Surveillance of Acute Flaccid Paralysis (AFP) in Greece: 2008-2024.

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.