Recognize and Report Cases of Acute Flaccid Paralysis

Advisory Alert

September 23, 2022

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To: Local Health System Partners


Reminder to recognize and report cases of acute flaccid paralysis

Public Health Sudbury & Districts is reminding health care providers to be vigilant in the recognition and reporting of suspected and confirmed cases of acute flaccid paralysis (AFP), which is a characteristic of poliovirus infection.

AFP and polio are designated as Diseases of Public Health Significance and are reportable under the Health Protection and Promotion Act. Canada has maintained a polio-free status since 1994. The objective of AFP surveillance is to rule out or detect polio and is required for Canada to maintain its polio free certification by demonstrating (through the capacity to identify non-polio AFP cases) that the provincial surveillance system would be capable of detecting polio should cases arise in Ontario.


Symptoms of AFP include rapid onset of weakness or paralysis, characterized as flaccid without other obvious causes. The most characteristic feature of AFP associated with paralytic polio is its asymmetric distribution which affects some muscle groups, but not others, with fever present at onset.


Persons of any age presenting with acute neurological presentations suggestive of AFP should have laboratory investigations performed to detect a viral cause. This includes testing for enterovirus D68 and polio. If Guillain-Barre syndrome is suspected, obtain 2 additional stool samples 24 hours apart, and place each stool sample in bacterial transport media (e.g., Cary-Blair) and write “Campylobacter Testing” in the “Test(s) Requested” field of each requisition.

Specimen collection information can be found in Public Health Ontario’s (PHO) Test Information Sheets. If polio is suspected in under/un-immunized persons with risk of exposure (i.e., travel), contact the Public Health Ontario laboratory for consultation and notify Public Health Sudbury & Districts immediately.

Please fill out PHO’s general test requisition. Indicate relevant clinical and exposure related information as appropriate.


AFP is designated as a Disease of Public Health Significance. All suspected and confirmed cases must be reported immediately to Public Health Sudbury & Districts at 705.522.9200, ext. 772, or toll-free 1.866.522.9200 and after hours at 705.688.4366. Please complete the communicable disease notification form  and fax to our confidential fax at 705.677.9618.


Original Signed By

Dr. Penny Sutcliffe
Medical Officer of Health and Chief Executive Officer

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This item was last modified on September 23, 2022