Paralytic Syndromes in Children: Epidemiology and Relationship to Vaccination

Zangwill, Kenneth M.; Yeh, Sylvia H.; Wong, Emily J.; Marcy, S. Michael; Eriksen, Eileen; Huff, Kenneth R.; Lee, Martin; Lewis, Edwin M.; Black, Steven B.; Ward, Joel I.

doi:10.1016/j.pediatrneurol.2009.10.012

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Volume 42, Issue 3 , Pages 206-212, March 2010

Paralytic Syndromes in Children: Epidemiology and Relationship to Vaccination

Kenneth M. Zangwill, MD
- UCLA Center for Vaccine Research, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
- Communications should be addressed to: Dr. Zangwill; Harbor-UCLA Medical Center; Liu Research Building; 1124 West Carson St.; Torrance, CA 90502.
Sylvia H. Yeh, MD
- UCLA Center for Vaccine Research, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
Emily J. Wong, MD
- UCLA Center for Vaccine Research, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
S. Michael Marcy, MD
- UCLA Center for Vaccine Research, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
- Southern California Kaiser Permanente Health Care Plan, Los Angeles, CA
Eileen Eriksen, MPH
- UCLA Center for Vaccine Research, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
Kenneth R. Huff, MD
- Departments of Pediatrics and Neurology, Harbor-UCLA Medical Center, Torrance, CA
Martin Lee, PhD
- UCLA Center for Vaccine Research, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
Edwin M. Lewis, MPH
- Kaiser Vaccine Study Center, Oakland, CA
Steven B. Black, MD
- Center for Global Child Health; Cincinnati Children's Hospital, Cincinnati, Ohio
Joel I. Ward, MD
- UCLA Center for Vaccine Research, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA

Received 2 July 2009; accepted 26 October 2009.

Acute flaccid paralysis is a standard outcome for detection of poliomyelitis globally and an ongoing potential vaccine-associated adverse event concern for polio, influenza, and meningococcal vaccines. No systematic population-based data on the epidemiologic and clinical features of this condition, or its potential association with immunization, have been reported from the United States. The present retrospective cohort study of acute flaccid paralysis in the Southern and Northern California Kaiser Permanente Health Care Plans was conducted using computerized diagnosis data and medical record review of potential cases among children aged 1 month to <15 years and diagnosed from January 1, 1992 through December 31, 1998. In all, 3297 potential cases were identified; of these, 2682 cases (81%) did not meet the case definition, and of the remaining 615 cases, 245 (7% of the total) were included. The incidence of disease was 1.4 per 100,000 children/year (95% confidence interval = 1.2–1.6); predicting approximately 844 children/year in the United States. Disease incidence did not vary with season or sex, varied inversely with age, and declined 28% during the study period. No cases of vaccine-associated acute flaccid paralysis were identified. In nonendemic countries, ongoing acute flaccid paralysis surveillance is often conducted, because of the risk of poliovirus importation, but this practice may be difficult to justify, given low disease incidence and breadth of clinical presentation.