It's important to remember that there have been several viral and other causes of acute flaccid paralysis (AFP) for as long as the polio eradication programme has been in existence (and indeed longer). AFP has been a useful marker of clinically apparent polio because it has historically been primarily caused by wild poliovirus. As we enter the endgame of polio eradication, this is less true. Other causes, notably vaccine-derived poliovirus, will become more prominent. This is also true for other non-polio enteroviruses and of course coxsackievirus and others.

Surveillance for AFP will remain crucial for the ongoing detection of polio as long as it continues to exist anywhere in the world (and be an excellent marker of surveillance sensitivity). It will also be useful to detect emergent causes of polio-like syndromes, of whatever cause.

I suspect such causes, viral and otherwise, have been around for a long time but largely hidden by polio's pre-eminence. Other paralysing organisms, especially viral, will increasing be recognised - I suspect - as AFP clusters are investigated. This is no bad thing. There is some speculation that polio's eradication will create a niche for other polio-like agents and lead to a new pandemic of paralysis. This is unfounded in evidence but is worthy of keeping in mind.

This is not a topic in my experience.

But in Cameroon, my country, major effors are done to eradicate cases of poliomyelitis. Vaccinations against poliomyelitis are performed in children, systematically at birth, and during childhood vaccinations. Vaccination campaigns are systematically done in children aged from 2 years.

In Centre Pasteur du Cameroun, a national laboratory, researchers focus on this topics and manyresearches and publications are made.