UMEM Educational Pearls

Category: International EM

Title: Enterovirus D68- The New Polio?

Keywords: Polio, enterovirus D68, acute flaccid paralysis (PubMed Search)

Posted: 4/1/2015 by Jon Mark Hirshon, MD, MPH, PhD
Click here to contact Jon Mark Hirshon, MD, MPH, PhD

Background:

Polio is a crippling and potentially fatal infectious disease
- Can cause temporary or permanent acute flaccid paralysis
- Fecal-oral or oral transmission
- The majority of cases of polio infection are asymptomatic
- The public/global health significance of polio has been discussed in previous UMEM Educational Pearls (See: 5/7/2014 and 12/18/2013).
Caused by small, single-strand, positive-sense RNA virus of the genus Enterovirus

Enterovirus D68

Recent widespread nationwide outbreak of this non-polio enterovirus
- From mid-August 2014 to January 15, 2015, federal and state public health laboratories confirmed 1,153 people with infections
- Usually seen in children
- Usually causes mild to severe respiratory illness.
Concurrent with the national outbreak of Enterovirus D68, there was a concurrent increase in children with acute flaccid myelitis

Is there a relationship between Enterovirus D68 and the outbreak of acute flaccid myelitis?

Recent NIH funded research published in Lancet Infectious Disease analyzed the genomes of 48 patients with enterovirus infections
- Phylogenetic analysis showed that all enterovirus D68 sequences associated with acute flaccid myelitis were part of the same clade B1 strain .
These findings strengthen the possible relationship between enterovirus D68 and acute flaccid myelitis

Bottom Line

Acute flaccid myelitis may rarely occur after Enterovirus D68 in susceptible hosts

http://www.cdc.gov/non-polio-enterovirus/about/ev-d68.html

http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2815%2970093-9/abstract