Document Type

Article

Publication Date

2-13-2020

Identifier

DOI: 10.1371/journal.pone.0228671; PMCID: PMC7018000

Abstract

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.

Journal Title

PLoS One

Volume

15

Issue

2

MeSH Keywords

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

Keywords

Central Nervous System Viral Diseases; Disease Outbreaks; Human Enterovirus D; Hospitalization; Hospitals, Pediatric; International Classification of Diseases; Magnetic Resonance Imaging; Myelitis; Neuromuscular Diseases

Comments

Grant support

This work was funded by the Centers for Disease Control and Prevention (CDC), which did not play a role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript and only provided financial support in the form of authors’ salaries and project materials. A.K. was employed by IHRC, Inc., a contracting agency to CDC. IHRC provided support in the form of salary for A.K. but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific role of AK is articulated in the ‘author contributions’ section.

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