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During 2018, the United Kingdom experienced an increase in reports of cases of acute flaccid paralysis (AFP). As at 21 January 2019, 40 cases had been identified with a peak in October 2018. The increase was temporally associated with an upsurge in enterovirus (EV) D68 activity. Enterovirus was detected in 15 cases, mainly from respiratory tract samples; nine were typed as EV-D68. A national task force has been established and investigations are ongoing.


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  1. Sejvar JJ, Lopez AS, Cortese MM, Leshem E, Pastula DM, Miller L, et al. Acute Flaccid Myelitis in the United States, August-December 2014: Results of Nationwide Surveillance. Clin Infect Dis. 2016;63(6):737-45.  https://doi.org/10.1093/cid/ciw372  PMID: 27318332 
  2. Knoester M, Helfferich J, Poelman R, Van Leer-Buter C, Brouwer OF, Niesters HGM, 2016 EV-D68 AFM Working Group. Twenty-nine Cases of Enterovirus-D68-associated Acute Flaccid Myelitis in Europe 2016: A Case Series and Epidemiologic Overview. Pediatr Infect Dis J. 2019;38(1):16-21.  https://doi.org/10.1097/INF.0000000000002188  PMID: 30234793 
  3. Williams CJ, Thomas RH, Pickersgill TP, Lyons M, Lowe G, Stiff RE, et al. Cluster of atypical adult Guillain-Barré syndrome temporally associated with neurological illness due to EV-D68 in children, South Wales, United Kingdom, October 2015 to January 2016. Euro Surveill. 2016;21(4):30119.  https://doi.org/10.2807/1560-7917.ES.2016.21.4.30119  PMID: 26848143 
  4. Chong PF, Kira R, Mori H, Okumura A, Torisu H, Yasumoto S, et al. , Acute Flaccid Myelitis Collaborative Study Investigators. Clinical Features of Acute Flaccid Myelitis Temporally Associated With an Enterovirus D68 Outbreak: Results of a Nationwide Survey of Acute Flaccid Paralysis in Japan, August-December 2015. Clin Infect Dis. 2018;66(5):653-64.  https://doi.org/10.1093/cid/cix860  PMID: 29028962 
  5. McKay SL, Lee AD, Lopez AS, Nix WA, Dooling KL, Keaton AA, et al. Increase in Acute Flaccid Myelitis - United States, 2018. MMWR Morb Mortal Wkly Rep. 2018;67(45):1273-5.  https://doi.org/10.15585/mmwr.mm6745e1  PMID: 30439867 
  6. Messacar K, Schreiner TL, Van Haren K, Yang M, Glaser CA, Tyler KL, et al. Acute flaccid myelitis: A clinical review of US cases 2012-2015. Ann Neurol. 2016;80(3):326-38.  https://doi.org/10.1002/ana.24730  PMID: 27422805 
  7. British paediatric association surveillance unit (BPASU). 9th Annual report. London: BPASU; 1995. Available from: healthhttps://www.rcpch.ac.uk/sites/default/files/2018-06/9th_annual_report.pdf
  8. Bitnun A, Yeh EA. Acute Flaccid Paralysis and Enteroviral Infections. Curr Infect Dis Rep. 2018;20(9):34.  https://doi.org/10.1007/s11908-018-0641-x  PMID: 29959591 
  9. Kim KT, Cho YW. Coxsackievirus B1 resulting acute flaccid myelitis with entire spinal cord lesion: a case report. Neurol Sci. 2018.  PMID: 30341479 
  10. Cho SM, MacDonald S, Frontera JA. Coxsackie B3/B4-Related Acute Flaccid Myelitis. Neurocrit Care. 2017;27(2):259-60.  https://doi.org/10.1007/s12028-017-0377-8  PMID: 28324262 
  11. Harvala H, Broberg E, Benschop K, Berginc N, Ladhani S, Susi P, et al. Recommendations for enterovirus diagnostics and characterisation within and beyond Europe. J Clin Virol. 2018;101:11-7.  https://doi.org/10.1016/j.jcv.2018.01.008  PMID: 29414181 
  12. Dyda A, Stelzer-Braid S, Adam D, Chughtai AA, MacIntyre CR. The association between acute flaccid myelitis (AFM) and Enterovirus D68 (EV-D68) - what is the evidence for causation? Euro Surveill. 2018;23(3):17-00310.  https://doi.org/10.2807/1560-7917.ES.2018.23.3.17-00310  PMID: 29386095 
  13. Brown DM, Hixon AM, Oldfield LM, Zhang Y, Novotny M, Wang W, et al. Contemporary Circulating Enterovirus D68 Strains Have Acquired the Capacity for Viral Entry and Replication in Human Neuronal Cells. MBio. 2018;9(5):e01954-18.  https://doi.org/10.1128/mBio.01954-18  PMID: 30327438 
  14. Zhang Y, Cao J, Zhang S, Lee AJ, Sun G, Larsen CN, et al. Genetic changes found in a distinct clade of Enterovirus D68 associated with paralysis during the 2014 outbreak. Virus Evol. 2016;2(1):vew015.  https://doi.org/10.1093/ve/vew015  PMID: 28512577 
  15. Rosenfeld A, Warren A, Racaniello V. Neurotropism of enterovirus D68 isolates is independent of sialic acid and is not a recently acquired phenotype. Posted July 10 2017. bioRxiv.
  16. Hixon AM, Yu G, Leser JS, Yagi S, Clarke P, Chiu CY, et al. A mouse model of paralytic myelitis caused by enterovirus D68. PLoS Pathog. 2017;13(2):e1006199.  https://doi.org/10.1371/journal.ppat.1006199  PMID: 28231269 
  17. Public Health England (PHE). Acute flaccid paralysis syndrome. Information on the reporting, investigation and management of acute flaccid paralysis (AFP) and acute flaccid myelitis (AFM). London: PHE; 2018. Available from: https://www.gov.uk/government/collections/acute-flaccid-paralysis-syndrome

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