Integrated surveillance of polio-negative acute flaccid paralysis cases for childhood tuberculosis: a novel GeneXpert-based screening approach in Rivers State, Nigeria

Nigeria was certified free of indigenous wild poliovirus transmission in 2020; however, acute flaccid paralysis (AFP) surveillance remains operational nationwide to detect poliovirus re-emergence and monitor eradication gains [1]. Simultaneously, tuberculosis (TB) remains a major public health challenge, particularly among children, in whom diagnosis is often delayed or missed because of nonspecific clinical presentations and difficulties in obtaining bacteriological confirmation [2, 3]. Innovative strategies that leverage existing surveillance systems may help bridge the persistent gap in detecting childhood TB. This study assessed the feasibility of integrating stool GeneXpert MTB/RIF testing into AFP surveillance and determined the yield of GeneXpert positivity among children with polio-negative AFP in Rivers State, Nigeria. We conducted a retrospective analysis of integrated AFP-TB surveillance data collected between January 2022 and March 2025 in Rivers State, Nigeria. During the study period, 147 cases of AFP were reported among children aged less than 15 years. Following exclusion of poliovirus-positive cases and cases with inadequate stool specimens, 118 polio-negative AFP cases underwent stool GeneXpert MTB/RIF testing. The primary outcome was stool GeneXpert positivity for Mycobacterium tuberculosis complex. Data were summarized using descriptive statistics. Among the 118 children tested, five had positive stool GeneXpert MTB/RIF results, yielding a GeneXpert positivity rate of 4.2% (95% CI: 1.6–9.6%). Four of the five positive cases were younger than five years. Three positive results were reported as “trace detected, rifampicin resistance indeterminate.” All GeneXpert-positive cases presented with acute limb weakness or paralysis and were successfully linked to the National Tuberculosis Programme for further evaluation and management. Data completeness was 100% for age, sex, local government area, and GeneXpert result. Integration of stool GeneXpert testing into AFP surveillance was operationally feasible and identified additional children with microbiological evidence of Mycobacterium tuberculosis DNA. Although GeneXpert positivity does not confirm active TB disease; this approach demonstrates the potential of leveraging existing surveillance platforms to strengthen childhood TB case-finding in high-burden settings. Larger studies incorporating clinical confirmation, treatment outcomes, and economic evaluation are warranted. Not applicable.