News story

PHE investigating rise in reports of rare illness

Updates on cases of acute flaccid paralysis in England.

Public Health England

Latest update

Following Public Health England (PHE)’s ongoing investigation into the increase in reported cases of AFP, a total of 40 cases have been reported in the UK across 2018. Many of these were reported months after the initial diagnosis.

Up until August 2018, 6 cases of AFP occurred which was then followed by a rapid rise in the number of people showing symptoms of AFP during September 2018. The number of reported cases peaked in October 2018 and have declined since. The cases were scattered across the United Kingdom.

Dr Mary Ramsay, Head of Immunisations at PHE said:

Our investigations into potential causes are ongoing, and we are continuing to build better awareness amongst health care professionals about how to test and manage patients with AFP.

We are not clear whether all of the apparent increase is real, or whether this represents increased awareness and diagnosis over recent years. The current best theory is that this is a very rare consequence of enterovirus infection, as the increase coincides with increases in infection.

Enterovirus D68 (EV-D68) has been found in around one quarter of cases. However, as the infection is very common, and most children have been infected by the age of 5 years, there must be other factors involved.

19 December 2018

Public Health England (PHE) is investigating an increase in reported cases of a rare condition called acute flaccid paralysis (AFP). So far in 2018, 28 cases have been reported in England, the majority of which have been since September. A rise in reported cases has also been seen in the US.

AFP affects the nervous system, causing one or more of the limbs to become weak or floppy – and may look similar to polio. It tends to particularly, though not exclusively, affect children. It is very rare, so PHE is stressing that if an adult or a child develops weakness in any limb they should seek medical attention so appropriate testing and care can be given.

Typically, a handful of cases of AFP are reported to PHE each year for investigation. PHE monitors these types of symptoms as part of the World Health Organization’s (WHO) requirements to monitor for polio and confirm it remains eliminated in the UK.

Certain viruses are known to cause AFP including polioviruses and non-polio enteroviruses. Enteroviruses commonly cause mild infections with a range of symptoms including colds, coughs and diarrhoea. Such illnesses from viral infections are common, especially in children, and most people recover. Enterovirus D68 (EV-D68) and other viruses have been detected in several cases of AFP so far in 2018. The risk of developing neurological symptoms due to EV-D68, or any other viral infection is extremely low.

Dr Mary Ramsay, Head of Immunisations at PHE said:

AFP is very rare. However, if you or your child develops weakness in any limb you should seek medical care immediately so that appropriate testing and care can be given.

We are investigating potential causes and working hard to build better awareness amongst health care professionals about how to test and manage patients with AFP.

We are ensuring up-to-date information is available for patients and their families who may be affected.

PHE is looking into the potential causes of the apparent rise in reports of AFP, including the role of EV-D68 or other infections. This will include ensuring that healthcare professionals’ are aware of and can access guidance on the investigation and management of such cases. PHE is also supporting healthcare providers by developing up-to-date information for patients and/or parents.

AFP can be difficult to diagnose because there are many other causes of weakness. Doctors will typically examine a patient’s nervous system and look at images of the spinal cord and brain. They can also test the fluid around the brain and spinal cord and may check the nervous system conduction.

Doctors should report any suspected cases of AFP to Public Health England and samples should be sent to specialist labs for additional testing.

Background

  1. Tests for enterovirus infection are typically only undertaken on individuals admitted to hospital with conditions such as chest infections and meningitis. Although enterovirus infection is not notifiable, PHE receives reports of confirmed enterovirus infection from NHS laboratories, and offers specialist typing for very serious cases – including children with AFP. 68 cases of laboratory confirmed EV-D68 infection have been diagnosed in 2018 – though many other cases occur but remain undiagnosed.
  2. 12 cases of AFP have been associated with an enterovirus. EV-D68 has been detected in 8, EV-C104 in 1, and coxsackie B1 in 1; in 2 cases the enterovirus was not typeable.
Published 19 December 2018
Last updated 7 February 2019 + show all updates
  1. Added latest update on cases.
  2. First published.