title: Lessons from diagnostic investigations of patients with poliomyelitis and their direct contacts for the present surveillance of acute flaccid paralysis.
abstract: One of the key strategies for the global eradication of poliomyelitis is the virological investigation of stool samples in cases of acute flaccid paralysis (AFP) to exclude poliovirus as a possible cause. Clinical specimens from a serotype 3 outbreak provided an opportunity to examine the potential of newly developed methods for the diagnosis of poliomyelitis. The virus isolation rate was maximal (89.6%) during the first 2 weeks after the onset of paralysis and then dropped sharply to 18.6%. In contrast, a high percentage of patients tested positive for poliovirus-specific IgM (93.9%) in the early phase of the infection and remained positive for up to 8 weeks. Virus isolation would have correctly identified only 54.9% of the AFP cases. This rate would have been increased to 92% through the use of the poliovirus-specific IgM ELISA. The IgM ELISA could serve as an important additional tool for the rapid diagnosis of poliomyelitis.
authors.affiliation: Research Laboratory for Infectious Diseases, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands. Tineke.Herremans@rivm.nl
authors.forename: T
authors.initials: T
authors.lastname: Herremans
authors.forename: M P
authors.initials: MP
authors.lastname: Koopmans
authors.forename: H G
authors.initials: HG
authors.lastname: van der Avoort
authors.forename: A M
authors.initials: AM
authors.lastname: van Loon
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay; D005243:Feces / Q000821:virology; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D009123:Muscle Hypotonia / Q000209:etiology; D010243:Paralysis / Q000209:etiology*; D011051:Poliomyelitis / Q000175:diagnosis*; D017955:Poliovirus / Q000302:isolation & purification
chemical_list: D000914:Antibodies, Viral; D007070:Immunoglobulin A; D007075:Immunoglobulin M