Enterovirus D68 Subclade B3 in Children with Acute Flaccid Paralysis in West Africa, 2016

U ntil 2014, enterovirus D68 (EV-D68) infections had been identified only sporadically after its discovery in 1962, but since 2014, the virus has emerged to cause large outbreaks of respiratory disease worldwide.In recent years, EV-D68 has been reported in outbreaks in the United States, Canada, Europe, Asia, and Africa, affecting >2,287 persons worldwide (1-4).The 2014 EV-D68 outbreak coincided temporally and geographically with increases in cases of acute flaccid myelitis (AFM), a subtype of acute flaccid paralysis (AFP), described by the Centers for Disease Control and Prevention as acute-onset flaccid weakness, combined with spinal cord lesions confirmed by magnetic resonance imaging, largely restricted to the gray matter, and spanning >1 spinal segments (5).In 2014, a total of 120 AFM cases in the United States (4,6) and >6 in Europe were associated with EV-D68 outbreaks.Subsequent biennial circulation of EV-D68 was associated with surges in AFM cases in the United States in 2016 and 2018 (7).In addition, 29 EV-D68-associated AFM cases were reported in Europe in 2016 (8).Africa, unlike Europe and the United States, has no active AFM surveillance.However, a 2016 study in Senegal reported 4 cases of paralysis associated with EV-D68 identified in fecal samples from children with AFP (2).With no AFM-or AFP-specific surveillance data available, we analyzed fecal samples collected for polio surveillance to better understand the extent of EV-D68 associated with AFP in West Africa and the genetic diversity of identified strains. The StudyWe retrospectively tested for EV-D68 in fecal samples from patients <15 years old with AFP.The samples were collected during June-September 2016 as part of routine poliomyelitis surveillance in Niger, Senegal, Guinea, Mauritania, Gambia, Guinea-Bissau, and Cape Verde.Specimens were collected 24-48 hours apart and <14 days of paralysis onset.We inoculated fecal specimens onto human rhabdomyosarcoma cells after using chloroform for EV isolation according to the procedures described in the laboratory manual for the World Health Organization's Global Polio Laboratory Network (http://polioeradication.org/wp-con-tent/uploads/2017/05/Polio_Lab_Manual04.pdf).We used a QIAmp Viral RNA Mini Kit (QIAGEN, https://www.qiagen.com) to extract RNA from 200 μL clarified fecal suspensions pretreated with Enterovirus D68 Subclade B3 inChildren with Acute Flaccid Paralysis in West Africa, 2016