12-Year Surveillance Results of Acute Flask Paralysis Cases in Southeast Turkey and the Effect of Refugee Movements on Surveillance Results

Introduction: Turkey accepted over 4 million refugees since 2011, due to the wars in neighboring countries. This study examines the 12-year surveillance results and incidence of Acute Flaccid Paralysis (AFP) cases in Diyarbakir which located in southeastern Turkey, and questions possible impact of refugee movements on these parameters, comparing the periods before and after 2011, when the refugee movements emerged. Method: The records of 207 cases reported with AFP suspicion between January 2007 and December 2019 were reviewed retrospectively. Results: The number of patients under 5 years of age increased significantly after 2011. Mean incidence was calculated as 0.88/100.000 and 1.58/100.000 in the period before and after 2011, respectively. Guillain-Barre Syndrome (GBS) was the most common cause of AFP before and after 2011. As of 2011 however, acute transverse myelitis increased approximately 4 times and GBS decreased proportionally. Non-polio enteroviruses were the most frequent isolates, at a rate of 9.17%, in stool samples of the patients. Conclusion: Although refugee movements appear to 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 Enteroviruses