"A novel outbreak enterovirus D68 strain associated with acute flaccid myelitis cases in the USA (2012–14): a retrospective cohort study", published last March on The Lancet Infectious Diseases.

Summary of the article

Enteroviruses cause a broad spectrum of clinical illnesses, including acute respiratory infection, febrile rash, handfoot-and-mouth disease, meningitis, encephalitis, and, rarely, acute flaccid paralysis. In 2014, in the USA, a nationwide outbreak of enterovirus D68 occurred in association with severe respiratory illness, with more than 1150 confi rmed cases. This enterovirus D68 outbreak coincided with an apparent increase in incidence of reported cases of acute flaccid paralysis.

In this study, the authours report new and extensive genomic data that strengthen the association between enterovirus D68 infection and acute flaccid paralysis. A novel B1 strain of enterovirus D68 was detected in two temporally and geographically linked clusters of acute flaccid myelitis that occurred during the height of the 2014 respiratory outbreak, and was also detected for the first time in blood from a child with acute flaccid myelitis during the progressive phase of his paralytic illness. Although enterovirus D68 was not detected in cerebrospinal fluid from patients with acute flaccid myelitis, no other candidate infectious cause was identified in cerebrospinal fluid by metagenomic deep sequencing. The collective evidence provided in this study implicates the virus as a trigger of acute flaccid myelitis, and the identification of enterovirus D68 viraemia shows its capacity to cause systemic infection. Moreover this study underscores the importance of ongoing clinical and public health surveillance for enterovirus D68 and the need for an eff ective treatment or vaccine for enterovirus-D68-associated illness.

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Authors: Alexander L Greninger, Samia N Naccache, Kevin Messacar, Anna Clayton, Guixia Yu, Sneha Somasekar, Scot Federman, Doug Stryke, Christopher Anderson, Shigeo Yagi, Sharon Messenger, Debra Wadford, Dongxiang Xia, James P Watt, Keith Van Haren, Samuel R Dominguez, Carol Glaser, Grace Aldrovandi, Charles Y Chiu.