Enterovirus D68 (EV-D68) is an emerging infection associated with acute flaccid myelitis(AFM). There are numerous reports of epidemiology and early clinical presentation. However the long-term outcome of this disabling neurological condition is not well reported. We report five cases of EV-D68 associated AFM in previously healthy children and their clinical outcome at 18 months.

After first case was diagnosed we set up a surveillance to monitor further cases. All presented during September-October 2016, were looked after in a tertiary children’s hospital and followed up by neurology and respiratory team. Their epidemiological, clinical, investigation (MRI, CSF studies, Neurophysiology & Virology), treatment and follow up data were collected prospectively.

All five children(2-6 years; M:F 3:2) from a small geographical (no previous contact with each other) presented with asymmetric proximal limb weakness, cranial nerve involvement, significant pain, respiratory failure, autonomic symptoms and bulbar involvement(Table 1).  EV-D68 was isolated in all cases (nasopharyngeal aspirate most sensitive). MRI T2 hyperintensity in the spinal cord grey matter/brainstem(Figure 1). EMG showed denervation and CSF lymphocytosis. Treatment with IVIG did not show any significant benefit. Gabapentin beneficial for pain control. All are mobile at 18 months all mobile, two requiring home ventilation through tracheostomy, four have severe proximal muscle weakness referred for nerve transfer.

EV-D68 associated AFM can cause severe neuro-disability and has significant impact on child, family and healthcare settings. Long term outcome is variable and in our cohort all children mobile, significant proximal weakness and two requiring home ventilation at 18 months.