Enterovirus D68 - The New Polio?

Abstract

Enterovirus D68 (EV-D68) has emerged over the recent years, with large outbreaks worldwide. Increased occurrence has coincided with improved clinical awareness and surveillance of non-polio enteroviruses. Studies showing its neurotropic nature and the change in pathogenicity have established EV-D68 as a probable cause of Acute Flaccid Myelitis (AFM). The EV-D68 storyline shows many similarities with poliovirus a century ago, stimulating discussion whether EV-D68 could be ascertaining itself as the "new polio." Increasing awareness amongst clinicians, incorporating proper diagnostics and integrating EV-D68 into accessible surveillance systems in a way that promotes data sharing, will be essential to reveal the burden of disease. This will be a necessary step in preventing EV-D68 from becoming a threat to public health.

Keywords: Enterovirus D68; emerging; outbreak response; pathogenicity; surveillance.

FIGURE 1

The number of published articles on PubMed describing Enterovirus-D68 from January 2002 to October2018. The number of published articles for each year is in accordance with EV-D68 interest from the previous year. ^∗Until October.

FIGURE 2

The number of confirmed United States AFM cases, published on the CDC by month of onset from August 2014-October 2018. The high number of confirmed AFM cases coincided with the 2014, 2016 and 2018 EV-D68 outbreaks. Figure taken from the NCIRD, AFM in the United States 2018. CDC and NCIRD (2018) retrieved from https://www.cdc.gov/acute-flaccid-myelitis/afm-surveillance.html.

FIGURE 3

MRI of a suspected EV-D68 AFM patient. The MRI presents sagittal (A,C) and axial images (B,D) of the central nerves system. (A) Presents a case where the whole central gray matter was involved, producing a characteristic “H” pattern on axial image (B). (C) Presents a case where T2 hyperintensity was confined to the left anterior horn cells, which is demonstrated on the axial image (D). Taken from Maloney et al., 2015. Order License Id: 4382500446364.

FIGURE 4

MRI of a poliovirus AFM patient. The MRI presents a sagittal (A) and an axial image (B) of the central nerves system. (A) presents a case showing hyperintensities involving the anterior horn cells from C3 to C7. (B) demonstrates the same case as an axial image. Taken from Haq and Wasay (2006). Order License Id: 4382500944212.