Unusual increase of cases of myelitis in a pediatric hospital in Argentina

Pérez, Guadalupe; Rosanova, María Teresa; Freire, María Cecilia; Paz, María I; Ruvinsky, Silvina; Rugilo, Carlos; Ruggieri, Víctor Luis; Cisterna, Daniel; Martiren, Soledad; Lema, Cristina; Savransky, Andrea; González, Soledad; Martínez, Leila; Viale, Diana; Bologna, Rosa

doi:10.5546/aap.2017.eng.364

Cited by 11 publications

(8 citation statements)

References 12 publications

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“…This study provides the first report of EV-D68 detection from patients with AFP in Senegal, similar to EV-D68 detection in AFM patients in Europe 28 , Latina America 26,27,29 , Asia 16,25 and the USA 30–33 . However, detection of EV-D68 from stool does not prove a causal relationship with paralytic disease, though all samples were negative for poliovirus.…”

Section: Discussionsupporting

confidence: 70%

Enterovirus D68 Subclade B3 Circulation in Senegal, 2016: Detection from Influenza-like Illness and Acute Flaccid Paralysis Surveillance

Fall

Ndiaye

Jallow

et al. 2019

Sci Rep

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Following the 2014 outbreak, active surveillance of the EV-D68 has been implemented in many countries worldwide. Despite subsequent EV-D68 outbreaks (2014 and 2016) reported in many areas, EV-D68 circulation remains largely unexplored in Africa except in Senegal, where low levels of EV-D68 circulation were first noted during the 2014 outbreak. Here we investigate subsequent epidemiology of EV-D68 in Senegal from June to September 2016 by screening respiratory specimens from ILI and stool from AFP surveillance. EV-D68 was detected in 7.4% (44/596) of patients; 40 with ILI and 4 with AFP. EV-D68 detection was significantly more common in children under 5 years (56.8%, p = 0.016). All EV-D68 strains detected belonged to the newly defined subclade B3. This study provides the first evidence of EV-D68 B3 subclade circulation in Africa from patients with ILI and AFP during a 2016 outbreak in Senegal. Enhanced surveillance of EV-D68 is needed to better understand the epidemiology of EV-D68 in Africa.

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Section: Discussionsupporting

confidence: 70%

Enterovirus D68 Subclade B3 Circulation in Senegal, 2016: Detection from Influenza-like Illness and Acute Flaccid Paralysis Surveillance

Fall

Ndiaye

Jallow

et al. 2019

Sci Rep

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“…Furthermore, in the second half of 2014, 120 pediatric patients with confirmed AFM, characterized by acute limb weakness with spinal cord motor neuron injury, were registered in the USA; this AFM cluster was coincident with the EVD68 outbreak, suggesting a possible causal association between EVD68 infection and AFM [ 10 , 11 ]. This speculation was further confirmed by a number of subsequent case reports and epidemiological investigations [ 12 , 13 , 14 , 15 , 16 ].…”

Section: Introductionmentioning

confidence: 53%

A Mouse Model of Enterovirus D68 Infection for Assessment of the Efficacy of Inactivated Vaccine

Zhang

Dai

et al. 2018

Viruses

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In recent years, enterovirus D68 (EVD68) has been reported increasingly to be associated with severe respiratory tract infections and acute flaccid myelitis (AFM) in children all over the world. Yet, no effective vaccines or antiviral drugs are currently available for EVD68. Although several experimental animal models have been developed, immunogenicity and protective efficacy of inactivated EVD68 vaccines has not been fully evaluated. To promote the development of vaccines, we established an Institute of Cancer Research (ICR) suckling mouse model of EVD68 infection in this study. The results showed that ICR neonatal mice up to about nine days of age were susceptible to infection with EVD68 clinical strain US/MO/14-18947 by intraperitoneal injection. The infected mice exhibited progressive limb paralysis prior to death and the mortality of mice was age- and virus dose-dependent. Tissue viral load analysis showed that limb muscle and spinal cord were the major sites of viral replication. Moreover, histopathologic examination revealed the severe necrosis of the limb and juxtaspinal muscles, suggesting that US/MO/14-18947 has a strong tropism toward muscle tissues. Additionally, β-propiolactone-inactivated EVD68 vaccine showed high purity and quality and induced robust EVD68-specific neutralizing antibody responses in adult mice. Importantly, results from both antisera transfer and maternal immunization experiments clearly showed that inactivated EVD68 vaccine was able to protect against lethal viral infection in the mouse model. In short, these results demonstrate the successful establishment of the mouse model of EVD68 infection for evaluating candidate vaccines against EVD68 and also provide important information for the development of inactivated virus-based EVD68 vaccines.

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“…Enterovirus D68 was identified in the CSF by PCR. Four additional cases have been reported of AFP or AFM with enterovirus D68 identified in CSF by PCR: one in a young adult with AFP in the USA in 2005 identified through enteroviral surveillance, 8 one in a child with AFM during the 2014 USA enterovirus D68 outbreak (noted to have a blood-contaminated CSF specimen and co-detection of Epstein-Barr virus nucleic acid), 23 one in a child with AFM during a cluster of cases in Argentina in 2016, 45,53 and a fatal case of AFM in an immunosuppressed adult in Italy in 2016. 46 Enterovirus D68 has also been detected in the CSF of two children and a young adult with aseptic meningitis without AFM.…”

Section: Weighing the Evidence For Causality Using Bradford Hill Critmentioning

confidence: 99%

Enterovirus D68 and acute flaccid myelitis—evaluating the evidence for causality

Messacar

Asturias

Hixon

et al. 2018

The Lancet Infectious Diseases

184

195

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Increased circulation of enterovirus D68 in 2014 and 2016 temporally and geographically coincided with increases in cases of acute flaccid myelitis, an uncommon condition of paralysis due to lesions in the anterior horn of the spinal cord. The identification of enterovirus D68 in respiratory specimens from cases of acute flaccid myelitis worldwide further supports an association, yet the absence of direct virus isolation from affected tissues, infrequent detection in cerebrospinal fluid, and the absence, until recently, of an animal model has left the causal nature of the relationship unproven. In this Personal View we evaluate epidemiological and biological evidence linking enterovirus D68 and acute flaccid myelitis. We applied the Bradford Hill criteria to investigate the evidence for a causal relationship and highlight the importance of comprehensive surveillance and research to further characterise the role of enterovirus D68 in acute flaccid myelitis and pursue effective therapies and prevention strategies.

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Unusual increase of cases of myelitis in a pediatric hospital in Argentina

Abstract: The first outbreak of acute flaccid myelitis associated to enterovirus D68 is reported in Argentina. Active epidemiological surveillance will help to determine the true incidence, epidemiology and etiology of this disease.

Cited by 11 publications

References 12 publications

Enterovirus D68 Subclade B3 Circulation in Senegal, 2016: Detection from Influenza-like Illness and Acute Flaccid Paralysis Surveillance

Enterovirus D68 Subclade B3 Circulation in Senegal, 2016: Detection from Influenza-like Illness and Acute Flaccid Paralysis Surveillance

A Mouse Model of Enterovirus D68 Infection for Assessment of the Efficacy of Inactivated Vaccine

Enterovirus D68 and acute flaccid myelitis—evaluating the evidence for causality

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