Researchers at the Children’s Hospital Colorado have described what they believe is the first defined cluster of children presenting with acute flaccid paralysis or cranial nerve dysfunction that they are linking to an outbreak of enterovirus D68 (EV-D68), according to a Medscape news report.
Cases of respiratory-related infections from EV-D68 have been documented in different regions in the US, and although findings don’t prove that this virus has caused the neurologic deficits, researchers believe that clinical, virologic, and epidemiologic factors point to an association.
Lead author of the paper Kevin Messacar says EV-D68 could be emerging alongside other viruses that have been tied to outbreaks of acute flaccid paralysis in areas where polioviruses no longer circulate.
The Medscape news report notes that between August 1 and September 30, 2014, a 36% increase in respiratory visits to the emergency department of Children’s Hospital Colorado was documented as well as a 77% increase in admissions for respiratory symptoms, compared with corresponding periods in 2012 and 2013. During the same period in 2014, the number of nasopharyngeal samples testing positive for rhinovirus or enterovirus increased substantially.
Of 25 specimens from children admitted to the ICU with severe respiratory illness who tested positive for enterovirus or rhinovirus in the nasopharynx, researchers identified EV-D68 in 76%. The research team decided investigate this and developed a “case definition.”
The cases studied had common features. Messacar explains, “All the children presented following a febrile upper respiratory illness and about a week later developed either weakness of muscles of the face, neck, arms or legs. The acute onset of weakness or flaccid paralysis is particularly unusual.”
Messacar states, “The etiologic link between AFM and EV-D68 needs to be investigated further through case-control studies of stored nasopharyngeal samples and serologic testing. And surveillance needs to be established to determine if and when EV-D68 is to recirculate.”
Messacar adds, “If further investigation confirms the association between enterovirus D68 and neurologic disease, and enterovirus D68 infections continue to happen in an endemic or epidemic pattern, development of effective antiviral or immunomodulatory therapies and vaccines will emerge as scientific priorities.”