Acute Flaccid Myelitis in the United States, August–December 2014: Results of Nationwide Surveillance
Top Cited Papers
Open Access
- 17 June 2016
- journal article
- research article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 63 (6), 737-745
- https://doi.org/10.1093/cid/ciw372
Abstract
Background. During late summer/fall 2014, pediatric cases of acute flaccid myelitis (AFM) occurred in the United States, coincident with a national outbreak of enterovirus D68 (EV-D68)–associated severe respiratory illness. Methods. Clinicians and health departments reported standardized clinical, epidemiologic, and radiologic information on AFM cases to the Centers for Disease Control and Prevention (CDC), and submitted biological samples for testing. Cases were ≤21 years old, with acute onset of limb weakness 1 August–31 December 2014 and spinal magnetic resonance imaging (MRI) showing lesions predominantly restricted to gray matter. Results. From August through December 2014, 120 AFM cases were reported from 34 states. Median age was 7.1 years (interquartile range, 4.8–12.1 years); 59% were male. Most experienced respiratory (81%) or febrile (64%) illness before limb weakness onset. MRI abnormalities were predominantly in the cervical spinal cord (103/118). All but 1 case was hospitalized; none died. Cerebrospinal fluid (CSF) pleocytosis (>5 white blood cells/µL) was common (81%). At CDC, 1 CSF specimen was positive for EV-D68 and Epstein-Barr virus by real-time polymerase chain reaction, although the specimen had >3000 red blood cells/µL. The most common virus detected in upper respiratory tract specimens was EV-D68 (from 20%, and 47% with specimen collected ≤7 days from respiratory illness/fever onset). Continued surveillance in 2015 identified 16 AFM cases reported from 13 states. Conclusions. Epidemiologic data suggest this AFM cluster was likely associated with the large outbreak of EV-D68–associated respiratory illness, although direct laboratory evidence linking AFM with EV-D68 remains inconclusive. Continued surveillance will help define the incidence, epidemiology, and etiology of AFM.This publication has 52 references indexed in Scilit:
- Adenovirus isolation rates in acute flaccid paralysis patientsJournal of Medical Virology, 2011
- Clinical features, diagnosis, and management of enterovirus 71The Lancet Neurology, 2010
- Summary of data reported to CDC's national automated biosurveillance system, 2008BMC Medical Informatics and Decision Making, 2010
- Rapid routine detection of enterovirus RNA in cerebrospinal fluid by a one-step real-time RT-PCR assayJournal of Clinical Virology, 2008
- Sensitive, Seminested PCR Amplification of VP1 Sequences for Direct Identification of All Enterovirus Serotypes from Original Clinical SpecimensJournal of Clinical Microbiology, 2006
- West Nile Virus–associated Flaccid ParalysisEmerging Infectious Diseases, 2005
- Enterovirus 68 is associated with respiratory illness and shares biological features with both the enteroviruses and the rhinovirusesJournal of General Virology, 2004
- Acute Encephalomyelitis during an Outbreak of Enterovirus Type 71 Infection in Taiwan: Report of an Autopsy Case with Pathologic, Immunofluorescence, and Molecular StudiesLaboratory Investigation, 2000
- Acute, chronic and persistent enterovirus and poliovirus infections: detection of viral genome by seminested PCR amplification in culture-negative samplesMolecular and Cellular Probes, 1994
- ACUTE ASCENDING MYELITIS FOLLOWING A MONKEY BITE, WITH THE ISOLATION OF A VIRUS CAPABLE OF REPRODUCING THE DISEASEThe Journal of Experimental Medicine, 1934