Non-Polio Enteroviruses from Acute Flaccid Paralysis Surveillance in Korea, 2012-2019

Abstract

The risk of polio importation and re-emergence persists since epidemic polio still occurs in some countries, and the resurgence of polio occurring almost 20 years after polio eradication was declared in Asia has been reported. We analyzed the results of acute flaccid paralysis (AFP) surveillance in Korea to assess the quality of AFP surveillance and understand the etiology of non-polio enterovirus (NPEV)-associated central nervous system diseases in a polio-free area. We investigated 637 AFP patients under 15 years of age whose cases were confirmed during 2012-2019 by virus isolation, real-time reverse transcription polymerase chain reaction, and VP1 gene sequencing. Among the 637 AFP cases, NPEV was detected in 213 (33.4%) patients, with the majority observed in EV-A71, with 54.9% of NPEV positives. EV-A71 has been shown to play a role as a major causative agent in most neurological diseases except for Guillain-Barré syndrome (GBS), acute disseminated encephalomyelitis (ADEM), and meningitis. This study provides information on the AFP surveillance situation in Korea and highlights the polio eradication stage in the monitoring and characterization of NPEV against the outbreak of neurological infectious diseases such as polio.

Keywords: acute flaccid paralysis (AFP); enterovirus; poliovirus; surveillance.

Figure 1

Monthly detection rate of AFP surveillance in Korea, 2012–2019.

Figure 2

Clinical diagnoses of AFP surveillance system in Korea, 2012–2019. Error bars show the standard deviation of cases during 2012–2019. ADEM, acute disseminated encephalomyelitis; GBS, Guillain-Barré syndrome; HFMD, hand-foot-and-mouth disease; Other, acute respiratory diseases, myocarditis, sepsis neonatorum, etc.; AFP, acute flaccid paralysis; NPEV, non-polio enterovirus.