PRO/EDR> Acute flaccid myelitis: human enterovirus D68

Opened up my email this morning to find this article, seems to show some similarities to the more severe forms of ME. Shame health authorities don't treat ME as seriously as this.

I obtained permission to copy ProMED posts to other Lists and websites many years ago. Just so you know that copyright isn't an issue.

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Date: Fri, 3 Nov 2017 21:09:22 +0000
From: promed@promedmail.org
Subject: PRO/EDR> Acute flaccid myelitis: human enterovirus D68
To: promed-post@promedmail.org, promed-edr-post@promedmail.org
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ACUTE FLACCID MYELITIS: HUMAN ENTEROVIRUS D68
*********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 1 Nov 2017
Source: PAHO [edited]
<http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=270&gid=42783&lang=en>


Epidemiological Alert: Acute Flaccid Myelitis associated with
enterovirus D68 in the context of Acute Flaccid Paralysis
surveillance
------------------------------------------------------------------------------------------------------------------------------------

Situation summary in the Americas and other regions
---------------------------------------------------
Although enterovirus cases have been reported sporadically since the
1960s, it was not until August 2014 that the 1st outbreaks were
documented in the United States (1).

Between August and December 2014, the United States Centers for
Disease Control and Prevention (CDC) reported an increase in acute
flaccid myelitis (AFM) associated with an outbreak of respiratory
disease caused by enterovirus (EV) D68 (2,3). Among the 120 AFM cases
reported in 34 states, the median age was 7.1 years (range: 4.8-12.1
years), 59 percent were male, and 81 percent had respiratory disease
before the onset of neurological symptoms(4,5). Following this event,
voluntary surveillance for AFM was initiated in some states, detecting
sporadic cases in 2015 and a new increase in cases in 2016 (Figure 1).
Cases were also detected in Asia, Canada, and Europe (1).

EV-D68 shares characteristics with rhinoviruses, causing mainly
respiratory diseases; however, its role in the pathogenesis of
neuroinvasive diseases is not clearly understood.

In 2016, the European Center for Disease Control and Prevention (ECDC)
informed that Denmark, France, the Netherlands, Spain, Sweden, and the
United Kingdom reported clusters and isolated cases of severe
neurological syndromes in children and adults associated with
enterovirus infection among which EV-D68 was detected. [footnote 1]

In October 2017, the Argentina International Health Regulations
National Focal Point reported a cluster of AFM associated with EV-D68
infection. Between epidemiological week (EW) 13 and EW 21 of 2016, 15
cases of AFM were identified in residents of the provinces of Buenos
Aires (13) and Chubut (one case) and the Autonomous City of Buenos
Aires (CABA per acronym in Spanish; one case). All cases were in
children under 15 years, since the detection occurred in the context
of acute flaccid paralysis (AFP) surveillance. This event coincided
with the increase in AFP cases in children under 15 years of age
observed at the national level between EW 16 and EW 21 of 2016. In 6
of the 15 reported AFM cases, the Regional Poliovirus Reference
Laboratory - INEI - ANLIS "Dr. Carlos G. Malbr?n" detected the
presence of EV-D68. Positive results were obtained in samples of
nasopharyngeal aspirate and in one case the same result was also
obtained in a cerebrospinal fluid (CSF) sample. In addition, human EV
B and human EV C were detected in stool samples of 2 of the AFM cases;
rhinovirus C in one case and coxsackie virus A13 in one case (7).

Considering the context of polio eradication, [footnote 2] the switch
from trivalent oral polio vaccine (OPV) to the bivalent OPV since
April 2016, that AFM is a type of AFP, and the need to increase
knowledge about the role of enteroviruses in the epidemiology of
neuroinvasive diseases, the Pan American Health Organization / World
Health Organization (PAHO / WHO) reminds Member States that
enterovirus is part of the differential diagnosis of AFP. The
following is a series of advice to health authorities regarding
surveillance, including laboratory detection.

Recommendations for national authorities
----------------------------------------
Case management
A patient with suspected AFM shall have timely access to health
services that manage neurological syndromes. The capacity to make a
differential diagnosis is key for defining complementary tests,
treatments to follow, guiding rehabilitation and, finally, determining
the prognosis.

Surveillance
AFM surveillance associated with enteroviruses is a component of AFP
surveillance and, as such, a support for polio eradication efforts.
The quality of this surveillance is measured based on the usual
performance indicators of AFP surveillance.

The following is recommended:
- Investigate all AFP cases in children under 15 or of any age where
polio [footnote 3] is suspected within 48 hours of notification.
[footnote 4]
- If there is a strong presumption of AFM, a respiratory sample
(necessary for the detection of enterovirus D68) should be obtained
and a spinal nuclear magnetic resonance should be considered.
- Investigate any increase or cluster of AFP. In this situation, if
cases have clinical characteristic of AFM, a respiratory sample in
addition to the stool sample should be obtained.
- Follow up cases, 60 days after the beginning of the paralysis, to
determine if they have residual paralysis.

Laboratory
Detection of poliovirus by laboratory is based on virus isolation in
cell cultures (L20B and RD), the intratypic differentiation by Reverse
Transcription - Polymerase Chain Reaction (RT-PCR) tests and genetic
sequencing.

The detection of EV-D68 is performed by molecular techniques (RT-PCR)
that can be both conventional or in real time. Per respiratory viruses
other than influenza detection protocols, a generic PCR test for
enterovirus (respiratory) detection followed by PCR with specific
primers for EV-D68 in those samples resulting positives, is
recommended. [footnote 5]

EV-D68 is a respiratory enterovirus that can be better detected in
respiratory specimens. Therefore, in the presence of EV-D68, a
nasopharyngeal swab sample should be collected in viral transportation
medium or nasopharyngeal aspirate in physiological solution. CSF
samples taken (only) by medical prescription may also be used for
virus detection. Stool samples that were collected to discard
poliovirus [footnote 6] may also be used, although it should be taken
into account that the possibility of detecting EV-D68 from this type
of sample is low.

Collection and shipping of samples
The quality of obtaining, transporting, and storing the obtained
samples (whether respiratory or stool) must be guaranteed. For this
purpose, it is important that laboratories ensure that the container
used to transport the sample is adequate at both the central and
subnational levels; the type and quantity (8 grams for feces) of the
sample is sufficient; the appropriate cold chain is maintained and the
sample is correctly packed and identified.

For the collection and transport of respiratory samples, it is
recommended to follow the PAHO/WHO Operational Guidelines for Sentinel
Severe Acute Respiratory Infection (SARI) Surveillance, 2014 (8).

Footnotes
---------
1 European Centre for Disease Prevention and Control. Communicable
disease threats report, 13-19 November 2016, week 46. Available at:
<https://ecdc.europa.eu/en/publicati...se-threats-report-13-19-november-2016-week-46>
2 The last wild poliovirus case in the Americas occurred in 1991.
3 Use the case definition in the PAHO/WHO scientific and technical
publication No. 607 - "Poliomyelitis
Eradication Field Guide". Available at:
<http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=3052&Itemid=27>04
All AFP cases should be reported within 14 days of the onset of
paralysis.
5 For molecular detection, the implementation of the CDC protocols
"Enterovirus D68 (EV-D68) 2014 outbreak strain-specific real-time
reverse transcription / Polymerase chain reaction (rRT-PCR) assay
instructions-Version 10/14/2014" is recommended. Available at:
<https://stacks.cdc.gov/view/cdc/25698>
6 The stool sample should be obtained within 14 days of the onset of
paralysis.

Figure 1. Acute flaccid myelitis cases in the United States. August
2014 - July 2017.
Source: Published by the United States Centers for Disease Control and
Prevention and reproduced by PAHO/WHO
[See source URL]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[See URL for References and related links.

A study in Colorado 2014 showed that "Adjusted analyses indicated
that, for children with acute flaccid myelitis, the odds of having
EV-D68 infection were 10.3 times greater than for those tested for
acute respiratory infection and 4.5 times greater than for those
tested for B. pertussis infection. No statistical association was seen
between acute flaccid myelitis and non-EV-D68 enterovirus or
rhinovirus infection. These findings support an association between
EV-D68 infection and acute flaccid myelitis." From Aliabadi N, et al.
Enterovirus D68 Infection in Children with Acute Flaccid Myelitis,
Colorado, USA, 2014. Emerg Infect Dis. 2016;22(8):1387-1394.
<https://dx.doi.org/10.3201/eid2208.151949>

See ProMED Acute flaccid myelitis - Europe: Germany
http://promedmail.org/post/20170912.5311829 for further discusison. -
Mod.LK


]

[See Also:
2017
----
Acute flaccid myelitis - Europe: Germany
http://promedmail.org/post/20170912.5311829
2016
-----
Acute flaccid myelitis - North America (09): USA
http://promedmail.org/post/20161215.4702290
Acute flaccid myelitis - North America (08): USA (AZ,WA) RFI
http://promedmail.org/post/20161117.4637077
Acute flaccid myelitis - North America (07): USA (WA), responses to
RFI http://promedmail.org/post/20161103.4605193
Acute flaccid myelitis - North America (06): USA causes, RFI
http://promedmail.org/post/20161101.4598660
Acute flaccid myelitis - North America (05): USA
http://promedmail.org/post/20161030.4596196
Acute flaccid myelitis - North America (04): USA
http://promedmail.org/post/20161030.4596196
Acute flaccid myelitis - North America (03): USA
http://promedmail.org/post/20161008.4545994
Acute flaccid myelitis - North America (02): USA, Canada, human
enterovirus D68 http://promedmail.org/post/20161002.4530332
Acute flaccid myelitis - North America: USA, human enterovirus D68
susp http://promedmail.org/post/20160923.4509548
Human enterovirus D68 - Netherlands: acute flaccid myelitis
http://promedmail.org/post/20160925.4513491
Acute flaccid myelitis - USA: human enterovirus D68 susp
http://promedmail.org/post/20160923.4509548
Human enterovirus D68 - Taiwan, Canada: acute flaccid paralysis
http://promedmail.org/post/20160902.4461647
Human enterovirus D68 - USA (CO) acute flaccid paralysis
http://promedmail.org/post/20160728.4375980

2015
----
Acute flaccid myelitis - USA: human enterovirus C105 susp
http://promedmail.org/post/20150707.3492771
2014
----
Human enterovirus D68 - North America (19): acute flaccid myelitis
assoc. http://promedmail.org/post/20141203.3009452
Human enterovirus D68 - Europe (02): France, acute flaccid paralysis
http://promedmail.org/post/20141106.2935270]
.................................................lk/ec/lm

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From this enterovirus? Or similar symptoms or problems? If so, maybe your local health authority should be alerted? Sorry for such poor reply, very tired tonight after long (for me) journey yesterday. ProMED mail is a recognised authority I believe, so share that mail if you need too. Best wishes.