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Review
. 2022 Oct;27(42):2200157.
doi: 10.2807/1560-7917.ES.2022.27.42.2200157.

Epidemiology of acute flaccid myelitis in children in the Netherlands, 2014 to 2019

Jelte Helfferich  1 , Marit Ma de Lange  2 , Kimberley Sm Benschop  2 , Bart C Jacobs  3 , Coretta C Van Leer-Buter  4 , Adam Meijer  2 , Dewi P Bakker  5 , Eva de Bie  5 , Hilde Mh Braakman  6 , Rick Brandsma  7 , Rinze F Neuteboom  8 , Erik H Niks  9 , Jikke-Mien Niermeijer  10 , Vincent Roelfsema  11 , Niels Schoenmaker  12 , Lilian T Sie  13 , Hubert G Niesters  4 , Oebele F Brouwer  1 , Margreet Jm Te Wierik  2
Affiliations
Review

Epidemiology of acute flaccid myelitis in children in the Netherlands, 2014 to 2019

Jelte Helfferich et al. Euro Surveill. 2022 Oct.

Abstract

BackgroundAcute 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.AimTo report AFM incidence in children in the Netherlands and its occurrence relative to EV-D68 and EV-A71 detections.MethodsIn 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.ResultsAmong 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.ConclusionsAFM 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.

Keywords: Acute flaccid myelitis; acute flaccid paralysis; children; enterovirus A71; enterovirus D68; epidemiology; surveillance.

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Conflict of interest statement

Conflict of interest: Jelte Helfferich, Marit M.A. de Lange, Kimberley S.M. Benschop, Bart C. Jacobs, Coretta C. Van Leer-Buter, Adam Meijer, Dewi P. Bakker, Eva de Bie, Hilde M.H. Braakman, Rick Brandsma, Rinze F. Neuteboom, Erik H. Niks, Jikke-Mien Niermeijer, Vincent Roelfsema, Niels Schoenmaker, Lilian T. Sie, Hubert G. Niesters, Oebele F. Brouwer, Margreet J.M. te Wierik declare no potential conflict of interest in relation to this study.

Figures

Figure 1
Figure 1
Results of the search and selection procedures, the Netherlands, January 2014–December 2019 (n = 1,778 patients screened)
Figure 2
Figure 2
Temporal distribution of number of cases of AFM, according to their classification (bars) and cases with an alternative diagnosis (plane), and monthly number of EV-D68 and EV-A71 detections (lines), the Netherlands, January 2014–December 2019
See this image and copyright information in PMC

References

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Supplementary concepts