Public Health England (PHE) is investigating an increase in reported cases of acute flaccid paralysis (AFP). So far in 2018, total of 28 cases have been reported in England, the majority of which have occurred since September.
Enterovirus has been implicated in 12 cases, with EV-D68 being detected in 8 patients, EV-C104 in 1 and coxsackie B1 virus being identified in another case. In 2 cases, the enterovirus was not typeable.
Large outbreaks of AFP due to non-polio enteroviruses have occurred in other parts of the world, particularly in South East Asia. The United States has seen a 250% increase in cases of AFP so far this year compared with 2017. By the end of November 2018, the condition had been confirmed in 116 American.
Enteroviruses A71 and D68 have both been associated with acute flaccid myelitis, but D68 is emerging as the leading causal candidate. In the United States, clinical specimens from 38 of 71 patients were positive for enterovirus or rhinovirus. Fourteen were positive for enterovirus D68 and 11 for A71. Poliovirus was not detected in any specimen.
PHE says it is working to ensure that health care professionals are aware of and can access guidance on the investigation and management of such cases. It is advising doctors that any suspected cases of AFP should be reported to PHE, and samples should be sent to specialist labs for additional testing.