PRO/EDR> Acute flaccid myelitis: human enterovirus D68

Discussion in 'Other health news and research' started by ladycatlover, Nov 4, 2017.

  1. ladycatlover

    ladycatlover Senior Member (Voting Rights)

    Liverpool, UK
    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.


    Date: Fri, 3 Nov 2017 21:09:22 +0000
    Subject: PRO/EDR> Acute flaccid myelitis: human enterovirus D68

    Content-Type: text/plain; charset=UTF-8

    A ProMED-mail post
    ProMED-mail is a program of the
    International Society for Infectious Diseases

    Date: Wed 1 Nov 2017
    Source: PAHO [edited]

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

    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.

    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.

    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

    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).

    1 European Centre for Disease Prevention and Control. Communicable
    disease threats report, 13-19 November 2016, week 46. Available at:
    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:
    All AFP cases should be reported within 14 days of the onset of
    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:
    6 The stool sample should be obtained within 14 days of the onset of

    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:

    [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.

    See ProMED Acute flaccid myelitis - Europe: Germany for further discusison. -


    [See Also:
    Acute flaccid myelitis - Europe: Germany
    Acute flaccid myelitis - North America (09): USA
    Acute flaccid myelitis - North America (08): USA (AZ,WA) RFI
    Acute flaccid myelitis - North America (07): USA (WA), responses to
    Acute flaccid myelitis - North America (06): USA causes, RFI
    Acute flaccid myelitis - North America (05): USA
    Acute flaccid myelitis - North America (04): USA
    Acute flaccid myelitis - North America (03): USA
    Acute flaccid myelitis - North America (02): USA, Canada, human
    enterovirus D68
    Acute flaccid myelitis - North America: USA, human enterovirus D68
    Human enterovirus D68 - Netherlands: acute flaccid myelitis
    Acute flaccid myelitis - USA: human enterovirus D68 susp
    Human enterovirus D68 - Taiwan, Canada: acute flaccid paralysis
    Human enterovirus D68 - USA (CO) acute flaccid paralysis

    Acute flaccid myelitis - USA: human enterovirus C105 susp
    Human enterovirus D68 - North America (19): acute flaccid myelitis
    Human enterovirus D68 - Europe (02): France, acute flaccid paralysis]

    merylg, chrisb, Allele and 2 others like this.
  2. lansbergen

    lansbergen Senior Member (Voting Rights)

    There were a few paralise cases in children in the Netherlands.
    ladycatlover likes this.
  3. ladycatlover

    ladycatlover Senior Member (Voting Rights)

    Liverpool, UK
    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.
  4. lansbergen

    lansbergen Senior Member (Voting Rights)

    Yes and the information came from the national authority.
    ladycatlover likes this.
  5. Webdog

    Webdog Senior Member (Voting Rights)

    Holodeck #2
    Another related news article, with a link to published paper.

    This story always interests me, as my ME/CFS onset was remarkably similar to descriptions of acute flaccid myelitis (sometimes called acute flaccid paralysis).

    Last edited: Jan 22, 2018
    ladycatlover likes this.
  6. Webdog

    Webdog Senior Member (Voting Rights)

    Holodeck #2
    ladycatlover likes this.

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