Detection of non-polio and polio enteroviruses in Acute Flaccid Paralysis surveillance in Turkey GULAY KORUKLUOGLU 1 p , UMIT OZDEMIRER 2 , FATMA BAYRAKDAR 1 , ZEHRA UNAL 3 , YASEMIN COSGUN 1 , TUNCA ATAK 1 , HULYA KARADEMIRTOK 1 , ISIL ATA 2 and FATIH KARA 4 1 Ministry of Health, General Directorate of Public Health, Virology Reference and Research Laboratory, Ankara, Turkey 2 Ministry of Health, General Directorate of Public Health, Vaccine Preventable Diseases Department, Ankara, Turkey 3 Izmir Public Health Laboratory, Provincial Health Directorate, Izmir, Turkey 4 Ministry of Health, General Directorate of Public Health, Ankara, Turkey Received: November 23, 2020 • Accepted: January 18, 2021 Published online: March 1, 2021 ABSTRACT Poliomyelitis was a disease feared worldwide, striking suddenly and paralysing mainly children for life. Monitoring of suspected cases of poliomyelitis is carried out with Acute Flaccid Paralysis (AFP) sur- veillance in Turkey. This study examines national data of AFP surveillance and the epidemiology of enteroviruses (EV) in Turkey from 2000 to 2019 and gives an overview of the detected serotypes of EVs. A total of 13,640 samples collected from patients with 5216 AFP pre-diagnosed cases (2 samples from each patient) and 3,208 contacts, during a 20-year period (2000–2019) were investigated. All isolated polioviruses were tested for their wild or vaccine origin according to the WHO recommended protocol by PCR and sequencing analysis were performed. Enterovirus positivity was detected in a total of 915 cases, which were identified as 204 Sabin-like polio virus (SLPV) and 711 non-polio enterovirus (NPEV). Of the 204 SLPV, 141 (69.1%) AFP were detected in patients and 63 (30.9%) were detected in samples taken from their contacts. Of the 711 NPEVs, 516 (72.5%) were from AFP cases and 195 (27.5%) were detected in samples taken from their contacts. It is concluded that the reason for the higher detection rate of NPEV in samples from AFP pre-diagnosed cases is attributed to the polio vaccination rates reaching 97% between 2008 and 2019 in Turkey. The most frequently detected NPEV serotypes were Coxackie A24, B3, and Echo 30. This retrospective study is the first comprehensive study in Turkey to evaluate the results of the AFP surveillance in the last 20 years. KEYWORDS enteroviruses, polio virus, surveillance, Turkey INTRODUCTION Human enteroviruses (HEV) are non-enveloped, single-stranded, positive-sense RNA viruses belonging to the Picornaviridae family and Polioviruses the causative agent of polio are a member of enteroviruses. Up to now, 15 types have been identified. Human enterovirus serotypes have traditionally been classified into Polioviruses (serotype 1–3), Coxsackievirus A (serotype 1–22, 24), Coxsackievirus B (serotype 1–6) and Echovirus (serotype 1–33) [1]. Enteroviruses are among the most common viral agents of infection in humans. Although HEV often cause asymptomatic or mild infections, they also cause severe illnesses such as encephalitis, meningitis, aseptic meningitis, hand-foot-and-mouth disease, acute haemor- rhagic conjunctivitis, Acute Flaccid Paralysis (AFP), herpangina, myalgia and myocarditis. Acta Microbiologica et Immunologica Hungarica 68 (2021) 2, 92–98 DOI: 10.1556/030.2021.01353 © 2021 Akad emiai Kiad o, Budapest ORIGINAL RESEARCH PAPER p Corresponding author. Tel.: þ90 03125655340; fax: þ90 03125655569. E-mail: gucank@gmail.com