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Abstract

Background

Acute flaccid myelitis (AFM) is a polio-like condition affecting mainly children and involving the central nervous system (CNS). AFM has been associated with different non-polio-enteroviruses (EVs), in particular EV-D68 and EV-A71. Reliable incidence rates in European countries are not available.

Aim

To report AFM incidence in children in the Netherlands and its occurrence relative to EV-D68 and EV-A71 detections.

Methods

In 10 Dutch hospitals, we reviewed electronic health records of patients diagnosed with a clinical syndrome including limb weakness and/or CNS infection and who were < 18 years old when symptoms started. After excluding those with a clear alternative diagnosis to AFM, those without weakness, and removing duplicate records, only patients diagnosed in January 2014–December 2019 were retained and further classified according to current diagnostic criteria. Incidence rates were based on definite and probable AFM cases. Cases’ occurrences during the study period were co-examined with laboratory-surveillance detections of EV-D68 and EV-A71.

Results

Among 143 patients included, eight were classified as definite and three as probable AFM. AFM mean incidence rate was 0.06/100,000 children/year (95% CI: −0.03 to 0.14). All patient samples were negative for EV-A71. Of respiratory samples in seven patients, five were EV-D68 positive. AFM cases clustered in periods with increased EV-D68 and EV-A71 detections.

Conclusions

AFM is rare in children in the Netherlands. The temporal coincidence of EV-D68 circulation and AFM and the detection of this virus in several cases’ samples support its association with AFM. Increased AFM awareness among clinicians, adequate diagnostics and case registration matter to monitor the incidence.

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2022-10-20
2024-04-19
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2022.27.42.2200157
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Epidemiology of acute flaccid myelitis in children in the Netherlands, 2014 to 2019
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Jelte+Helfferich&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Helfferich Jelte</a>, <a href="/search?value1=Marit+MA+de+Lange&option1=author&noRedirect=true" class="nonDisambigAuthorLink">de Lange Marit MA</a>, <a href="/search?value1=Kimberley+SM+Benschop&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Benschop Kimberley SM</a>, <a href="/search?value1=Bart+C+Jacobs&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jacobs Bart C</a>, <a href="/search?value1=Coretta+C+Van+Leer-Buter&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Van Leer-Buter Coretta C</a>, <a href="/search?value1=Adam+Meijer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Meijer Adam</a>, <a href="/search?value1=Dewi+P+Bakker&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bakker Dewi P</a>, <a href="/search?value1=Eva+de+Bie&option1=author&noRedirect=true" class="nonDisambigAuthorLink">de Bie Eva</a>, <a href="/search?value1=Hilde+MH+Braakman&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Braakman Hilde MH</a>, <a href="/search?value1=Rick+Brandsma&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Brandsma Rick</a>, <a href="/search?value1=Rinze+F+Neuteboom&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Neuteboom Rinze F</a>, <a href="/search?value1=Erik+H+Niks&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Niks Erik H</a>, <a href="/search?value1=Jikke-Mien+Niermeijer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Niermeijer Jikke-Mien</a>, <a href="/search?value1=Vincent+Roelfsema&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Roelfsema Vincent</a>, <a href="/search?value1=Niels+Schoenmaker&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schoenmaker Niels</a>, <a href="/search?value1=Lilian+T+Sie&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sie Lilian T</a>, <a href="/search?value1=Hubert+G+Niesters&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Niesters Hubert G</a>, <a href="/search?value1=Oebele+F+Brouwer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Brouwer Oebele F</a>, <a href="/search?value1=Margreet+JM+te+Wierik&option1=author&noRedirect=true" class="nonDisambigAuthorLink">te Wierik Margreet JM</a></span>. Epidemiology of acute flaccid myelitis in children in the Netherlands, 2014 to 2019. <a href="/content/ecdc">Euro Surveill.</a> 2022;27(42):pii=2200157. <a href="https://doi.org/10.2807/1560-7917.ES.2022.27.42.2200157" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2022.27.42.2200157</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 06 Feb 2022;&nbsp;&nbsp; <span class="generated">Accepted</span>: 25 Jul 2022 </span> </p>
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