1 case in every 100,000 children under 15 each year, and other enteroviruses cause it more often than poliovirus does. Surveillance works by reporting all of them; a system that only reports the ones that look like polio finds nothing.", "REPORTING ROUTE - the cached article gives the United States route: \"All suspected cases of poliomyelitis in the United States should be immediately reported to the United States Centers for Disease Control and Prevention (CDC).\" The Egyptian equivalent is the Ministry of Health surveillance system through the district health office, and no cached document sets out that route, so the local telephone number is not printed here. Find it once and keep it by the telephone." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "acute-flaccid-paralysis" }, { "id": 52, "generic": "Referral & safety-netting (no drug therapy)", "line": 2, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Poliomyelitis - StatPearls (NCBI Bookshelf NBK558944) - https://www.ncbi.nlm.nih.gov/books/NBK558944/", "rationale": "Admission is for the airway and the swallow, not for a drug. No antiviral exists, so the whole of hospital care is support, and the reason to move the child today is that bulbar and respiratory involvement kills.", "cautions": [ "THERE IS NO ANTIVIRAL - no effective antiviral exists for acute poliomyelitis, so treatment is supportive throughout: something for fever and for irritation, keeping respiratory infection away, and mechanical ventilation where the breathing muscles are paralysed. Nothing on this page substitutes for admission.", "WHY IT IS URGENT - of those who develop poliomyelitis, meaning symptomatic infection, 10% to 15% die, from bulbar involvement, with the respiratory and cardiovascular systems collapsing. Weak cough, pooling secretions, a change in the voice or a struggling swallow are the signs that the child needs ventilatory support now.", "SEPARATE GUILLAIN-BARRE FROM POLIO, BUT NOTIFY EITHER WAY - Guillain-Barre syndrome is another common cause of acute flaccid paralysis, and it separates from polio clinically: it ascends, it is symmetrical, it comes with sensory loss, and there are no meningeal symptoms beforehand. The limbs help too - paralytic polio hits the lower limbs predominantly, while acute flaccid paralysis from the other enteroviruses tends to favour an upper limb.", "THE OTHER CAUSES WORTH HOLDING IN MIND - infections that can look the same: rabies, West Nile virus, Japanese encephalitis virus, varicella-zoster virus, adeno-associated virus, and Clostridium botulinum. Non-infectious ones: myasthenia gravis, Lambert-Eaton myasthenic syndrome, transverse myelitis, an acquired axonal neuropathy, and infarction of the spinal cord.", "SPLINTS AND PHYSIOTHERAPY ARE NOT COSMETIC - physiotherapists use splints to take the pain and the spasm down, and splints matter just as much for keeping deformity from developing. Recovery is long: it can run to 2 years, with the greatest improvement in the first 6 months. Around 60% of polio survivors are left with a permanent deficit.", "THE COMPANION ARTICLE, FOR THE NON-POLIO CASES - the polio chapter points by name at StatPearls' companion article on Acute Flaccid Myelitis, for acute flaccid paralysis linked to other viruses. Both are cached here." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "acute-flaccid-paralysis" } ] }