UMEM Educational Pearls

Title: Enterovirus D68- The New Polio?

Category: International EM

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

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

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

References

http://www.cdc.gov/polio/

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

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