As of 10 June 2019, 50 cases of acute flaccid paralysis (AFP) have been reported to Public Health England (PHE) since 1 January 2018. The latest data show the number of cases has decreased since peaking in October 2018. The increase was temporally associated with an upsurge in enterovirus (EV) D68 activity. However, PHE says it is not yet clear whether the increase in reports is a genuine increase in disease incidence or due to improved detection and awareness.
A national incident was declared in November 2018 and management guidelines have been issued by PHE:
- Cases are defined as acute flaccid paralysis/myelitis in an individual ≤30 years, not explained by a non-infectious cause.
- Priority for immediate management is to secure the airway.
- High dependency or intensive care unit admission should be considered according to neurological progression or deficits.
- Intravenous immunoglobulin is generally safe and well tolerated.
- There is no clear evidence that steroids are beneficial or harmful in AFP.
- There is no clear evidence that plasma exchange is beneficial or harmful.
- There is no indication that interferon is beneficial.
- There is no evidence that fluoxetine improves neurological outcomes in AFP.
- There is no indication that any other antivirals are beneficial, unless herpesvirus infection is suspected.
- Early physiotherapy and occupational therapy are key to long-term outcomes.
- Nerve transfers are beneficial in restoring innervation and function to denervated muscles.
- Other strategies used in the rehabilitation of children with transverse myelitis, such as functional electrical stimulation may be considered, though their effectiveness in AFP has not been evaluated.