# Surveillance of Acute Flaccid Paralysis (AFP) in Greece: 2008–2024

## TL;DR

This paper tracks 17 years of acute flaccid paralysis surveillance in Greece, identifying non-polio enteroviruses and other pathogens to support public health efforts.

## Contribution

The study provides a comprehensive 17-year analysis of AFP surveillance in Greece, highlighting regional and viral trends in a polio-free setting.

## Key findings

- 256 AFP cases were recorded from 2008 to 2024 in Greece, with the Attica region having the highest number.
- 18 specimens had identified etiological agents, including 13 non-polio enteroviruses.
- More than half of the positive specimens were from the densely populated Attica region.

## Abstract

As part of the WHO’s Global Polio Eradication Initiative, acute flaccid paralysis (AFP) surveillance in children under 15 years old is crucial for monitoring the emergence of polioviruses and tracking Non-Polio Enteroviruses (NPEVs). This study outlines the past 17 years of AFP surveillance in Greece from 2008 to 2024, during which a total of 256 AFP cases were recorded. Stool samples from these cases were analyzed using virus isolation in cell cultures (RD/L20B) and sequencing of NPEV-positive samples. The Attica region reported the highest number of cases with 81 (31%), followed by Central Macedonia and Crete, each with 29 cases (11%). The overall analysis of fecal specimens identified the etiological agent in 18 (7%) specimens, with 13 (4.7%) classified as NPEVs, 4 (1.5%) as adenoviruses, and 1 (0.4%) as a parechovirus. Coxsackievirus A, Coxsackievirus B, and various Echoviruses were the most frequently detected NPEV types. Notably, more than half of these positive specimens (10/18) were from the Attica region, which has the highest population density. These findings highlight the ongoing relevance of AFP surveillance in polio-free settings for broader pathogen monitoring and public health preparedness. Continued vigilance and investment in AFP surveillance are critical to sustaining Greece’s polio-free status and detecting emerging viral threats.