Diagnosis of acute flaccid paralysis: injection injury or polio?

In many countries, the treatment of choice for all fevers is one or more injections. These injections are associated with a risk of nerve damage. If cases of poliomyelitis are not to be missed, the diagnosis of injection trauma or traumatic neuritis (TN) must be exact. The guides for distinguishing between TN and polio are not clear. It is probable that some cases of polio are misdiagnosed as TN. As three-quarters of children with paralytic polio receive injections just before the onset of paralysis, their paralysis may be mistaken for TN. Clearer guidelines are proposed, together with suggestions for better documentation of muscles injected and paralysed. All cases of reported TN should be monitored and new diagnostic guidelines published. To protect their children, mothers must be educated to understand that injections for fever can cause harm. This must be an important part of the eradication programme for poliomyelitis.