{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T12:16:54Z","timestamp":1794313014719,"version":"4.9.0"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      Enterovirus-D68 (EV-D68) is a respiratory virus within the genus\n                      <jats:italic toggle=\"yes\">Enterovirus<\/jats:italic>\n                      and the family of\n                      <jats:italic toggle=\"yes\">Picornaviridae<\/jats:italic>\n                      . Genetically, it is closely related to rhinovirus that replicates in the respiratory tract and causes respiratory disease. Since 2014, EV-D68 has been associated with the neurologic syndrome of acute flaccid myelitis (AFM).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In October 2016, questionnaires were sent out to a European network including 66 virologists and clinicians, to develop an inventory of EV-D68\u2013associated AFM cases in Europe. Clinical and virologic information of case patients was requested. In addition, epidemiologic information on EV testing was collected for the period between March and October 2016.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Twenty-nine cases of EV-D68\u2013associated AFM were identified, from 12 different European countries. Five originated from France, 5 from Scotland and 3 each from Sweden, Norway and Spain. Twenty-six were children (median age 3.8 years), 3 were adults. EV-D68 was detected in respiratory materials (n = 27), feces (n = 8) and\/or cerebrospinal fluid (n = 2). Common clinical features were asymmetric flaccid limb weakness, cranial nerve deficits and bulbar symptoms. On magnetic resonance imaging, typical findings were hyperintensity of the central cord and\/or brainstem; low motor amplitudes with normal conduction velocities were seen on electromyography. Full clinical recovery was rare (n = 3), and 2 patients died. The epidemiologic data from 16 European laboratories showed that of all EV-D68\u2013positive samples, 99% was detected in a respiratory specimen.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>For 2016, 29 EV-D68\u2013related AFM cases were identified in mostly Western Europe. This is likely an underestimation, because case identification is dependent on awareness among clinicians, adequate viral diagnostics on respiratory samples and the capability of laboratories to type EVs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/inf.0000000000002188","type":"journal-article","created":{"date-parts":[[2018,9,26]],"date-time":"2018-09-26T17:35:18Z","timestamp":1537983318000},"page":"16-21","source":"Crossref","is-referenced-by-count":127,"title":["Twenty-nine Cases of Enterovirus-D68\u2013associated Acute Flaccid Myelitis in Europe 2016"],"prefix":"10.1097","volume":"38","author":[{"given":"Marjolein","family":"Knoester","sequence":"first","affiliation":[{"name":"Medical Microbiology and Infection Prevention"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelte","family":"Helfferich","sequence":"additional","affiliation":[{"name":"Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randy","family":"Poelman","sequence":"additional","affiliation":[{"name":"Medical Microbiology and Infection Prevention"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Coretta","family":"Van Leer-Buter","sequence":"additional","affiliation":[{"name":"Medical Microbiology and Infection Prevention"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oebele F.","family":"Brouwer","sequence":"additional","affiliation":[{"name":"Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hubert G. 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