Clinical Assessment of Self-Reported Acute Flaccid Paralysis in a Population-Based Setting in Guatemala

James J. Sejvar Division of Viral and Rickettsial Diseases, National Center for Zoonotic and Vector-Borne Diseases (NCZVED), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; Division of Vector-Borne Infectious Diseases, NCZVED, CDC, Atlanta, Georgia; Division of Emerging Infections and Surveillance Services, National Center for Prevention, Detection, and Control of Infectious Diseases, CDC, Atlanta, Georgia; CDC–Universidad del Valle de Guatemala Collaboration, Centro de Estudios en Salud, UVG, Guatemala City, Guatemala; Johns Hopkins School of Public Health, Baltimore, Maryland

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Kim A. Lindblade Division of Viral and Rickettsial Diseases, National Center for Zoonotic and Vector-Borne Diseases (NCZVED), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; Division of Vector-Borne Infectious Diseases, NCZVED, CDC, Atlanta, Georgia; Division of Emerging Infections and Surveillance Services, National Center for Prevention, Detection, and Control of Infectious Diseases, CDC, Atlanta, Georgia; CDC–Universidad del Valle de Guatemala Collaboration, Centro de Estudios en Salud, UVG, Guatemala City, Guatemala; Johns Hopkins School of Public Health, Baltimore, Maryland

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Wences Arvelo Division of Viral and Rickettsial Diseases, National Center for Zoonotic and Vector-Borne Diseases (NCZVED), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; Division of Vector-Borne Infectious Diseases, NCZVED, CDC, Atlanta, Georgia; Division of Emerging Infections and Surveillance Services, National Center for Prevention, Detection, and Control of Infectious Diseases, CDC, Atlanta, Georgia; CDC–Universidad del Valle de Guatemala Collaboration, Centro de Estudios en Salud, UVG, Guatemala City, Guatemala; Johns Hopkins School of Public Health, Baltimore, Maryland

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Norma Padilla Division of Viral and Rickettsial Diseases, National Center for Zoonotic and Vector-Borne Diseases (NCZVED), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; Division of Vector-Borne Infectious Diseases, NCZVED, CDC, Atlanta, Georgia; Division of Emerging Infections and Surveillance Services, National Center for Prevention, Detection, and Control of Infectious Diseases, CDC, Atlanta, Georgia; CDC–Universidad del Valle de Guatemala Collaboration, Centro de Estudios en Salud, UVG, Guatemala City, Guatemala; Johns Hopkins School of Public Health, Baltimore, Maryland

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Kimberly Pringle Division of Viral and Rickettsial Diseases, National Center for Zoonotic and Vector-Borne Diseases (NCZVED), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; Division of Vector-Borne Infectious Diseases, NCZVED, CDC, Atlanta, Georgia; Division of Emerging Infections and Surveillance Services, National Center for Prevention, Detection, and Control of Infectious Diseases, CDC, Atlanta, Georgia; CDC–Universidad del Valle de Guatemala Collaboration, Centro de Estudios en Salud, UVG, Guatemala City, Guatemala; Johns Hopkins School of Public Health, Baltimore, Maryland

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Emily Zielinski-Gutierrez Division of Viral and Rickettsial Diseases, National Center for Zoonotic and Vector-Borne Diseases (NCZVED), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; Division of Vector-Borne Infectious Diseases, NCZVED, CDC, Atlanta, Georgia; Division of Emerging Infections and Surveillance Services, National Center for Prevention, Detection, and Control of Infectious Diseases, CDC, Atlanta, Georgia; CDC–Universidad del Valle de Guatemala Collaboration, Centro de Estudios en Salud, UVG, Guatemala City, Guatemala; Johns Hopkins School of Public Health, Baltimore, Maryland

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Eileen Farnon Division of Viral and Rickettsial Diseases, National Center for Zoonotic and Vector-Borne Diseases (NCZVED), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; Division of Vector-Borne Infectious Diseases, NCZVED, CDC, Atlanta, Georgia; Division of Emerging Infections and Surveillance Services, National Center for Prevention, Detection, and Control of Infectious Diseases, CDC, Atlanta, Georgia; CDC–Universidad del Valle de Guatemala Collaboration, Centro de Estudios en Salud, UVG, Guatemala City, Guatemala; Johns Hopkins School of Public Health, Baltimore, Maryland

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Lawrence B. Schonberger Division of Viral and Rickettsial Diseases, National Center for Zoonotic and Vector-Borne Diseases (NCZVED), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; Division of Vector-Borne Infectious Diseases, NCZVED, CDC, Atlanta, Georgia; Division of Emerging Infections and Surveillance Services, National Center for Prevention, Detection, and Control of Infectious Diseases, CDC, Atlanta, Georgia; CDC–Universidad del Valle de Guatemala Collaboration, Centro de Estudios en Salud, UVG, Guatemala City, Guatemala; Johns Hopkins School of Public Health, Baltimore, Maryland

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Erica Dueger Division of Viral and Rickettsial Diseases, National Center for Zoonotic and Vector-Borne Diseases (NCZVED), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; Division of Vector-Borne Infectious Diseases, NCZVED, CDC, Atlanta, Georgia; Division of Emerging Infections and Surveillance Services, National Center for Prevention, Detection, and Control of Infectious Diseases, CDC, Atlanta, Georgia; CDC–Universidad del Valle de Guatemala Collaboration, Centro de Estudios en Salud, UVG, Guatemala City, Guatemala; Johns Hopkins School of Public Health, Baltimore, Maryland

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Historically, poliovirus infection has been an important cause of acute flaccid paralysis (AFP) worldwide; however, successful elimination of wild-type poliovirus in much of the world has highlighted the importance of other causes of AFP. Despite the evolving etiology, AFP surveillance in most developing countries still focuses on poliovirus detection and fails to detect many AFP cases, particularly among adults. We assessed 41 subjects self-reporting symptoms suggestive of AFP during a population-based health survey in the Department of Santa Rosa, Guatemala. Thirty-five (85%) of the suspected cases were not hospitalized. Most subjects (37) did not have features consistent with AFP or had other diagnoses explaining weakness. We identified two adults who had not received medical attention for a clinical illness consistent with Guillain-Barré syndrome, the most important cause of non-poliovirus AFP. Usual surveillance methods for AFP, particularly in developing countries, may underestimate the true burden of non-poliovirus AFP.

Author Notes

*Address correspondence to James J. Sejvar, CDC, 1600 Clifton Rd., Mailstop A-39, Atlanta, GA 30333. E-mail: zea3@cdc.gov

Authors' addresses: James J. Sejvar and Lawrence B. Schonberger, Division of Viral and Rickettsial Diseases (DVRD) and Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, E-mails: JSejvar@cdc.gov and LSchonberger@cdc.gov. Kim A. Lindblade, Wences Arvelo, Kimberly Pringle, and Norma Padillo, Universidad de Valle de Guatemala, Guatemala City, Guatemala, E-mails: KLindblade@cdc.gov, WArvelo@cdc.gov, kimberly.pringle@gmail.com, and Npadilla@uvg.edu. Erica Dueger, U.S. Naval Medical Research Unit 3 (NAMRU-3), FPO AE 09835-9998, E-mail: erica.dueger@navy.med.mil. Emily Zielinksi-Guttierez, Foothills Campus, Fort Collins, CO, E-mail: EZielinski-Guttierez@cdc.gov. Eileen Farnon, Division of Healthcare Quality Promotion, CDC, Atlanta, GA, E-mail: EFarnon@cdc.gov.

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