LB8. Outbreak of Enterovirus A71 Neurologic Disease in Children — Colorado, 2018
Session: Oral Abstract Session: Late Breaker Oral Abstracts: Emerging Infections
Friday, October 5, 2018: 2:10 PM
Room: S 152-154
Background: In May 2018, an outbreak of enterovirus A71 (EV-A71) neurologic disease was detected at Children’s Hospital Colorado (CHCO) prompting a public health investigation. We characterized clinical, laboratory, and radiologic findings during this outbreak.

Methods: A case was defined as meningitis, encephalitis, or acute flaccid myelitis with EV-A71 identified from a biologic specimen in a child examined at CHCO after March 1, 2018. Biologic specimens from children with neurologic disease and EV identified by clinical reverse-transcription polymerase chain reaction (RT-PCR) were typed by VP1 sequencing at CDC.

Results: As of July 20, 2018, 28 cases of EV-A71 neurologic disease were identified. This report describes the clinical, laboratory, and radiologic findings for the first 13 children identified with EV-A71 neurologic disease, for whom complete information is available. The median age was 13 months (range = 10 days–35 months) and 11 (85%) were male. Neurologic presentations included 12 (92%) with meningitis, 9 (69%) with encephalitis, and 3 (23%) with acute flaccid myelitis (AFM). All 13 children had fever and irritability; 3 (23%) had hand, foot, and mouth disease. Neurologic signs included encephalopathy (n = 7, 54%), ataxia (n = 7, 54%), myoclonus (n = 6, 46%), limb weakness (n = 4, 31%), cranial nerve deficits (n = 2, 15%), and seizures (n = 1, 8%). Nine (90%) of 10 children with cerebrospinal fluid (CSF) specimen analyzed had a pleocytosis (>5 white blood cells/uL); 6 of 8 (75%) children who had brain imaging showed abnormalities, with 5 (63%) in the brainstem, 3 (38%) in the cerebellum, and 3 (38%) in the spinal cord. All 13 children had EV-A71 identified in nasopharyngeal, pharyngeal, or fecal specimens; only 2 of 11 (18%) tested had EV identified in CSF. All 13 children were hospitalized and 4 (31%) required intensive care. The 3 (23%) children with AFM had residual limb weakness at time of discharge. All children survived.

Conclusion: EV-A71 should be considered when children present with myoclonus, ataxia, or limb weakness in the setting of a febrile illness. Testing of nonsterile sites (respiratory, pharyngeal, or fecal) should be considered when CNS disease associated with EV is suspected and initial CSF testing is negative.

Kevin Messacar, MD1, Alexis Burakoff, MD, MPH2, William A. Nix, BS3, Shannon Rogers, MS2, Adriana S. Lopez, MHS2, M Steve Oberste, PhD4, Susan I. Gerber, MD5, Emily Spence-Davizon, MPH6, Rachel Herlihy, MD MPH7 and Samuel Dominguez, MD, PhD8, (1)Pediatric Infectious Diseases and Hospital Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, (2)Centers for Disease Control and Prevention, Atlanta, GA, (3)Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, Atlanta, GA, (4)Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, GA, (5)Cdph, Chicago, IL, (6)Colorado Department of Public Health and the Environment, Denver, CO, (7)Colorado Department of Public Health and Environment, Denver, CO, (8)Pediatrics, University of Colorado and The Children's Hospital, Aurora, CO

Disclosures:

K. Messacar, None

A. Burakoff, None

W. A. Nix, None

S. Rogers, None

A. S. Lopez, None

M. S. Oberste, None

S. I. Gerber, None

E. Spence-Davizon, None

R. Herlihy, None

S. Dominguez, None

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