Acute flaccid myelitis in Europe between 2016 and 2023: indicating the need for better registration

Jelte Helfferich; Cristina Calvo; Ekkehardt Alpeter; Cristina Andrés; Andrés Antón; Melodie Aubart; Stefania Maria Bova; Maria Cabrerizo; Karin von Eije; Stollar Fabiola; Ana Felipe; Ralitsa Iordanova; Marianne Kragh Thomsen; Per Kristian Knudsen; Freek van Loenen; Noemi Lopez; Audrey Mirand; Richard Molenkamp; Sofie Midgley; Raquel Neves; Lubomira Nikolaeva Glomb; Joakim Øverbø; Gülten Öztürk; Paula Palminha; Helle Cecilie Viekilde Pfeiffer; Birgit Prochazka; Carlos Ribeiro; Martine Rodesch; Isabelle Schuffenecker; Jay Shetty; Sandy Siegert; Silje Lae Solberg; Artur Sulik; Dilşad Türkdoğan; Olcay Ünver; Jaco Verweij; Jorgina Vila; Tytti Vuorinen; Ronny Wickström; Thea K Fischer; Heli Harvala; Kimberley S.M. Benschop

doi:10.2807/1560-7917.ES.2025.30.21.2400579

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Acute flaccid myelitis in Europe between 2016 and 2023: indicating the need for better registration
Jelte Helfferich¹ , Cristina Calvo^2,3 , Ekkehardt Alpeter⁴ , Cristina Andrés^2,5 , Andrés Antón^2,5 , Melodie Aubart^6,7 , Stefania Maria Bova⁸ , Maria Cabrerizo⁹ , Karin von Eije¹⁰ , Stollar Fabiola^11,12 , Ana Felipe^13,14 , Ralitsa Iordanova^15,16 , Marianne Kragh Thomsen¹⁷ , Per Kristian Knudsen¹⁸ , Freek van Loenen¹⁰ , Noemi Lopez^19,20 , Audrey Mirand²¹ , Richard Molenkamp¹⁰ , Sofie Midgley²² , Raquel Neves²³ , Lubomira Nikolaeva Glomb²⁴ , Joakim Øverbø²⁵ , Gülten Öztürk²⁶ , Paula Palminha²³ , Helle Cecilie Viekilde Pfeiffer^27,28 , Birgit Prochazka²⁹ , Carlos Ribeiro²³ , Martine Rodesch³⁰ , Isabelle Schuffenecker³¹ , Jay Shetty³² , Sandy Siegert³³ , Silje Lae Solberg³⁴ , Artur Sulik³⁵ , Dilşad Türkdoğan²⁶ , Olcay Ünver²⁶ , Jaco Verweij³⁶ , Jorgina Vila^37,38 , Tytti Vuorinen^39,40 , Ronny Wickström⁴¹ , Thea K Fischer^42,43 , Heli Harvala^44,45,46,47 , Kimberley S.M. Benschop⁴⁸
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Affiliations: ¹ Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands ² Centro de Investigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain ³ Pediatric Infectious and Tropical Diseases Department, La Paz University Hospital and Translational Research Network in Pediatric Infectious Diseases (RITIP), Institute for Health Research IdiPAZ, Autonomous University of Madrid, Madrid, Spain ⁴ Federal Department of Home Affairs FDHA, Federal Office of Public Health FOPH, Division of Communicable Disease, Bern, Switzerland ⁵ Respiratory Viruses Unit, Virology Section, Microbiology Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Institut of Research (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain ⁶ Pediatric Neurology Department, Necker-Enfants malades Hospital, AP-HP, Paris, France ⁷ Human Genetics of Infectious Diseases, University of Paris Cité, Institut Imagine, Paris, France ⁸ Child Neurology Unit, Buzzi Children hospital, Milan, Italy ⁹ Polio/Enterovirus National Lab, National Centre of Microbiology, Instituto de Salud Carlos III, Madrid, Spain. CIBERESP and RITIP (Idipaz) ¹⁰ Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands ¹¹ Division of General Pediatrics, Department of Pediatrics, Gynecology & Obstetrics, University Hospitals of Geneva, Geneva, Switzerland ¹² Member of the SPSU (Swiss paediatric Surveillance Unit) committee, Switzerland ¹³ Paediatric Neurology Research Group, Vall d'Hebron Institut de Recerca, Barcelona, Catalonia, Spain ¹⁴ Paediatric Neurology Section, Children's Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain ¹⁵ Department of Pediatrics UMHAT “St. George” - Plovdiv, Plovdiv, Bulgaria ¹⁶ Department of Pediatrics, Medical University of Plovdiv, Plovdiv, Bulgaria ¹⁷ Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark ¹⁸ Department of Paediatric and Adolescent Medicine and Department of Paediatric Research, Oslo University Hospital, Oslo, Norway ¹⁹ Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain ²⁰ CIBERESP, Dpto. Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid, Madrid, Spain ²¹ CHU Clermont-Ferrand, Centre National de référence des entéroviurs et parechovirus-laboratoire coordonnateur, Clermont-Ferrand, France ²² The Danish WHO National Reference Laboratory for Poliovirus, Section for Virus Genomics, Department of Virus & Microbiological Preparedness, Division of Infectious Disease Diagnostic Preparedness, Copenhagen, Denmark ²³ National Reference Laboratory for Vaccine-Preventable Diseases, Department of Infectious Diseases, National Institute of Health, Doutor Ricardo Jorge, Lisbon, Portugal ²⁴ National Reference Laboratory for Enteroviruses, National Center for Infectious and Parasitic Diseases, Sofia, Bulgaria ²⁵ The Norwegian Institute of Public Health (NIPH), Oslo, Norway ²⁶ Department of pediatric neurology, Marmara University, Istanbul, Türkiye ²⁷ Department of Pediatrics, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark ²⁸ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark ²⁹ AGES, Wien, Austria ³⁰ Department of pediatrics, Hôpital Erasme, Brussels, Belgium ³¹ Department of Virology, National Reference Centre for Enteroviruses and Parechoviruses, Associated Laboratory, Université Claude Bernard Lyon 1, CHU Lyon, Lyon, France ³² Department of Paediatric Neurosciences, Royal Hospital for Children and Young People, Edinburgh, United Kingdom ³³ Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria ³⁴ Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway ³⁵ Department of Pediatric Infectious Diseases, Medical University of Bialystok, Bialystok, Poland ³⁶ Microvida Laboratory for Medical Microbiology and Immunology, ElisabethTweesteden Hospital, Tilburg, The Netherlands ³⁷ Infection and Immunity Research Group, Vall d'Hebron Institut de Recerca, Barcelona, Catalonia, Spain ³⁸ Paediatric Hospitalization Unit, Children's Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain ³⁹ Department of Clinical Microbiology, Turku University Hospital, Turku, Finland ⁴⁰ Institute of Biomedicine, University of Turku, Turku, Finland ⁴¹ Neuropediatric Unit, Department of Women’s and Children’s Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden ⁴² Department of Public Health, Section of Global Health, University of Copenhagen, Copenhagen, Denmark ⁴³ Department of Clinical Research, North Zealand University Hospital, Hillerød, Denmark ⁴⁴ Department of Infection and Immunity, University College of London, London, United Kingdom ⁴⁵ Microbiology Services, National Health Service (NHS) Blood and Transplant, London, United Kingdom ⁴⁶ Department of Clinical Microbiology, Turku University Hospital, Turku, Finland ⁴⁷ Institute of Biomedicine, University of Turku, Turku, Finland ⁴⁸ Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands

Correspondence:
Jelte Helfferich
j.helfferich umcg.nl
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Citation style for this article: Helfferich Jelte, Calvo Cristina, Alpeter Ekkehardt, Andrés Cristina, Antón Andrés, Aubart Melodie, Bova Stefania Maria, Cabrerizo Maria, von Eije Karin, Fabiola Stollar, Felipe Ana, Iordanova Ralitsa, Thomsen Marianne Kragh, Knudsen Per Kristian, van Loenen Freek, Lopez Noemi, Mirand Audrey, Molenkamp Richard, Midgley Sofie, Neves Raquel, Glomb Lubomira Nikolaeva, Øverbø Joakim, Öztürk Gülten, Palminha Paula, Viekilde Pfeiffer Helle Cecilie, Prochazka Birgit, Ribeiro Carlos, Rodesch Martine, Schuffenecker Isabelle, Shetty Jay, Siegert Sandy, Solberg Silje Lae, Sulik Artur, Türkdoğan Dilşad, Ünver Olcay, Verweij Jaco, Vila Jorgina, Vuorinen Tytti, Wickström Ronny, Fischer Thea K, Harvala Heli, Benschop Kimberley S.M.. Acute flaccid myelitis in Europe between 2016 and 2023: indicating the need for better registration. Euro Surveill. 2025;30(21):pii=2400579. https://doi.org/10.2807/1560-7917.ES.2025.30.21.2400579 Received: 30 Aug 2024; Accepted: 02 Feb 2025

Abstract

Background

Acute flaccid myelitis (AFM) is a rare polio-like condition affecting mainly children and characterised by severe, often persistent, weakness. It is one of several causes of acute flaccid paralysis (AFP), which manifests as acute onset of limb weakness and reduced muscle tone. Some non-polio enteroviruses (EV), such as EV-D68 may cause AFM. Little is known about AFM incidence in Europe.

Aim

We aimed to better understand AFM incidence, aetiology and current surveillance policies in Europe.

Methods

In 28 countries, members of the European non-polio enterovirus network (ENPEN) and a newly established AFM network of clinicians under ENPEN received a survey asking them how AFM surveillance was performed in their countries in 2016−2023 and the numbers of AFM cases including those diagnosed with EV-D68 infection during this period.

Results

Surveillance information was obtained for 16 countries. In eight countries, AFP surveillance initiated for poliomyelitis eradication was still ongoing, while non-polio AFM cases were only systematically reported in Norway. The survey revealed 130 AFM cases for 14 countries, with 48 (37%) EV-D68-laboratory-confirmed. Among the AFM cases, 70% (n = 91) occurred in 2016, 2018 and 2022, when EV-D68 circulation increased.

Conclusions

This report provides some indication of AFM case numbers in Europe since 2016. However, as 15 of 16 countries with AFM monitoring information lacked structural AFM surveillance, numbers should be interpreted with caution. Knowing AFM incidence matters to determine its impact and detect future outbreaks. Thus, the newly established clinical network will develop a European AFM repository.

This work is licensed under a Creative Commons Attribution 4.0 International License.

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Acute flaccid myelitis in Europe between 2016 and 2023: indicating the need for better registration

Citation style for this article: <a href="/search?value1=Jelte+Helfferich&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Helfferich Jelte</a>, <a href="/search?value1=Cristina+Calvo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Calvo Cristina</a>, <a href="/search?value1=Ekkehardt+Alpeter&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Alpeter Ekkehardt</a>, <a href="/search?value1=Cristina+Andr%C3%A9s&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Andrés Cristina</a>, <a href="/search?value1=Andr%C3%A9s+Ant%C3%B3n&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Antón Andrés</a>, <a href="/search?value1=Melodie+Aubart&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Aubart Melodie</a>, <a href="/search?value1=Stefania+Maria+Bova&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bova Stefania Maria</a>, <a href="/search?value1=Maria+Cabrerizo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cabrerizo Maria</a>, <a href="/search?value1=Karin+von+Eije&option1=author&noRedirect=true" class="nonDisambigAuthorLink">von Eije Karin</a>, <a href="/search?value1=Stollar+Fabiola&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Fabiola Stollar</a>, <a href="/search?value1=Ana+Felipe&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Felipe Ana</a>, <a href="/search?value1=Ralitsa+Iordanova&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Iordanova Ralitsa</a>, <a href="/search?value1=Marianne+Kragh+Thomsen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Thomsen Marianne Kragh</a>, <a href="/search?value1=Per+Kristian+Knudsen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Knudsen Per Kristian</a>, <a href="/search?value1=Freek+van+Loenen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">van Loenen Freek</a>, <a href="/search?value1=Noemi+Lopez&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lopez Noemi</a>, <a href="/search?value1=Audrey+Mirand&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mirand Audrey</a>, <a href="/search?value1=Richard+Molenkamp&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Molenkamp Richard</a>, <a href="/search?value1=Sofie+Midgley&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Midgley Sofie</a>, <a href="/search?value1=Raquel+Neves&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Neves Raquel</a>, <a href="/search?value1=Lubomira+Nikolaeva+Glomb&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Glomb Lubomira Nikolaeva</a>, <a href="/search?value1=Joakim+%C3%98verb%C3%B8&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Øverbø Joakim</a>, <a href="/search?value1=G%C3%BClten+%C3%96zt%C3%BCrk&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Öztürk Gülten</a>, <a href="/search?value1=Paula+Palminha&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Palminha Paula</a>, <a href="/search?value1=Helle+Cecilie+Viekilde+Pfeiffer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Viekilde Pfeiffer Helle Cecilie</a>, <a href="/search?value1=Birgit+Prochazka&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Prochazka Birgit</a>, <a href="/search?value1=Carlos+Ribeiro&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ribeiro Carlos</a>, <a href="/search?value1=Martine+Rodesch&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rodesch Martine</a>, <a href="/search?value1=Isabelle+Schuffenecker&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schuffenecker Isabelle</a>, <a href="/search?value1=Jay+Shetty&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Shetty Jay</a>, <a href="/search?value1=Sandy+Siegert&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Siegert Sandy</a>, <a href="/search?value1=Silje+Lae+Solberg&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Solberg Silje Lae</a>, <a href="/search?value1=Artur+Sulik&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sulik Artur</a>, <a href="/search?value1=Dil%C5%9Fad+T%C3%BCrkdo%C4%9Fan&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Türkdoğan Dilşad</a>, <a href="/search?value1=Olcay+%C3%9Cnver&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ünver Olcay</a>, <a href="/search?value1=Jaco+Verweij&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Verweij Jaco</a>, <a href="/search?value1=Jorgina+Vila&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vila Jorgina</a>, <a href="/search?value1=Tytti+Vuorinen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vuorinen Tytti</a>, <a href="/search?value1=Ronny+Wickstr%C3%B6m&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wickström Ronny</a>, <a href="/search?value1=Thea+K+Fischer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Fischer Thea K</a>, <a href="/search?value1=Heli+Harvala&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Harvala Heli</a>, <a href="/search?value1=Kimberley+S.M.+Benschop&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Benschop Kimberley S.M.</a>. Acute flaccid myelitis in Europe between 2016 and 2023: indicating the need for better registration. <a href="/content/ecdc">Euro Surveill.</a> 2025;30(21):pii=2400579. <a href="https://doi.org/10.2807/1560-7917.ES.2025.30.21.2400579" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2025.30.21.2400579</a> Received: 30 Aug 2024;   Accepted: 02 Feb 2025

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Acute flaccid myelitis in Europe between 2016 and 2023: indicating the need for better registration

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