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Acute flaccid myelitis in Europe between 2016 and 2023: indicating the need for better registration
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Background: Acute flaccid myelitis (AFM) is a rare polio-like condition affecting mainly children and characterised by severe, often persistent, weakness. It is one of several causes of acute flaccid paralysis (AFP), which manifests as acute onset of limb weakness and reduced muscle tone. Some non-polio enteroviruses (EV), such as EV-D68 may cause AFM. Little is known about AFM incidence in Europe.AimWe aimed to better understand AFM incidence, aetiology and current surveillance policies in Europe.MethodsIn 28 countries, members of the European non-polio enterovirus network (ENPEN) and a newly established AFM network of clinicians under ENPEN received a survey asking them how AFM surveillance was performed in their countries in 2016-2023 and the numbers of AFM cases including those diagnosed with EV-D68 infection during this period.ResultsSurveillance information was obtained for 16 countries. In eight countries, AFP surveillance initiated for poliomyelitis eradication was still ongoing, while non-polio AFM cases were only systematically reported in Norway. The survey revealed 130 AFM cases for 14 countries, with 48 (37%) EV-D68-laboratory-confirmed. Among the AFM cases, 70% (n = 91) occurred in 2016, 2018 and 2022, when EV-D68 circulation increased.ConclusionsThis report provides some indication of AFM case numbers in Europe since 2016. However, as 15 of 16 countries with AFM monitoring information lacked structural AFM surveillance, numbers should be interpreted with caution. Knowing AFM incidence matters to determine its impact and detect future outbreaks. Thus, the newly established clinical network will develop a European AFM repository.
Key public health message: - What did you want to address in this study? Acute flaccid myelitis (AFM) is a rare but serious condition involving progressive and often severe limb weakness. Several viruses can cause AFM, and AFM cases have been observed to occur when enterovirus D68 (EV-D68) circulates. Little is known about AFM incidence in Europe, so we wanted to shed light on AFM surveillance policies in different countries there, and on AFM case numbers recorded between 2016 and 2023, as well as their aetiology. - What have we learnt from this study? A survey of members of the European non-polio enterovirus network (ENPEN), which includes a newly established clinical network was conducted in 28 countries. Through the survey we obtained surveillance information from 16 countries. Among these, only Norway had a valid structured surveillance for AFM. The survey revealed 130 AFM cases for 14 countries, with 91 cases (70%) in years 2016, 2018 and 2022, when EV-D68 circulation increased. - What are the implications of your findings for public health? Due to the lack of structured surveillance, the numbers of AFM cases reported through our study should be interpreted with caution. Improved knowledge of the incidence of AFM in European countries is crucial to determine its impact on people’s health, as well as to detect future AFM outbreaks. To this end, the newly established clinical network under ENPEN will develop a European AFM repository, aiming to involve of as many countries as possible.
Key public health message: - What did you want to address in this study? Acute flaccid myelitis (AFM) is a rare but serious condition involving progressive and often severe limb weakness. Several viruses can cause AFM, and AFM cases have been observed to occur when enterovirus D68 (EV-D68) circulates. Little is known about AFM incidence in Europe, so we wanted to shed light on AFM surveillance policies in different countries there, and on AFM case numbers recorded between 2016 and 2023, as well as their aetiology. - What have we learnt from this study? A survey of members of the European non-polio enterovirus network (ENPEN), which includes a newly established clinical network was conducted in 28 countries. Through the survey we obtained surveillance information from 16 countries. Among these, only Norway had a valid structured surveillance for AFM. The survey revealed 130 AFM cases for 14 countries, with 91 cases (70%) in years 2016, 2018 and 2022, when EV-D68 circulation increased. - What are the implications of your findings for public health? Due to the lack of structured surveillance, the numbers of AFM cases reported through our study should be interpreted with caution. Improved knowledge of the incidence of AFM in European countries is crucial to determine its impact on people’s health, as well as to detect future AFM outbreaks. To this end, the newly established clinical network under ENPEN will develop a European AFM repository, aiming to involve of as many countries as possible.
Descrição
Palavras-chave
Acute Flaccid Myelitis Acute Flaccid Paralysis Children Enterovirus A71 Enterovirus D68 Surveillance Central Nervous System Viral Diseases Neuromuscular Diseases Europe Agentes Microbianos e Ambiente Políticas de Saúde
Contexto Educativo
Citação
Euro Surveill. 2025 May;30(21):2400579. doi: 10.2807/1560-7917.ES.2025.30.21.2400579
Editora
European Centre for Disease Prevention and Control