ACUTE FLACCID MYELITIS - EUROPE: UNITED KINGDOM
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A ProMED-mail post
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International Society for Infectious Diseases
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Date: Wed 19 Dec 2018
Source: UK Government: Public Health England [edited]
https://www.gov.uk/government/ news/phe-investigating-rise- in-reports-of-rare-illness


Public Health England (PHE) is investigating an increase in reported cases of a rare condition called acute flaccid paralysis (AFP). So far in 2018, 28 cases have been reported in England, the majority of which have been since September [2018]. A rise in reported cases has also been seen in the United States.

AFP affects the nervous system, causing one or more of the limbs to become weak or floppy, and may look similar to polio. It tends particularly, though not exclusively, to affect children. It is very rare, so PHE stresses that if an adult or a child develops weakness in any limb they should seek medical attention so appropriate testing and care can be given.

Typically, a handful of cases of AFP are reported to PHE each year for investigation. PHE monitors these types of symptoms as part of the World Health Organization's requirements to monitor for polio and confirm it remains eliminated in the UK.

Certain viruses are known to cause AFP including polioviruses and non-polio enteroviruses. Enteroviruses commonly cause mild infections with a range of symptoms including colds, coughs and diarrhoea. Such illnesses from viral infections are common, especially in children, and most people recover. Enterovirus D68 (EV-D68) and other viruses have been detected in several cases of AFP so far in 2018. The risk of developing neurological symptoms due to EV-D68, or any other viral infection is extremely low.

Dr Mary Ramsay, head of immunisations at PHE said: "AFP is very rare. However, if you or your child develops weakness in any limb you should seek medical care immediately so that appropriate testing and care can be given. We are investigating potential causes and working hard to build better awareness amongst health care professionals about how to test and manage patients with AFP. We are ensuring up-to-date information is available for patients and their families who may be affected."

PHE is looking into the potential causes of the apparent rise in reports of AFP, including the role of EV-D68 or other infections. This will include ensuring that healthcare professionals' are aware of and can access guidance on the investigation and management of such cases. PHE is also supporting healthcare providers by developing up-to-date information for patients and/or parents.

AFP can be difficult to diagnose because there are many other causes of weakness. Doctors will typically examine a patient's nervous system and look at images of the spinal cord and brain. They can also test the fluid around the brain and spinal cord and may check the nervous system conduction.

Doctors should report any suspected cases of AFP to Public Health England and samples should be sent to specialist labs for additional testing.

Background
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- Tests for enterovirus infection are typically only undertaken on individuals admitted to hospital with conditions such as chest infections and meningitis. Although enterovirus infection is not notifiable, PHE receives reports of confirmed enterovirus infection from NHS laboratories, and offers specialist typing for very serious cases - including children with AFP.
- A total of 12 cases of AFP have been associated with an enterovirus. EV-D68 has been detected in 8, EV-C104 in 1, and coxsackie B1 in 1; in 2 cases the enterovirus was not typeable.

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communicated by:
ProMED-mail rapporteur Mary Marshall

[Laboratory tests have detected enteroviruses in 12 out of the 28 AFP cases. Enteroviruses most commonly cause mild illness. They can also cause neurologic illness, such as meningitis, encephalitis, and acute flaccid limb weakness, but these are rare.

The case number is smaller but the trend is similar to the increased number of cases seen in the United States in 2018. The Centers for Disease Control and Prevention has recently issued updated interim precautions for management of patients with acute flaccid myelitis which are Standard + Contact + Droplet precautions. This is consistent with CDC's recommendations for EV-D68. Since there is no known causative agent for AFM, there are no pathogen-specific recommendations. - Mod.UBA

HealthMap/ProMED map available at:
United Kingdom: http://healthmap.org/promed/p/ 40 ]

See Also