Abstract
In July–December 2018, an outbreak of polio-like acute flaccid myelitis (AFM) occurred in Zhejiang province, China. Enterovirus (EV)-D68 infection has been reported to be associated with AFM. This study aimed to investigate the clinical presentation, laboratory findings, and outcomes of AFM patients. We investigated the clinical and virologic information regarding the AFM patients, and real-time PCR, sequencing, and phylogenetic analysis were used to investigate the cause of AFM. Eighteen cases met the definition of AFM, with a median age of 4.05 years (range, 0.9–9 years), and nine (50%) were EV-D68 positive. Symptoms included acute flaccid limb weakness and cranial nerve dysfunction. On magnetic resonance imaging, 11 (61.1%) patients had spinal gray matter abnormalities. Electromyography results of 16 out of 17 patients (94.1%) were abnormal. Cerebrospinal fluid (CSF) pleocytosis was common (94.4%), while CSF protein concentration was normal in all patients. There was little improvement after early aggressive therapy. Phylogenetic analysis revealed that EV-D68 subclade B3 was the predominant lineage circulating in Zhejiang province in 2018.
Highlights
The Global Polio Eradication Initiative (GPEI), which was launched in response to a directive from the World Health Assembly, has dramatically reduced the number of cases of wild poliovirus [which is an enterovirus (EV)] globally, including in China [1, 2]
The others were designated as non-acute flaccid myelitis (AFM) Acute flaccid paralysis (AFP) cases, and mostly consisted of Guillain–Barré syndrome, acute transverse myelitis, and acute disseminated encephalomyelitis (ADEM)
Six of nine EV-D68-positive AFM patients and 5/9 EV-D68-negative AFM patients showed no improvement after a series treatment; 3/9 EV-D68-positive AFM patients and 4/9 EV-D68-negative AFM patients had some improvement
Summary
The Global Polio Eradication Initiative (GPEI), which was launched in response to a directive from the World Health Assembly, has dramatically reduced the number of cases of wild poliovirus [which is an enterovirus (EV)] globally, including in China [1, 2]. The GPEI uses both the oral polio vaccine (which consists of live attenuated poliovirus strains) and the inactivated polio vaccine, both of which are very effective. Based on the high oral polio vaccine coverage, China eradicated polio in October 2000 [3]. Clusters of AFP have become uncommon, infection is still a primary cause. Wild poliovirus is no longer the principal cause of AFP; instead, EVs, flaviviruses, herpesviruses, and adenoviruses have become the common etiological factors associated with AFP [5]
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