Key result
Biennial acute flaccid myelitis epidemics link closely to circulating enterovirus D68.
Why the study?
Acute flaccid myelitis has been reemerging globally in epidemic form despite polioviruses being near global eradication, temporally associated instead with nonpolio enteroviruses such as EV-D68.
This perspective reviews the reemergence of acute flaccid myelitis and its association with nonpolio enteroviruses like EV-D68, offering clues to mechanisms of viral disease emergence.
Since 2014, acute flaccid myelitis (AFM), a long-recognized condition associated with polioviruses, nonpolio enteroviruses, and various other viral and nonviral causes, has been reemerging globally in epidemic form. This unanticipated reemergence is ironic, given that polioviruses, once the major causes of AFM, are now at the very threshold of global eradication and cannot therefore explain any aspect of AFM reemergence. Instead, the new AFM epidemic has been temporally associated with reemergences of nonpolio enteroviruses such as EV-D68, until recently thought to be an obscure virus of extremely low endemicity. This perspective reviews the enigmatic epidemiologic, virologic, and diagnostic aspects of epidemic AFM reemergence; examines current options for clinical management; discusses future research needs; and suggests that the AFM epidemic offers important clues to mechanisms of viral disease emergence.
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Morens et al. (2019) conducted a review in Acute flaccid myelitis (AFM). Nonpolio enteroviruses (e.g., EV-D68) was evaluated. Epidemic acute flaccid myelitis has reemerged globally and in the United States since 2014 in biennial waves that are closely associated with the circulation of nonpolio enteroviruses, notably EV-D68.
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