Acute flaccid paralysis encompasses motor weakness of acute onset from diverse pathologies, including enterovirus-associated spinal cord anterior horn cell injury, immune-mediated peripheral nerve damage as seen in Guillain-Barré syndrome, and flavivirus-induced neurologic disease [1][2][3]. It is a syndromic surveillance concept rather than a single disease entity [1].
Disease overview
Other Evidence-backed information EN 4/7 applicable sections · ZH 4/7 applicable sections Updated Oct 23, 2026
Acute flaccid paralysis is a clinical syndrome with multiple etiologies, including enteroviral anterior horn cell disease, immune-mediated peripheral nerve disorders such as Guillain-Barré syndrome, and flavivirus infections [1][2][3]. Poliomyelitis incidence has fallen by 99.9% since 1988, with endemic transmission now limited to Afghanistan, Pakistan, and Nigeria, while non-polio enteroviruses like EV-D68 and EV-A71 have become principal viral causes [1]. Guillain-Barré syndrome is the most frequent worldwide cause of the syndrome [2].
Read the full clinical and epidemiological profile 5
Enterovirus-associated AFP arises from spinal cord anterior horn cell disease [1]. Guillain-Barré syndrome typically follows an antecedent illness such as upper respiratory infection and manifests as progressive motor weakness, with Campylobacter jejuni, Zika virus, and SARS-CoV-2 among associated triggers and possible autoimmune mimicry mechanisms [2]. In children, demyelinating neuropathy predominates, with potential autonomic instability and respiratory compromise requiring intensive monitoring [4]. Flavivirus infections can produce AFP as part of a severe disease spectrum [3].
Global polio incidence declined 99.9% after the 1988 eradication initiative, with persistent poliomyelitis reported only in Afghanistan, Pakistan, and Nigeria [1]. Other enteroviruses, chiefly EV-D68 and EV-A71, have emerged as leading viral causes of AFP, partly through recent viral genetic evolution [1]. Flaviviruses infect up to 400 million people annually and can unexpectedly emerge to cause AFP, as seen with West Nile and Zika viruses [3].
GlobalID source-data note: Japan's acute flaccid paralysis surveillance series explicitly excludes acute poliomyelitis. It is a syndrome-surveillance count for non-polio AFP and must not be used as a poliomyelitis count or as an unrestricted total of every AFP cause.
- 1 Bitnun A et al. Acute Flaccid Paralysis and Enteroviral Infections. Curr Infect Dis Rep. 2018 Jun 29. PMID: 29959591. doi: 10.1007/s11908-018-0641-x. PubMed: https://pubmed.ncbi.nlm.nih.gov/29959591/
- 2 Shahrizaila N et al. Guillain-Barré syndrome. Lancet. 2021 Mar 27. PMID: 33647239. doi: 10.1016/S0140-6736(21)00517-1. PubMed: https://pubmed.ncbi.nlm.nih.gov/33647239/
- 3 Pierson TC et al. The continued threat of emerging flaviviruses. Nat Microbiol. 2020 Jun. PMID: 32367055. doi: 10.1038/s41564-020-0714-0. PubMed: https://pubmed.ncbi.nlm.nih.gov/32367055/
- 4 Langille MM et al. Guillain-Barre Syndrome in Children and Adolescents. Adv Pediatr. 2023 Aug. PMID: 37422300. doi: 10.1016/j.yapd.2023.04.001. PubMed: https://pubmed.ncbi.nlm.nih.gov/37422300/
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Literature links are provided for discovery and do not alter or validate the surveillance series above.
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