Acute flaccid myelitis – has it gone unrecognised in Australian children?

Abstract

We have identified a previously unrecognised cluster of a newly recognised condition – acute flaccid myelitis (AFM) – among acute flaccid paralysis (AFP) cases identified by the Australian Paediatric Active Enhanced Disease Surveillance Network (PAEDS) 2007–2017. In the 12 months before and after detection of enterovirus D68 (EV-D68) from a single AFP case in April 2016, 24 of 97 notified cases of AFP were found to be clinically compatible with AFM; of these 24 cases, ten, clustered in early 2016, met magnetic resonance imaging (MRI) criteria for AFM. Detection of emerging enteroviruses requires collection of respiratory, cerebrospinal fluid and stool specimens, and should be routine practice for all AFP cases.

Acute Flaccid Myelitis: Review of Clinical Features, Diagnosis, and Management with Nerve Transfers

“…After removal of duplicates and initial screening, 500 were reviewed and assessed for eligibility. After application of inclusion and exclusion criteria, 99 articles were included in this study (55 case reports/series, 1,4–7,9–57 33 retrospective cohort studies, 2,3,58–88 seven cross-sectional studies, 89–95 and four case-control studies 96–99 ) (Fig. 1).…”

Using the Acute Flaccid Paralysis Surveillance System to Identify Cases of Acute Flaccid Myelitis, Australia, 2000‒2018

“…In Australia, AFP surveillance detected EV-D68 during 2008, and peaks of activity occurred during 2011 and 2013 in laboratory-based enterovirus surveillance ( 21 ). EV-D68 was detected in 1 stool specimen associated with an AFM case in July 2018, and a review of PAEDS data for 2007‒2017 found EV-D68 in a respiratory specimen of another AFM case during March 2016 ( 22 ). Both viruses were identified as EV-D68 subgenotype B3, which was detected in increasing numbers in Europe and the United States during 2016 ( 23 , 24 ).…”

Acute Flaccid Paralysis in Australian Children from 2007 to 2017

“…In our study, AHCD cases further clustered in 2016 and EV-D68 was isolated in a single patient with PEP diagnosis of encephalitis. We have recently published an analysis showing that a cluster of AFM occurred in Australia at this time [37].…”