Cent Eur J Public Health 2024, 32(1):45-51 | DOI: 10.21101/cejph.a7605

Thirteen-year surveillance results of acute flaccid paralysis cases in Southeast Turkey and the effect of refugee movements on surveillance results

Nezir Özgün¹, Gülnaz Kubat², Birgül Turan², Mert Özgün³, İzzettin Toktaş⁴, Gülay Korukluoğlu⁵

¹ Department of Paediatrics, Division of Paediatric Neurology, Mardin Artuklu University School of Medicine, Mardin, Turkey

² Infectious Diseases Unit, Provincial Health Directorate, Diyarbakir, Turkey

³ İstinye University School of Medicine, İstanbul, Turkey

⁴ Department of Public Health, Division of Public Health, Mardin Artuklu University School of Medicine, Mardin, Turkey

⁵ Virology Reference and Research Laboratory, General Directorate of Public Health, Ministry of Health, Ankara, Turkey

Objective: Acute flaccid paralysis (AFP) is a major neurological problem. Turkey has accepted over 4 million refugees since 2011 due to the wars in neighbouring countries. In the long term, refugees can have adverse effects on the limited resources of health, sanitation, water supply, foodstuff, and shelter services of host countries, precipitating the transmission and spread of enteroviruses causing AFP. This study examines the 13-year surveillance and incidence of AFP cases in southeast Turkey, and questions possible impact of refugee movements on these parameters, comparing the periods before (2007-2010) and after (2011-2019) 2011, when the refugee movements emerged.

Methods: The records of cases reported from southeast part of Turkey with suspected AFP between January 2007 and December 2019 were reviewed retrospectively.

Results: Of the patients, 121 (58.5%) were male. Mean age was 80.36 ± 46.67 months. Eighty-five (41.1%) were aged 60 months or younger. The number of patients under 60 months increased significantly after 2011. Mean incidence was calculated as 0.88 cases/100,000 person years versus 1.58 cases/100,000 person years in the period before and after 2011, respectively. Guillain-Barré syndrome (GBS) was the most common cause of AFP in both periods. As of 2011, however, the incidence of acute transverse myelitis increased approximately 4 times and GBS decreased proportionally. Non-polio enteroviruses were the most frequent isolates, detected from 9.1% of stool samples.

Conclusion: Although refugee movements appear to may have adverse effects on AFP incidence and surveillance outcomes, larger studies involving the whole country, particularly at places where no refugees settled, are needed to achieve more conclusive evidence.

Keywords: acute flaccid paralysis, surveillance, refugees, enterovirus, non-polio enterovirus

Received: September 25, 2022; Revised: February 29, 2024; Accepted: February 29, 2024; Published: March 31, 2024  Show citation