Trends in Nonpolio Acute Flaccid Paralysis Incidence in India 2000 to 2013

Although the incidence of polio acute flaccid paralysis (AFP) has decreased in India, the nonpolio AFP (NPAFP) rate has increased. Nationwide, the NPAFP rate is 11.82 per 100 000 population, whereas the expected rate is 1 to 2 per 100 000 population. We examined the correlates of NPAFP to discern explanations for the increase. The incidence of polio AFP in India has decreased. However, the nonpolio AFP rate has increased since 2000. Follow-up of these cases of nonpolio AFP is not done routinely. However, one-fifth of these cases of nonpolio AFP in the state of Uttar Pradesh (UP) were followed up after 60 days in 2005; 35.2% of patients were found to have residual paralysis, and 8.5% had died. This suggests that the pathology in children being registered as having nonpolio AFP cannot be considered trivial. Therefore, there is a compelling reason to try to determine the underlying causes for...