Hot topic lecture: Paralytic disease caused by enteroviruses: the role of non-polio serotypes

Posted on May 31, 2019   by Kaisa Berg

One of the two Hot Topic Lectures taking place at the Microbiology Society Annual Conference in April this year was held by Dr Javier Martin (National Institute for Biological Standards and Control [NIBSC], UK). In his talk, titled ‘Paralytic disease caused by enteroviruses: the role of non-polio serotypes’ Dr Martin discussed the recent upsurge of acute flaccid myelitis cases reported in various countries in 2018 and their possible association with enterovirus infections.

In the autumn of 2018, a number of reports of a ‘polio-like’ disease hit the headlines in the UK and the US. Symptoms of the disease, Acute Flaccid Myelitis (AFM), include fever, an excessively runny nose, coughing, vomiting or diarrhoea, as well as weakness in one of more limbs. Sometimes, people with AFM will also experience a stiff neck, headache or pain in the affected limbs.

AFM is thought to be caused by a viral infection of the nervous system, specifically the grey matter of the spinal cord. There is currently no known cure for AFM, with doctors often recommending physical therapy to help with the muscle weakness.

Dr Martin detailed this upsurge of AFM cases between August and December 2018 and their possible association with enterovirus (EV) infection, specifically EV-D68. EV-D68 was first described in 1962, but since 2010, large increases in severe respiratory illness associated with EV-D68 infection began to be reported worldwide. In 2014, the US experienced a nationwide outbreak of EV-D68-associated severe respiratory illness and 120 AFM cases. The country has since seen two further outbreaks in 2016 and 2018.

In the UK, a substantial increase in AFM cases was reported in 2018. Usually, the UK has fewer than five cases of AFM annually, however this escalated to 40 in 2018. This increase in AFM was reported in association with an upsurge in EV-D68 detections, with similar increases in D68 detection in other European countries.

In addition to discussing the possible link between AFM and EV-D68, the lecture covered a number of related topics, including an update on global polio eradication, new molecular approaches for the detection and identification of polio and non-polio enteroviruses in environmental samples, and circulation patterns of non-polio enterovirus which have been identified as potential causes of neurological disease.

Among other things, Dr Martin concluded that EV-D68 is likely responsible for the AFM cases detected since 2014. Other EV infections and/or other unidentified factors might also contribute to the development of AFM. The molecular basis of EV-D68 phenotypic change leading to increased EV-D68 incidence and AFM is unknown.

You can view Dr Martin’s full Hot Topic Lecture below.

Hot Topic 2019: Paralytic disease caused by enteroviruses: the role of non-polio serotypes