BACKGROUND:

Following Enterovirus-D68 (EV-D68) outbreaks in 2014 and 2016, increased reports of Acute Flaccid Myelitis (AFM) in children were reported.^{1, 2} Epidemiological and biological link was made between the AFM and EV-D68.^{2, 3,4,5,6} We present the clinical and epidemiological data from our European collaboration study.

METHODS:

In 2016, European collaboration was set up to share clinical and virology data of EV-D68 associated AFM cases and EV-testing data from reference laboratories. The working group met to discuss this data. Data (age, sex, prodromal phase, clinical manifestations, neurological abnormalities, virology [including sequencing], neurological investigations [CSF analysis, MRI, EMG] and clinical follow-up) were collected and analysed by the co-ordinating centre (University Medical Center-Groningen).

RESULTS:

Data on 27 children (median age 3.9-years) were collated (Table 1). Common features were asymmetric flaccid limb weakness, cranial nerve deficits and bulbar symptoms, CSF pleocytosis, MRI hyperintensity (central cord and/or brainstem), and low motor amplitudes with normal conduction velocities on EMG.  Clinical recovery was variable (19 Ventilated and two died).

EV-D68 was detected in respiratory samples(93%), stool(27%) and CSF(7%) of AFM cases. 22.000 EV-tests were carried out, with 2381 EV positive results and 416 EV-D68 positive results. 414 out of these 416 EV-D68 positive samples were respiratory specimens (99%). Those strains that were sequenced clustered with EV-D68 subclade B3.

CONCLUSIONS:

In Europe EV-D68 related AFM cases were identified mostly in Western–Europe. Successful collaborations are key in improving awareness, diagnosis and potential prevention of this devastating global health problem with significant impact on child, family and healthcare setting.