Key result
The absence of consumption of unwashed fruits and vegetables was a significant protective factor against developing acute flaccid paralysis (RR 0.65).
Why the study?
Epidemiological surveillance of acute flaccid paralysis is conducted under WHO polio eradication strategy, but risk factors in children up to 15 years and surveillance system effectiveness in Bulgaria required analysis.
Cross-Sectional (n=92)
No
Epidemiological surveillance of acute flaccid paralysis in Bulgaria identified key protective factors such as central sewage and hygiene practices, highlighting the importance of continued monitoring for polio eradication.
Answers are grounded in this paper and cite their sources.
Sanitation and hygiene were associated with lower AFP risk; cross-sectional data leaves open causality and generalizability for polio surveillance.
Poliomyelitis is the infection that, after smallpox, is a “serious candidate” for eradication worldwide. In accordance with the WHO strategy for 2022-2026, epidemiological surveillance of acute flaccid paralysis (AFP) is carried out with the aim of poliomyelitis eradication. The aim of the study is to determine the risk factors for the occurrence of AFP in children up to 15 years of age and to analyze the effectiveness of the established system for epidemiological surveillance of AFP, in Bulgaria. Materials and methods. All cases of AFP for the monitoring period 2012-2021, in Stara Zagora district, were studied. A questionnaire (34 questions) for sociodemographic and lifestyle possible risk factors for developing of AFP was also completed. Retrospective, descriptive and analytic cross-sectional epidemiological methods were applied. The data were analyzed using SPSS Statistics, Version 25.0 (IBM Corp. Armonk, NY, USA) (with Fisher’s exact test). Results. There were 81 cases of Facial paralysis only, registered in the Web based system for surveillance of AFP, for Stara Zagora region, and 11 – AFP (without facial paralysis), for the period 2012-2021, in Stara Zagora district (92 in total). The protective factors for developing of AFP from our study were significantly associated to: having no history of paresis or paralysis in the past; absence of trauma; presence of central sewage near the home; absence of contact with animals; absence of consumption of unwashed fruits and vegetables. Conclusion. It is very important to carry out systematic surveillance of AFP, in children up to 15 years, with the aim of investigating all cases as part of the Global strategy for the eradication of poliomyelitis; monitoring of the immunization coverage with polio vaccine to maintain a high level; surveillance of the waste and sewage waters, twice during the year in 6 months.
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Simeonova et al. (2023) conducted a cross-sectional in Acute flaccid paralysis (n=92). Absence of consumption of unwashed fruits and vegetables vs. Consumption of unwashed fruits and vegetables was evaluated on Development of acute flaccid paralysis (without facial paralysis) (RR 0.65, 95% CI 0.60-0.77, p=0.014). The absence of consumption of unwashed fruits and vegetables was a significant protective factor against developing acute flaccid paralysis (RR 0.65).
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