EV-D68 Virus Identified as a Cause of Acute Flaccid Myelitis

Parents and families of children who developed a case of acute flaccid myelitis (AFM) now have a few more answers regarding this mystery disease. 

A research team found Enterovirus-D68 (EV-D68) in the cerebrospinal fluid of one affected patient, concluding that, "identification of EV-D68 in the CSF of case 2 is considered the cause of AFM in this patient." 

This insight may be a small clue to better understand the course of illness and cause of AFM.   

“The fact that we were able to definitively identify the EV-D68 virus as the cause of paralysis in 1 of our Minnesota patients, does suggest this virus as a probable cause in our other recent AFM cases,” said these researchers in a press release. 

AFM is a condition that causes severe muscle weakness and loss of muscle tone in one or more parts of the body. This profound weakness is caused by inflammation of the spinal cord. 

AFM primarily affects children, but adult cases have also been reported. 

In the new report, “Notes from the Field: Six Cases of Acute Flaccid Myelitis in Children – Minnesota, 2018” lead author Heidi Moline, MD, MPH, Chief Resident of Pediatrics at the University of Minnesota Medical School and University of Minnesota Masonic Children’s Hospital, collaborates with experts from the Centers for Disease Control and Prevention (CDC) and the Minnesota Department of Health (MDH), during September 14 through October 1, 2018. 

The MDH was notified of 10 confirmed AFM cases in the Minneapolis-St. Paul area. The important components of this report include: 

• This AFM cluster—the largest identified in Minnesota—occurred during a period of increased AFM reports nationally
• The average patient age for this cluster in Minnesota was 6 years old
• All patients in this cluster live in different counties of Minnesota
• All patients experienced fever and upper respiratory signs and symptoms such as rhinorrhea, cough, beginning an average of 8 days prior to weakness onset
• Magnetic resonance imaging showed spinal cord grey matter involvement in all 6 children patients, largely in the anterior horns

“Clinically, we need to continue efforts to rapidly identify these patients to optimize therapy and improve long term outcome of affected children, ” said Dr. Moline. 

“Essentially, children would go to sleep feeling well but then wake up unable to brush their hair or walk without assistance.” 

AFM is believed to be caused by certain infections—most of them viral—that attack the spinal cord and damage it. Most of these viruses—known as enteroviruses—are common infections that everyone eventually acquires. 

No one knows why these viruses affect the spinal cord in only a tiny fraction of the population. 

As of April 2019, there have been 4 confirmed cases of AFM in Nebraska, North Carolina, Utah, and West Virginia. 

And, the CDC confirmed 201 AFM cases during 2018. The leading states reporting confirmed AFM cases in 2018 were Texas (25), Colorado (16), Ohio (13), Washington (11).

Across the Atlantic Ocean, the United Kingdom experienced an increase in reports of acute flaccid paralysis (AFP). As of January 21, 2019, 40 AFP cases had been identified, with a peak in October 2018.   

To empower future AFM diagnosis, the CDC published an updated “Interim Considerations for Clinical Management of Patients with AFM” in November 2018.