Association of Enterovirus D68 with Acute Flaccid Myelitis, Philadelphia, Pennsylvania, USA, 2009–2018

Abstract

Acute flaccid myelitis (AFM) is a polio-like disease that results in paralysis in previously healthy persons. Although the definitive cause of AFM remains unconfirmed, enterovirus D68 (EV-D68) is suspected based on 2014 data demonstrating an increase in AFM cases concomitant with an EV-D68 outbreak. We examined the prevalence in children and the molecular evolution of EV-D68 for 2009–2018 in Philadelphia, Pennsylvania, USA. We detected widespread EV-D68 circulation in 2009, rare detections in 2010 and 2011, and then biennial circulation, only in even years, during 2012–2018. Prevalence of EV-D68 significantly correlated with AFM cases during this period. Finally, whole-genome sequencing revealed early detection of the B1 clade in 2009 and continued evolution of the B3 clade from 2016 to 2018. These data reinforce the need to improve surveillance programs for nonpolio enterovirus to identify possible AFM triggers and predict disease prevalence to better prepare for future outbreaks.

Co-circulation of multiple enterovirus D68 subclades, including a novel B3 cluster, across Europe in a season of expected low prevalence, 2019/20

“…Enterovirus D68 (EV-D68) is primarily a respiratory virus. Previously published data have suggested circulation with a biennial epidemic cycle in Europe and North America [1][2][3], but surveillance is not consistent. The Danish enterovirus surveillance detected two cases of EV-D68 infection in August 2019 and a further case in early September.…”

Evolution, geographic spreading, and demographic distribution of Enterovirus D68

“…In many countries, particularly in Europe and North America, EV-D68 has exhibited a biennial pattern, with peaks in the late summers and autumns of evennumbered years (2014,2016,2018) (Khetsuriani et al, 2006;Kramer et al, 2018;Messacar et al, 2019;Poelman et al, 2015b;Pons-Salort et al, 2018;Shen et al, 2019;Uprety et al, 2019). Other countries have re-ported odd-year outbreaks, such as Thailand in 2009(Linsuwanon et al, 2012, Australia in 2011 and 2013 (peaking in Southern Hemisphere winter to spring) (Levy et al, 2015), and Japan in 2015 (Funakoshi et al, 2019).…”

A Bayesian approach for detecting a disease that is not being modeled

“…However, it does this with a limited set of medical findings. While this highlights DUDE's ability to identify outbreaks of diseases such as EV-D68 merely from common symptoms, it potentially misses diseases that are characterized by the presence of unusual symptoms (such as paralysis which is associated with EV-D68 [22]). To be more effective, DUDE will need access to a much wider range of symptoms than it currently uses.…”