title: Acute flaccid paralysis and its differential diagnosis in in kurdistan province, Western iran; an 11-year surveillance.
abstract: OBJECTIVE
  The surveillance of acute flaccid paralysis (AFP) is a key strategy for monitoring the progress of poliomyelitis eradication and is a sensitive measure for detecting potential cases of poliomyelitis and poliovirus infection. This study was conducted to describe the characteristics of patients reported with AFP, and to evaluate the performance of the surveillance system in Kurdistan province, western Iran, using indicators recommended by the World Health Organization (WHO).
  
  
  METHODS
  This observational study was conducted from January 2000 to December 2010 at the Kurdistan Center for Disease Control and the Department of Pediatrics. All children who fulfilled the WHO definition for AFP were included in our study. The stool samples of all the children were sent for poliovirus isolation. All the patients were evaluated for 60 days after the onset of symptoms to identify the signs of residual weakness.
  
  
  RESULTS
  One-hundred thirty nine children aged <15 years were reported to the Center for Diseases Control with AFP. In 138 (99%) stool samples no poliovirus was isolated. None of the patients was diagnosed as having acute poliomyelitis or polio-compatible paralysis. Guillain-Barré syndrome was the most frequent final diagnosis (79 cases) followed by Transverse Myelitis (7 cases) and Encephalitis (6 cases). By detecting 1.3 to 3.6 (mean 3.2) AFP cases per 100 000 population in Kurdistan during the study period, we achieved the WHO target for AFP surveillance. All performance indicators but one consistently met the WHO requirements and therefore demonstrated the effectiveness of the AFP surveillance program in Kurdistan.
  
  
  CONCLUSIONS
  The effective surveillance system in Kurdistan and its evaluation may serve as a model for the surveillance of other infectious diseases.
authors.affiliation: Department of Pediatrics.
authors.forename: Jafar
authors.initials: J
authors.lastname: Soltani
authors.affiliation: Department of Epidemiology & Biostatistics, Faculty of Medicine.
authors.forename: Nader
authors.initials: N
authors.lastname: Esmailnasab
authors.affiliation: Department of Epidemiology & Biostatistics, Faculty of Medicine.
authors.forename: Daem
authors.initials: D
authors.lastname: Roshani
authors.affiliation: Center for Disease Control and Prevention, Kurdistan University of Medical Sciences , Sanandaj, Iran.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Karimi
authors.affiliation: Center for Disease Control and Prevention, Kurdistan University of Medical Sciences , Sanandaj, Iran.
authors.forename: Mohamad-Jamil
authors.initials: MJ
authors.lastname: Amjadi
keywords: Acute Flaccid Paralysis; Epidemiology; Paralysis; Poliomyelitis; Surveillance