Acute Flaccid Myelitis Among Children — Washington, September<b>–</b>November 2016

Bonwitt, Jesse; Poel, Amy; DeBolt, Chas; Gonzales, E. Lozano; Lopez, Adriana; Routh, Janell; Rietberg, Krista; Linton, Natalie M.; Reggin, James D.; Sejvar, James J.; Lindquist, Scott; Otten, Catherine

doi:10.15585/mmwr.mm6631a2

Cited by 22 publications

(17 citation statements)

References 7 publications

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“…These results highlight that the CDC case definition, while appropriately sensitive for epidemiologic ascertainment of possible AFM cases, also encompasses other neurologic diseases that can cause acute weakness. Previously published case series have used either the CDC case definition alone 7,[11][12][13] or with varying degrees of modification, 4,[8][9][10][14][15][16] indicating variable approaches to defining research populations. This raises the possibility that the populations reported in these studies may represent a heterogeneous collection of neurologic illnesses or that AFM may be co-occurring with another defined neurologic disease.…”

Section: Discussionmentioning

confidence: 99%

“…8 Epidemiologic evidence suggested that the outbreaks of AFM in the United States may be associated primarily with enterovirus D68, 9 although other implicated viruses include enterovirus-A71, Epstein-Barr virus, and adenovirus. 10 Scientists have since adopted this case definition to define research cohorts, 4,[7][8][9][10][11][12][13][14][15][16] and clinicians have used it to guide the diagnosis and treatment of children presenting with limb weakness. While this definition has aided comprehensive ascertainment of cases for epidemiologic surveillance of AFM, our experience suggests that the CDC case definition may also capture children with acute weakness owing to other definable illnesses.…”

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confidence: 99%

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Clinical Subpopulations in a Sample of North American Children Diagnosed With Acute Flaccid Myelitis, 2012-2016

et al. 2019

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IMPORTANCE Acute flaccid myelitis (AFM) is an emerging poliolike illness of children whose clinical spectrum and associated pathogens are only partially described. The case definition is intentionally encompassing for epidemiologic surveillance to capture all potential AFM cases. Defining a restrictive, homogenous subpopulation may aid our understanding of this emerging disease. OBJECTIVE To evaluate the extent to which the US Centers for Disease Control and Prevention (CDC) case definition of AFM incorporates possible alternative diagnoses and to assess the plausibility of a case definition that enriches the biological homogeneity of AFM for inclusion in research studies. DESIGN, SETTING, AND PARTICIPANTS Retrospective case analysis of children younger than 18 years diagnosed as having AFM between 2012 and 2016 using the CDC case definition. Group 1 included patients recruited from the United States and Canada based on the CDC case definition of AFM. Group 2 included patients referred to the Johns Hopkins Transverse Myelitis Center for evaluation of suspected AFM. Patients' records and imaging data were critically reviewed by 3 neurologists to identify those cases with definable alternative diagnoses, and the remaining patients were categorized as having restrictively defined AFM (rAFM). Clinical characteristics were compared between patients with rAFM (cases) and those with alternative diagnoses, and a case description distinguishing these AFM groups was identified. Interrater reliability of this description was confirmed for a subset of cases by a fourth neurologist. Data were analyzed between May 2017 and November 2018. MAIN OUTCOMES AND MEASURES Proportion of patients with possible alternative diagnosis. RESULTS Of the 45 patients who met the CDC AFM case definition and were included, the mean age was 6.1 years; 27 were boys (60%); and 37 were white (82%), 3 were Asian (7%), 1 was Hispanic (2%), and 4 were mixed race/ethnicity (9%). Of the included patients, 34 were classified as having rAFM, and 11 had alternate diagnoses (including transverse myelitis, other demyelinating syndromes, spinal cord stroke, Guillain-Barre syndrome, Chiari I myelopathy, and meningitis). Factors differing between groups were primarily asymmetry of weakness, lower motor neuron signs, preceding viral syndrome, symptoms evolving over hours to days, absence of sensory deficits, and magnetic resonance imaging findings. A case description was able to reliably define the rAFM group. CONCLUSIONS AND RELEVANCE We present an approach for defining a homogeneous research population that may more accurately reflect the pathogenesis of the prototypical poliomyelitis-like subgroup of AFM. The definition of rAFM forms a blueprint for inclusion criteria in future research efforts, but more work is required for refinement and external validation.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Clinical Subpopulations in a Sample of North American Children Diagnosed With Acute Flaccid Myelitis, 2012-2016

et al. 2019

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“…IQR, interquartile range; ADHD, and convalesence are depicted in Figure 4. MRC-sum scores increased in eight patients, indicating increased strength, with a median individual change of 18 (IQR [11][12][13][14][15][16][17][18][19][20][21][22]. Overall, the MRC-sum score rose from a median of 29 (IQR 17-38) to 32 (IQR .…”

Section: Neuroimaging Analysismentioning

confidence: 96%

Comparative quantitative clinical, neuroimaging, and functional profiles in children with acute flaccid myelitis at acute and convalescent stages of disease

Gordon-Lipkin

Muñoz

Klein

et al. 2018

Develop Med Child Neuro

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“…The clinical similarity of AFM to other neurologic syndromes, e.g. Guillain-Barré syndrome and idiopathic transverse myelitis, increases the chance of misdiagnosis, potentially concealing the true AFM incidence further (37). Interestingly, the onset of the 2018 outbreak coincides with time-of-onset observed in both previous outbreaks in 2014 and 2016: August to October (4).…”

Section: Critical Analysismentioning

confidence: 98%

“…In 2014, 11 Non-EV-D68 enterovirus species were detected in the stool of AFM cases, suggestive of EV-A71 infection as a faecal-oral pathogen but was not specified (38). In 2016, a single AFM case in Washington State tested positive for EV-A71 among 10 confirmed AFM cases (37). Similarly, there is little evidence internationally for co-circulation of EV-D68 and EV-A71 among AFM cases.…”

Section: Critical Analysismentioning

confidence: 99%

Report on the 2018 Acute Flaccid Myelitis Outbreaks in the USA

Adam

2019

Global Biosecurity

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Feedback from operational stakeholders who manage or respond to outbreaks is that they are often too busy to review literature or obtain relevant background information to assist them with acute response. Unlike a traditional analytical outbreak investigation report, Watching Briefs are intended as a rapid resource for public health or other first responders in the field on topical, serious or current outbreaks, and provide a digest of relevant information including key features of an outbreak, comparison with past outbreaks and a literature review.

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Acute Flaccid Myelitis Among Children — Washington, September–November 2016

Cited by 22 publications

References 7 publications

Clinical Subpopulations in a Sample of North American Children Diagnosed With Acute Flaccid Myelitis, 2012-2016

Clinical Subpopulations in a Sample of North American Children Diagnosed With Acute Flaccid Myelitis, 2012-2016

Comparative quantitative clinical, neuroimaging, and functional profiles in children with acute flaccid myelitis at acute and convalescent stages of disease

Report on the 2018 Acute Flaccid Myelitis Outbreaks in the USA

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