Poliomyelitis

[Previous][Table of Contents][Next]

Nationally notifiable since 1924

1.0 National Notification

Only confirmed cases of disease should be notified.

Immediate notification to the Public Health Agency of Canada is required in the event that any jurisdiction is investigating a probable case of poliomyelitis.

2.0 Type of Surveillance

Routine case-by-case notification to the federal level

3.0 Case Classification

3.1 Confirmed case (see also section 3.4, Confirmed case categories)

Clinical illness (see section 5.0) with laboratory confirmation of infection:

• isolation of polio virus (vaccine or wild-type) from an appropriate clinical specimen OR
• detection of polio virus RNA

OR
Clinical illness in a person who is epidemiologically linked to a laboratory-confirmed case

3.2 Probable case

Clinical illness without detection of polio virus from an appropriate clinical specimen and without evidence of infection with other neurotropic viruses but with one of the following laboratory confirmations of infection:

• significant rise (e.g. fourfold or greater) in polio IgG titre by any standard serologic assay between acute and convalescent sera
  OR
• positive serologic test for polio IgM antibody in the absence of recent immunization with polio virus-containing vaccine

3.3 Suspected case

Clinical illness and no laboratory confirmation of infection (no polio virus detection or serologic evidence), including negative test results and inadequate or no investigation

3.4 Confirmed case categories

Confirmed cases of poliomyelitis can be further subdivided into the following two categories:

1) Wild virus
Laboratory investigation implicates wildtype virus. This group is further subdivided as follows:

• Imported: travel in or residence in a polioendemic area 30 days or less before onset of symptoms
• Import-related: epidemiologic link to someone who has travelled in or resided in a polio-endemic area within 30 days of onset of symptoms
• Indigenous: no travel or contact as described above

2) Vaccine-associated virus
Laboratory investigation implicates vaccine-type virus. This group is further subdivided as follows:

• Recipient: the illness began 7-30 days after the patient received oral polio vaccine (OPV)
• Contact: the patient was shown to have been in contact with an OPV-recipient and became ill 7-60 days after the contact was vaccinated
• Possible contact: the patient had no known direct contact with an OPV-recipient and no history of receiving OPV, but the paralysis occurred in an area in which a mass vaccination campaign using OPV had been in progress 7-60 days before the onset of paralysis
• No known contact: the patient had no known contact with an OPV-recipient and no history of receiving OPV, and the paralysis occurred in an area where no routine or intensive OPV vaccination had been in progress. In Canada, this would include all provinces and territories.

4.0 Laboratory Comments

5.0 Clinical Evidence

Clinical illness is characterized by all of the following:

• acute flaccid paralysis of one or more limbs
• decreased or absent deep tendon reflexes in the affected limbs
• no sensory or cognitive loss
• no other apparent cause (including laboratory investigation to rule out other causes of a similar syndrome) neurologic deficit present 60 days after onset of initial symptoms, unless the patient has died

6.0 ICD Code(s)

6.1 ICD-10 Code(s)

A80

Acute poliomyelitis

6.2 ICD-9/ICD-9CM Code(s)

045

Acute poliomyelitis

7.0 Type of International Reporting

Notification of any case of poliomyelitis due to wild-type poliovirus is required under the International Health Regulations (2005).

8.0 Comments

Detection and investigation of all acute flaccid paralysis (AFP) cases is necessary to rule out poliovirus infection. AFP surveillance is used to monitor Canada’s polio-free status (refer to section on Acute Flaccid Paralysis).

There is a global goal to eradicate polio. Elimination of indigenous wild poliovirus transmission was certified in Canada, and the rest of the American region, in September 1994. However, until global eradication of poliomyelitis is achieved, there is an ongoing risk for importation of wild polioviruses. The WHO and global polio eradication initiative partners maintain information on countries currently affected by outbreaks and/or importations of polio (see The Global Polio Eradication Initiative. http://www.polioeradication.org/).

9.0 References

1. Activities leading to polio elimination. In: Canadian National Report on Immunization, 1996. CCDR1997;23(S4).
2. Pan American Health Organization. Poliomyelitis Eradication Field Guide. 3^rd edition. Scientific and Technical Publication No. 607. 2006. Retrieved May 2008, from www.paho.org/english/ad/fch/im/fi eldguide_polio.pdf
3. The Global Polio Eradication Initiative. Retrieved May 2008, from http://www.polioeradication.org/

10.0 Previous Case Definitions

Canadian Communicable Disease Surveillance System: disease-specific case definitions and surveillance methods. Can Dis Wkly Rep 1991;17(S3).

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

Date of Last Revision/Review:

May 2008