ARCHIVED - Acute Flaccid Paralysis


Nationally notifiable since 1996

1.0 National Notification

Only clinical cases should be notified.

2.0 Type of Surveillance

Syndromic surveillance involving the following:

  1. Enhanced, active case-by-case notification by the Canadian Paediatric Surveillance Program (CPSP).
  2. Enhanced, active case-by-case notification by paediatric tertiary care hospitals involved in the Immunization Monitoring Program, Active (IMPACT).

3.0 Case Classification

3.1 Clinical case

Acute onset of focal weakness or paralysis characterized as flaccid (reduced tone) without other obvious cause (e.g. trauma) in children < 15 years old, including Guillain Barré syndrome (GBS). Transient weakness (e.g. post-ictal weakness) should not be reported.

Note: Other conditions present symptoms similar to paralytic poliomyelitis. A record is kept of all definitive diagnoses for all reported cases of AFP meeting the clinical case definition. GBS is the most common cause of AFP in childhood, but other differential diagnoses include, but are not limited to, transverse myelitis, peripheral neuropathy, enteroviruses, acute non-bacterial meningitis, brain abscess, China Syndrome and postpolio sequelae. Poliomyelitis must be distinguished from other paralytic conditions by isolation of polio virus from stool.

4.0 Laboratory Comments

5.0 Clinical Evidence

6.0 ICD Code(s)

There are no specific ICD codes for acute flaccid paralysis as it is the clinical presentation of a set of symptoms and not the final diagnosis.

7.0 Type of International Reporting

Polio is targeted for eradication. As such, it requires highly sensitive surveillance for AFP, including immediate case investigation and specimen collection. The case definitions implemented by Canada’s Working Group on Polio Eradication are standardized case definitions recommended by the WHO.

Other conditions present symptoms similar to paralytic poliomyelitis. Documenting polio-specific investigations, regardless of suspected diagnosis, is the means by which Canada maintains its polio-free certification. In addition, global surveillance indicators for certification include the detection of at least one AFP case in every 100,000 children under 15 years of age. Canadian data are reported regularly to the WHO


The Canadian clinical case definition is more specific than the WHO definition. The WHO’s Technical Advisory Group on Polio Eradication has adopted a probable case definition as being any case of acute flaccid paralysis in a person under 15 years of age for any reason other than severe trauma, or paralytic illness in a person of any age in whom polio is suspected.

9.0 References

Pan American Health Organization. Norms and standards in epidemiology: guidelines for epidemiological surveillance (malaria, poliomyelitis). Epidemiol Bull 1999;20(2):11 3.

Pan American Health Organization. Poliomyelitis Eradication Field Guide. 3rd edition. 2006. Retrieved May 2008, from eldguide_polio.pdf

The Global Polio Eradication Initiative. Retrieved May 2008, from

10.0 Previous Case Definitions

Case definitions for diseases under national surveillance. CCDR 2000;26(S3).

Date of Last Revision/Review:

May 2008

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