Cluster of acute flaccid paralysis in children following enterovirus D68 infection in Scotland

Introduction Enterovirus D68 infection associated with severe neurological sequelae in children emerged as a serious public health concern in the USA in the winter of 2014. Similar cases did not emerge in Europe until a reported cluster of cases in Wales in 2016. In South East Scotland, from September to October 2016, five previously healthy children were admitted to the regional children’s hospital with neurological symptoms suggestive of acute flaccid paralysis following a prodromal illness over a period of four weeks. Methods A multidisciplinary incident management team was set up and clinical, virological and epidemiological investigations were undertaken. Epidemiological investigations included a line listing of all confirmed cases of Enterovirus D68 identified by the regional virological laboratory. Case definitions were agreed by the incident management team. Interviews were carried out with the parents of the children in hospital using a trawling questionnaire. Results The children with severe neurological symptoms were aged 2-6. They had no direct contact with each other before becoming ill. Virological investigations identified Enterovirus D68 via PCR from nasopharyngeal aspirates of all five cases. These cases had a marked impact on the intensive care capacity at the regional children’s hospital as they required supportive care over a long time period. The epidemic curve of all cases of D68 from the regional laboratory demonstrated circulation of the virus more widely in the region of 1 million people over this time period. Conclusions These five cases were linked in time, place and person. Other countries in Europe have also reported severely affected cases associated with Enterovirus D68 in 2016-2017. Europe should be prepared for similar or larger clusters of cases in the future. Stringent infection control procedures including personal protective equipment are vital when treating cases with an emerging infection. Key messages: Enterovirus D68 is a potential emerging cause of Acute Flaccid Paralysis in children and is of major public health concern due to the serious consequences of infection in a number of cases. Europe should be prepared for further clusters of cases of Enterovirus D68 in the future. Ongoing surveillance and vigilence for further clusters is required.