A research team that reviewed studies on acute flaccid myelitis (AFM), a rare poliolike illness, and enterovirus D68 (EV-D68) found good evidence the virus causes the condition, according to a report published today in Eurosurveillance.In 2014, large outbreaks of EV-D68 occurred in the United States that predominantly affected children, followed by similar events in Canada, Europe, and Asia. AFM clusters—again, mostly affecting children—were simultaneously reported in the same regions, with 120 cases reported in the United States and smaller clusters reported in six European countries, raising the possibility of a link between EV-D68 and AFM.EV-D68 was first identified in 1962 and until 2014 had caused small, sporadic clusters of generally mild respiratory illness. In 2014, however, the outbreaks in the United States and Canada were marked by severe respiratory symptoms, piling up 1,153 cases in the United States, with neurologic complications seen in 120 US cases and 5 Canadian cases.CDC probe continues into AFM causeThe US Centers for Disease Control and Prevention (CDC) said it is still concerned about AFM, because it is a serious condition, but officials don’t have a clear picture of a cause, and there are no known strategies for preventing it.The CDC is still actively investigating AFM cases. After the 2014 surge, the agency confirmed 21 cases in 2015, 149 cases in 2016, and 23 cases in 2017, based on reports received as of Jan 3. For the spike in cases in 2016, the CDC did not receive reports of large EV-D68 outbreaks, but it did get sporadic case reports.Based on its investigation into the US AFM cases, the CDC said EV-D68 wasn’t consistently found in patients’ spinal fluid, and it has noted that a wide range of pathogens can cause AFM.Good evidence for linkIn the new analysis, researchers from Australia and the Arizona State University used the Bradford Hill criteria to evaluate the evidence of a link between EV-D68 and AFM. The Bradford Hill criteria include nine factors that experts use to formally weigh causality between exposure and a disease. In 2016, the Bradford Hill criteria were one of the systems the CDC used to conclude that Zika virus was the cause of microcephaly.Of 123 studies that the experts identified in their literature review, they included 20 in their study, including 7 epidemiologic studies that allowed them to investigate the association’s strength or consistency.Overall, their analysis suggested good evidence for EV-D68 as being the cause of AFM. They noted that although enteroviruses are neurotropic, AFM had never been linked to EV-D68 before, possibly because the incidence of the virus had been much lower in the past, masking rare complications, similar to what may have occurred with Zika virus before it triggered large outbreaks.A change in virus or epidemiology?The team also suggested that, based on indications from animal studies, EV-D68 strains apparently evolved after 2000 into three clades that seem to be highly neurovirulent. “It appears that the incidence of this infection and the clade-specific epidemiology have changed,” they wrote.More studies are needed to identify the timing and geographic changes in the virus and to determine if the changes would explain AFM’s new association with it, the authors wrote—especially given the severity of AFM, ongoing outbreaks, and the lack of treatment or vaccine.See also:Jan 18 Eurosurveill reportCDC AFM page
COLUMBIA, S.C. (AP) — Steve Spurrier wasn’t on the sidelines for South Carolina. But his visor was, waved by interim coach Shawn Elliott as he ran on the field. And Elliott’s first game for the Gamecocks ended like many of Spurrier’s did— with a win.Pharoh Cooper caught seven passes for 160 yards including South Carolina’s only touchdown as the Gamecocks (3-4, 1-4 Southeastern) beat Vanderbilt 19-10 on Saturday.Spurrier wasn’t in Columbia, choosing instead to hang out with ESPN at the Michigan State-Michigan game. But Elliott wanted to make sure he did something for the man who gave him this opportunity.“I know I wanted to do something to pay tribute to him. And I thought what better way than to bring out the visor,” Elliott said.Spurrier’s signature headgear and an opponent the Gamecocks typically dominate appeared to do the trick. South Carolina is 21-4 against Vanderbilt (2-4, 0-3) and has won seven straight over the Commodores.Cooper’s third-quarter touchdown turned the tables after Vanderbilt scored a touchdown late in the second quarter and a field goal in its first second half possession to take a 10-6 lead.Perry Orth hit Cooper as he came across the field and the junior outran the Vanderbilt defense for the 78-yard TD.“It changed momentum. And then we gave it right back to them,” Vanderbilt coach Derek Mason said.The rest of the game turned sloppy. Vanderbilt would turn the ball over four times and South Carolina twice after Cooper’s touchdown.Skai Moore had an interception, a sack, recovered a fumble, forced another fumble and led the Gamecocks with 11 tackles. Former walk-on Orth was 17-for-28 for 272 yards and Brandon Wilds ran 24 times for 119 yards as South Carolina won just its second league game since September 2014.Elliott Fry made four field goals of 19, 22, 31 and 47 yards and missed two from 39 and 55 yards for South Carolina.Darrius Sims ran six times for 104 yards, while Johnny McCrary went 21-of-42 for 177 yards, a touchdown and three interceptions for the Commodores, who have lost 11 in a row in the SEC, all since Mason took over as coach.“If you have five turnovers on the road, I don’t see how you can win at somebody else’s house,” Mason said. “We still kept it to a 19-point game. And if you can do that, you should have an opportunity to win.”For the first time since 1999, South Carolina started a game without a coach who won a national championship on the sidelines. Spurrier resigned Tuesday during his 11th season after he had taken over for Lou Holtz.The Gamecocks turned to former offensive line coach Elliott, who continues his tradition of pushing and jumping into his linemen like they were in a mosh pit before the game. He slapped hands with fans and couldn’t stop smiling during his postgame news conference.“I won a state championship on that field,” said Elliott, who played for Camden High, about 30 miles from Columbia. “There is something special about this place.”Cooper said Elliott jolted the team out of its doldrums.“All the guys were pretty much pumped,” Cooper said. “We know what kind of guy coach Elliott is. He’s loud, he’s always passionate about the game He always has fun.”South Carolina responded to Elliott with its best offensive performance of the season, gaining 424 yards. And the defense, which came into the game last in the SEC, held Vanderbilt to 332 yards — 96 yards below the unit’s average.But there aren’t a lot of easy games left on South Carolina’s schedule. The Gamecocks play three teams — Texas A&M, Florida and Clemson — who all started Saturday in the top 10. They have to win one of those to be eligible for an eighth straight bowl game. The Gamecocks also failed to get a touchdown on four trips to the red zone and have just six TDs in 21 trips inside the 20 this season.South Carolina has trailed at half every game this year. The Gamecocks led for most of the first 30 minutes, but a 14-play, 79-yard drive that took up nearly half the second quarter ended with a 4-yard touchdown pass from McCrary to Caleb Scott that put Vanderbilt up 7-6 at the break.South Carolina failed to get a first down in its next possession, and Vanderbilt put together a 10-play drive, but the Gamecocks defense stopped the Commodores on third-and-2 from the 5, forcing a 23-yard field goal.Cooper caught his touchdown pass three plays later.