DOI: 10.1371/journal.pone.0228671; PMCID: PMC7018000
BACKGROUND: Acute flaccid myelitis (AFM) is a severe illness similar to paralytic poliomyelitis. It is unclear how frequently AFM occurred in U.S. children after poliovirus elimination. In 2014, an AFM cluster was identified in Colorado, prompting passive US surveillance that yielded 120 AFM cases of unconfirmed etiology. Subsequently, increased reports were received in 2016 and 2018. To help inform investigations on causality of the recent AFM outbreaks, our objective was to determine how frequently AFM had occurred before 2014, and if 2014 cases had different characteristics.
METHODS: We conducted a retrospective study covering 2005-2014 at 5 pediatric centers in 3 U.S. regions. Possible AFM cases aged ≤18 years were identified by searching discharge ICD-9 codes and spinal cord MRI reports (>37,000). Neuroradiologists assessed MR images, and medical charts were reviewed; possible cases were classified as AFM, not AFM, or indeterminate.
RESULTS: At 5 sites combined, 26 AFM cases were identified from 2005-2013 (average annual number, 3 [2.4 cases/100,000 pediatric hospitalizations]) and 18 from 2014 (12.6 cases/100,000 hospitalizations; Poisson exact p
CONCLUSION: Our data support emergence of AFM in 2014 in the United States, and those cases demonstrated distinctive features compared with preceding sporadic cases.
Adolescent; Age Factors; Central Nervous System Viral Diseases; Child; Child, Preschool; Disease Outbreaks; Enterovirus D, Human; Female; Hospitalization; Hospitals, Pediatric; Humans; Infant; International Classification of Diseases; Magnetic Resonance Imaging; Male; Myelitis; Neuromuscular Diseases; Retrospective Studies; Seasons; United States
Central Nervous System Viral Diseases; Disease Outbreaks; Human Enterovirus D; Hospitalization; Hospitals, Pediatric; International Classification of Diseases; Magnetic Resonance Imaging; Myelitis; Neuromuscular Diseases
Cortese, M. M., Kambhampati, A. K., Schuster, J. E., Alhinai, Z., Nelson, G. R., Guzman Perez-Carrillo, G. J., Vossough, A., Smit, M. A., McKinstry, R. C., Zinkus, T., Moore, K. R., Rogg, J. M., Candee, M. S., Sejvar, J. J., Hopkins, S. E. A ten-year retrospective evaluation of acute flaccid myelitis at 5 pediatric centers in the United States, 2005-2014. PLoS One 15, (2020).