Acute flaccid paralysis (AFP) surveillance: challenges and opportunities from 18 years’ experience, Spain, 1998 to 2015

Josefa Masa-Calles, Nuria Torner, Noemí López-Perea, María de Viarce Torres de Mier, Beatriz Fernández-Martínez, María Cabrerizo, Virtudes Gallardo-García, Carmen Malo, Mario Margolles, Margarita Portell, Natividad Abadía, Aniceto Blasco, Sara García-Hernández, Henar Marcos, Núria Rabella, Celia Marín, Amelia Fuentes, Isabel Losada, Juan García Gutiérrez, Alba NietoVisitación García Ortúzar, Manuel García Cenoz, José María Arteagoitia, Ángela Blanco Martínez, Ana Rivas, Daniel Castrillejo, S. Sanbonmatsu, J. M. Navarro, M. Omeñaca, C. Pérez-González, M. del Cuerpo, S. Guiral, J. M. Ramos, A. García-Fulgueiras, A. Barricarte, E. Martínez Ochoa

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14 Citations (Scopus)


© 2018, European Centre for Disease Prevention and Control (ECDC). All rights reserved. Acute flaccid paralysis (AFP) surveillance is key for global polio eradication. It allows detecting poliovirus (PV) reintroductions from endemic countries. This study describes AFP surveillance in Spain from 1998 to 2015. During this time, 678 AFP cases were reported to the Spanish National Surveillance Network. The mean notification rate was 0.58 AFP cases/100,000 population under 15 years old (range: 0.45/100,000– 0.78/100,000). Two periods (P) are described: P1 (1998–2006) with the AFP notification rate ranging from 0.66/100,000 to 0.78/100,000, peaking in 2001 (0.84/100,000); and P2 (2007–2015) when the AFP rate ranged from 0.43/100,000 to 0.57/100,000, with the lowest rate in 2009 (0.31/100,000). No poliomyelitis cases were caused by wild PV infections, although two Sabin-like PVs and one imported vaccine-derived PV-2 were detected. Overall, 23 (3.4%) cases met the hot case definition. Most cases were clinically diagnosed with Guillain–Barré syndrome (76.9%; 504/655). The adequate stool collection rate ranged from 33.3% (7/21) to 72.5% (29/40). The annual proportion of AFP cases with non-polio enterovirus findings varied widely across the study period. AFP surveillance with laboratory testing for non-polio enteroviruses must be maintained and enhanced both to monitor polio eradication and to establish sensitive surveillance for prompt detection of other enteroviruses causing serious symptoms.
Original languageEnglish
Article number1700423
Publication statusPublished - 22 Nov 2018


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