Polio-like Syndrome Alert Issued for Children

U.S.health officials recently issued an alert notifying doctors about an increase in enterovirus D68 (EV-D68) pediatric cases. This common virus can cause a polio-like syndrome in rare cases in children.

The U.S. CDC Health Alert Network CDCHAN-00474, issued on September 9, 2022, confirmed various healthcare providers and hospitals had notified the CDC during August 2022 about increases in hospitalizations in pediatric patients with severe respiratory illness who also tested positive for rhinovirus (RV) and/or enterovirus (EV).

RVs and EVs can have clinically similar presentations and are often genomically indistinguishable from one another.

Upon advanced testing, some of these specimens were found positive for EV-D68.

Concurrently with these reports, pediatric acute respiratory illness sentinel surveillance sites reported a higher proportion of EV-D68 positivity in RV/EV positive children compared to previous years.

Although it primarily causes acute respiratory illness, EV-D68 has been associated with acute flaccid myelitis (AFM), a severe but rare neurologic complication involving limb weakness and a progressive form of paralysis.

However, increases in EV-D68 respiratory illnesses have typically preceded cases of AFM, indicating that increased vigilance for AFM in the coming weeks will be essential.

As of September 2, 2022, there have been (13) confirmed AFM cases this year. In 2021, there were (28) total confirmed ARM cases.

Since CDC began tracking AFM in 2014, there have been 692 confirmed cases.

AFM can also be caused by other viruses, including flaviviruses (West Nile virus, Japanese encephalitis virus), herpes viruses, and adenoviruses.

Furthermore, the CDC published recommendations for healthcare providers regarding this new Alert:

• Consider EV-D68 as a possible cause of acute, severe respiratory illness in children, and report any 'clusters' of cases.
• Consider laboratory testing of respiratory specimens for RVs and EVs when the cause of respiratory infection in severely ill patients is unclear.
• Strongly consider AFM in patients with acute flaccid limb weakness, especially after respiratory illness or fever, and between August and November 2022.
• Collect specimens from multiple sources from patients presenting with possible AFM as early as possible and preferably on the day of onset of limb weakness.
• And coordinate with state public health laboratories to send AFM specimens to the CDC for AFM and polio testing.

Since AFM looks a lot like polio, the CDC previously tested stool specimens from AFM patients for poliovirus.

All AFM specimens tested were negative for poliovirus. 

The CDC says, 'This means that poliovirus has not been detected in cases of AFM observed in the U.S.'

This is good news since New York's Governor Kathy Hochul issued an Executive Order on September 9, 2022, declaring a State Disaster Emergency to increase the availability of resources to protect New Yorkers against paralytic disease.

The New York Emergency Order follows poliovirus samples recently identified in Rockland County, Orange County, Sullivan County, New York City, and Nassau County wastewater. 

Recently, both the United Kingdom and Israel also reported poliovirus detections in wastewater samples.

The CDC also confirmed there are no U.S. FDA-approved vaccines or antiviral treatments for AFM available today.

But there are several approved polio vaccines.

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