TY - JOUR
T1 - A ten-year retrospective evaluation of acute flaccid myelitis at 5 pediatric centers in the United States, 2005–2014
AU - Cortese, Margaret M.
AU - Kambhampati, Anita K.
AU - Schuster, Jennifer E.
AU - Alhinai, Zaid
AU - Nelson, Gary R.
AU - Guzman Perez-Carrillo, Gloria J.
AU - Vossough, Arastoo
AU - Smit, Michael A.
AU - McKinstry, Robert C.
AU - Zinkus, Timothy
AU - Moore, Kevin R.
AU - Rogg, Jeffrey M.
AU - Candee, Meghan S.
AU - Sejvar, James J.
AU - Hopkins, Sarah E.
N1 - Funding Information:
This work was funded by the Centers for Disease Control and Prevention (CDC), which did not play a role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript and only provided financial support in the form of authors’ salaries and project materials. A.K. was employed by IHRC, Inc., a contracting agency to CDC. IHRC provided support in the form of salary for A.K. but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific role of AK is articulated in the ‘author contributions’ section. We acknowledge Brenda Banwell, MD, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA for contributions to the protocol for MRI review; Elizabeth S. Doll, MD, formerly with Primary Children’s Hospital, Salt Lake City, UT, for efforts in obtaining site IRB approvals and process planning; Kayoko Shioda, DVM, MPH, formerly with Centers for Disease Control and Prevention, for database development and administrative support.
Publisher Copyright:
Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - Background Acute flaccid myelitis (AFM) is a severe illness similar to paralytic poliomyelitis. It is unclear how frequently AFM occurred in U.S. children after poliovirus elimination. In 2014, an AFM cluster was identified in Colorado, prompting passive US surveillance that yielded 120 AFM cases of unconfirmed etiology. Subsequently, increased reports were received in 2016 and 2018. To help inform investigations on causality of the recent AFM outbreaks, our objective was to determine how frequently AFM had occurred before 2014, and if 2014 cases had different characteristics. Methods We conducted a retrospective study covering 2005–2014 at 5 pediatric centers in 3 U.S. regions. Possible AFM cases aged ≤18 years were identified by searching discharge ICD-9 codes and spinal cord MRI reports (>37,000). Neuroradiologists assessed MR images, and medical charts were reviewed; possible cases were classified as AFM, not AFM, or indeterminate. Results At 5 sites combined, 26 AFM cases were identified from 2005–2013 (average annual number, 3 [2.4 cases/100,000 pediatric hospitalizations]) and 18 from 2014 (12.6 cases/100,000 hospitalizations; Poisson exact p<0.0001). A cluster of 13 cases was identified in September–October 2014 (temporal scan p = 0.0001). No other temporal or seasonal trend was observed. Compared with cases from January 2005–July 2014 (n = 29), cases from August–December 2014 (n = 15) were younger (p = 0.002), more frequently had a preceding respiratory/febrile illness (p = 0.03), had only upper extremities involved (p = 0.008), and had upper extremity monoplegia (p = 0.03). The cases had higher WBC counts in cerebrospinal fluid (p = 0.013). Conclusion Our data support emergence of AFM in 2014 in the United States, and those cases demonstrated distinctive features compared with preceding sporadic cases.
AB - Background Acute flaccid myelitis (AFM) is a severe illness similar to paralytic poliomyelitis. It is unclear how frequently AFM occurred in U.S. children after poliovirus elimination. In 2014, an AFM cluster was identified in Colorado, prompting passive US surveillance that yielded 120 AFM cases of unconfirmed etiology. Subsequently, increased reports were received in 2016 and 2018. To help inform investigations on causality of the recent AFM outbreaks, our objective was to determine how frequently AFM had occurred before 2014, and if 2014 cases had different characteristics. Methods We conducted a retrospective study covering 2005–2014 at 5 pediatric centers in 3 U.S. regions. Possible AFM cases aged ≤18 years were identified by searching discharge ICD-9 codes and spinal cord MRI reports (>37,000). Neuroradiologists assessed MR images, and medical charts were reviewed; possible cases were classified as AFM, not AFM, or indeterminate. Results At 5 sites combined, 26 AFM cases were identified from 2005–2013 (average annual number, 3 [2.4 cases/100,000 pediatric hospitalizations]) and 18 from 2014 (12.6 cases/100,000 hospitalizations; Poisson exact p<0.0001). A cluster of 13 cases was identified in September–October 2014 (temporal scan p = 0.0001). No other temporal or seasonal trend was observed. Compared with cases from January 2005–July 2014 (n = 29), cases from August–December 2014 (n = 15) were younger (p = 0.002), more frequently had a preceding respiratory/febrile illness (p = 0.03), had only upper extremities involved (p = 0.008), and had upper extremity monoplegia (p = 0.03). The cases had higher WBC counts in cerebrospinal fluid (p = 0.013). Conclusion Our data support emergence of AFM in 2014 in the United States, and those cases demonstrated distinctive features compared with preceding sporadic cases.
UR - http://www.scopus.com/inward/record.url?scp=85079339865&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0228671
DO - 10.1371/journal.pone.0228671
M3 - Review article
C2 - 32053652
AN - SCOPUS:85079339865
SN - 1932-6203
VL - 15
JO - PLoS ONE
JF - PLoS ONE
IS - 2
M1 - e0228671
ER -