# Acute flaccid paralysis (polio surveillance) - Category: emergency - Review status: reviewed (every claim checked against a document named on this page) - 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 - Verified date: 2026-08 ## 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 ## Treatment metadata - NOTIFY TODAY and send two stools - do this first - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text ACUTE FLACCID PARALYSIS (POLIO SURVEILLANCE) 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 against 5 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (7) - Sudden onset of pure motor weakness without sensory loss or confusion raises concern for paralytic polio - A prodrome can include fever, feeling unwell, headache, muscle aches, tiredness, nausea and vomiting, belly pain, and a sore throat [abdominal pain · fatigue · fever · headache · malaise · muscle pain · nausea · sore throat · vomiting] - When meningitis follows the prodrome, it can bring back fever along with a stiff neck, back pain, and muscle spasms [back pain · fever · muscle cramps · neck stiffness] - Fever returning with severe muscle pain, twitching, spasms, and brisk reflexes 1 to 3 days after an apparent recovery signals paralytic polio [fever · hyperreflexia · muscle cramps · muscle pain] - Weakness develops asymmetrically, spreading from proximal to distal muscle groups - Maximum paralysis is usually reached within 2 to 4 days and rarely worsens once the fever settles [fever · paralysis] - Bladder problems, constipation, or abnormal sweating can occur from autonomic involvement [constipation · sweating] SIGNS - what you find (3) - Cranial nerve testing plus reflexes, tone, and strength in every limb should be recorded - Bulbar involvement can impair breathing control, facial or eye movement, and swallowing - Severe bulbar disease can bring on respiratory failure, autonomic crises, fast heart rate, high blood pressure, and collapse [collapse · hypertension · tachycardia] TESTS (7) - Two stool or throat specimens taken at least 24 hours apart, within the first 14 days after paralysis onset, are recommended - Stool is the preferred specimen for detecting the virus; CSF or throat secretions are alternatives - Virus shedding can persist in nasal secretions for up to 2 weeks and in stool for 3 to 6 weeks, even without symptoms - A negative spinal fluid test does not exclude polio, since finding the virus there is uncommon - Serology is not useful, since most people carry anti-polio antibodies from vaccination or past silent infection - Brain and spinal MRI can show patterns typical of polio and help exclude other causes such as spinal cord infarction - EMG changes take time to appear, showing up later in the illness course IF NOT THIS - what else fits (5) - Non-polio enteroviruses such as A71, D68, and coxsackievirus A cause AFP more often than poliovirus does now - Most other enterovirus-related AFP favors the arms rather than the legs, unlike polio - West Nile virus, varicella-zoster, Japanese encephalitis, rabies, and botulism can present similarly - Guillain-Barre syndrome differs from polio by ascending symmetric weakness, sensory loss, and no preceding meningeal symptoms - Non-infectious causes include spinal cord infarction, transverse myelitis, acquired axonal neuropathy, myasthenia gravis, and Lambert-Eaton syndrome Source Acute flaccid paralysis - disease-level clinical article (acute-flaccid-paralysis- full.txt) Status traced to the source above 1. NOTIFY TODAY AND SEND TWO STOOLS - DO THIS FIRST [1st line] Adult Source Poliomyelitis - StatPearls (NCBI Bookshelf NBK558944) - https://www.ncbi.nlm.nih.gov/books/NBK558944/ Why 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. Caution 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. 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [2nd line] Adult Source Poliomyelitis - StatPearls (NCBI Bookshelf NBK558944) - https://www.ncbi.nlm.nih.gov/books/NBK558944/ Why 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. Caution 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. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)