An outbreak of enterovirus 71 in metropolitan Sydney: enhanced surveillance and lessons learnt

Zander, Alexis; Britton, Philip N; Navin, Tina; Horsley, Emily; Tobin, Sean; McAnulty, Jeremy

doi:10.5694/mja14.00014

Cited by 26 publications

(35 citation statements)

References 16 publications

(21 reference statements)

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“…However, a peak in AHCD and TM cases was also observed in late 2013, coinciding with a well-documented EV-A71 outbreak in Sydney. 10 Some of these had AFM-compatible MRIs, though rarely involving the cervical spine. 11 Conversely, the demographic and clinical features of our 2015-2016 cluster are very similar to those of the AFM outbreak described across the USA in 2014: MRI with predominant cervical spinal cord involvement, upper limb paralysis, CSF pleocytosis, strong male predominance, and peak occurrence during summer.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…Automated case classification will contribute significantly to the timely diagnosis of important infectious diseases, which may be under-recognized in routine care and therefore under-represented in surveillance datasets ( Kelly et al, 2013 , Dale, 2003 ). The recent outbreak of enterovirus 71-associated CNS infections provides a practical example, where automated case classification in real-time might have been useful to surveillance clinics and reference laboratories ( Zander et al, 2014 ). Further development and improvements of the VACC-Tool could include the ability to ‘flag’ any clinically suspect cases prompting automated reporting of anonymized data signals.…”

Section: Discussionmentioning

confidence: 99%

Enabling Precision Medicine With Digital Case Classification at the Point-of-Care

et al. 2016

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Infectious and inflammatory diseases of the central nervous system are difficult to identify early. Case definitions for aseptic meningitis, encephalitis, myelitis, and acute disseminated encephalomyelitis (ADEM) are available, but rarely put to use. The VACC-Tool (Vienna Vaccine Safety Initiative Automated Case Classification-Tool) is a mobile application enabling immediate case ascertainment based on consensus criteria at the point-of-care. The VACC-Tool was validated in a quality management program in collaboration with the Robert-Koch-Institute. Results were compared to ICD-10 coding and retrospective analysis of electronic health records using the same case criteria. Of 68,921 patients attending the emergency room in 10/2010–06/2013, 11,575 were hospitalized, with 521 eligible patients (mean age: 7.6 years) entering the quality management program. Using the VACC-Tool at the point-of-care, 180/521 cases were classified successfully and 194/521 ruled out with certainty. Of the 180 confirmed cases, 116 had been missed by ICD-10 coding, 38 misclassified. By retrospective application of the same case criteria, 33 cases were missed. Encephalitis and ADEM cases were most likely missed or misclassified. The VACC-Tool enables physicians to ask the right questions at the right time, thereby classifying cases consistently and accurately, facilitating translational research. Future applications will alert physicians when additional diagnostic procedures are required.

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“…HEV71 epidemics are seasonal, with the highest transmission rates occurring during warmer, wetter months [52]. Recent outbreak data from Malaysia and Australia suggest that epidemics occur in two to three year cycles corresponding with new, naive birth cohorts [53,54]. Characteristic clinical features of HEV CNS disease include myoclonus, tremor, ataxia, nystagmus and cranial nerve palsies, which may develop with or without HFMD.…”

Section: Non-polio Enterovirus Encephalitis Including Hev71mentioning

confidence: 98%

Paediatric Acute Encephalitis: Infection and Inflammation

Jones

2015

Curr Pediatr Rep

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Encephalitis is a multifaceted syndrome with a myriad of clinical presentations. It is defined as inflammation of the brain with functional disturbance. Infectious diseases, particularly viruses, and autoimmune disorders are the commonest causes in children. Young infants have the highest burden of disease for most infectious causes. Recent advances include the publication of international consensus guidelines, emergence of new aetiologies including human parechoviruses and better characterisation of known infectious causes, including enterovirus 71, which continue to cause large epidemics, death and impairment in children although a number promising vaccines are on the horizon; and neurological syndromes associated with influenza which occur most commonly in children who are not immunised against the virus. Understanding of childhood autoimmune encephalopathies is also rapidly expanding including responses to immunomodulation and prognosis. Future research should see better understanding of the pathogenesis of all forms of encephalitis, with hope for advances in therapy and prevention.

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An outbreak of enterovirus 71 in metropolitan Sydney: enhanced surveillance and lessons learnt

Abstract: EV71 infection is likely to continue to be a public health problem in Australia. Surveillance of routinely collected emergency department data can provide a useful indication of its activity in the community.

Cited by 26 publications

References 16 publications

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

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

Enabling Precision Medicine With Digital Case Classification at the Point-of-Care

Paediatric Acute Encephalitis: Infection and Inflammation

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