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Outbreaks of acute flaccid myelitis in the US

BMJ 2018; 363 doi: (Published 19 December 2018) Cite this as: BMJ 2018;363:k5246
  1. Sacha Stelzer-Braid, senior postdoctoral scientist1 2,
  2. William Rawlinson, professor1 2 3
  1. 1Virology Research Laboratory, Prince of Wales Hospital, Sydney, NSW 2031, Australia
  2. 2School of Medical Sciences, and School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
  3. 3Serology and Virology Division (SAViD), Microbiology NSW Health Pathology Randwick, NSW 2031, Australia
  1. Correspondence to: S Stelzer-Braid s.stelzer-braid{at}

Enteroviruses are implicated, particularly D68

The World Health Organization has declared much of the world free of polio, including the UK (1982) and the US (1979). However, acute flaccid myelitis and paralysis due to vaccine associated poliomyelitis are still evident in Papua New Guinea,1 and large outbreaks of acute flaccid myelitis due to non-polio enteroviruses (often enterovirus A71) have occurred, particularly in South East Asia.2

Outbreaks of acute flaccid myelitis are currently ongoing in the US, where the Centers for Disease Control and Prevention (CDC) recently described an outbreak of a polio-like disease in children as “a mystery illness.”3 Symptoms include sudden onset of paralysis in the arms or legs and grey matter lesions in the spinal cord. By the end of November 2018, the condition had been confirmed in 116 children from 31 US states,4 an increase of 250% from 2017, when 33 confirmed cases were recorded. This is a rare condition, with 404 confirmed cases across the US since the CDC began investigating in 2014.4

US outbreaks of acute flaccid myelitis occur …

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