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Pediatr Infect Dis J. 2018 Sep 18. doi: 10.1097/INF.0000000000002188. [Epub ahead of print]

Twenty-Nine Cases of Enterovirus-D68 Associated Acute Flaccid Myelitis in Europe 2016; A Case Series and Epidemiologic Overview.

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Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.



Enterovirus D68 (EV-D68) is a respiratory virus within the genus Enterovirus and the family of Picornaviridae. Genetically, it is closely related to rhinovirus that replicates in the respiratory tract and causes respiratory disease. Since 2014, EV-D68 has been associated with the neurologic syndrome of acute flaccid myelitis (AFM).


In October 2016, questionnaires were sent out to a European network including 66 virologists and clinicians, to develop an inventory of EV-D68 associated AFM cases in Europe. Clinical and virologic information of case patients was requested. In addition, epidemiologic information on EV-testing was collected for the period between March and October 2016.


Twenty-nine cases of EV-D68 associated AFM were identified, from 12 different European countries. Five originated from France, 5 from Scotland and 3 each from Sweden, Norway and Spain. Twenty-six were children (median age 3.8 years), 3 were adults. EV-D68 was detected in respiratory materials (n=27), feces (n=8) and/or cerebrospinal fluid (n=2).Common clinical features were asymmetric flaccid limb weakness, cranial nerve deficits and bulbar symptoms. On magnetic resonance imaging, typical findings were hyperintensity of the central cord and/or brainstem; low motor amplitudes with normal conduction velocities were seen on electromyography. Full clinical recovery was rare (n=3), and 2 patients died.The epidemiologic data from 16 European laboratories showed that of all EV-D68 positive samples, 99% was detected in a respiratory specimen.


For 2016, 29 EV-D68 related AFM cases were identified in mostly Western Europe. This is likely an underestimation, since case identification is dependent on awareness among clinicians, adequate viral diagnostics on respiratory samples, and the capability of laboratories to type EVs.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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