Aug 13, 2019

NIAID working on enterovirus vaccine to fight acute flaccid myelitis

Electron microscope photo of EV-D68, a suspect in causing AFM. Photo: Cynthia S. Goldsmith, Yiting Zhang/CDC

Recent research showing stronger links between an enterovirus and the polio-like illness called acute flaccid myelitis has led the National Institutes of Allergy and Infectious Diseases to start work on an EV-D68 vaccine, director Anthony Fauci tells Axios.

Why it matters: While rare, the devastating illness AFM suddenly strikes children, causing abrupt muscle weakness, paralysis or sometimes death. Researchers have been on the hunt for its cause — and while not definitive, the link with enterovirus D68 has grown stronger, including via a new study in the peer-reviewed journal mBio.

What's new: Using a new tool, scientists detected more traces of virus in this study, which was funded by NIAID.

"This is a hit-and-run virus. It comes in, does its bad thing, and leaves [while] its antibodies hang around."
— Anthony Fauci

The backdrop: Since the Centers for Disease Control and Prevention began tracking AFM in 2014, 574 patients have been confirmed, mostly children who often reported a respiratory or gastrointestinal illness in the weeks prior to the attack.

  • Spikes in AFM cases tended to happen during outbreaks of EV-D68 and EV-A71 — casting suspicion on these viruses as playing a role. However, most prior studies were unable to detect significant amounts of virus in the spinal fluid, despite some showing 40% of patients had evidence of enterovirus RNA in other samples.
  • A preliminary report published last month in the journal BioRxiv, which is not peer-reviewed, used different methods but also found higher levels of antibodies from enteroviruses in the spinal fluid of children who had AFM.
  • Viral presence in spinal fluid would indicate a stronger link to the illness, which affects the spinal cord's gray matter.
  • The illness appears to peak every other year (2014, 2016, 2018). For 2019, CDC has confirmed 13 cases in 8 states so far.

What they did: The mBio study examined the spinal fluid from AFM patients and compared them to non-AFM patients with other central nervous system diseases — looking for both genetic.

  • They first tested the samples of 14 AFM patients and 5 non-AFM patients through a highly sensitive viral genetic sequencing system.
  • They then looked for more indirect evidence of EV infections by developing a microchip assay to detect antibodies from any human enterovirus infection. They tested the same 14 AFM samples and compared them with 11 non-AFM patients.

What they found:

  • The initial genetic test found enterovirus RNA in only 1 adult AFM case and 1 non-AFM case.
  • But, the second test found roughly 79% had antibodies to enteroviruses — "significantly higher" than the controls, Fauci says.
  • While most people are exposed to EV-D68 and EV-D71 at some point resulting in antibodies, most do not have the antibodies in their spinal fluid, he adds.

What's next: The link between EV-D68 and AFM is strong enough that NIAID is in very early stages of developing a vaccine against it, Fauci tells Axios. "We might as well start now."

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Editor's note: This piece was updated to clarify the mBio study was 100% funded by NIAID and did not build on the preliminary findings posted in BioRxiv.

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In photos: Authorities issue warning as Americans venture out for Memorial Day weekend

Venice Beach in Los Angeles on May 24. Photo: David McNew/Getty Images

Authorities urged Americans to maintain social distancing and wear masks against the coronavirus amid reports of packed beaches and bars during the Memorial Day weekend.

Driving the news: Law enforcement stepped up beach patrols, authorities on Florida's Gulf Coast closed parking lots because they were full and there were crowded scenes at Lake of the Ozarks bars in Missouri, per AP, which reports a shooting injured several people at a packed Daytona Beach in Florida.

Coronavirus dashboard

Illustration: Aïda Amer/Axios

  1. Global: Total confirmed cases as of 9:30 p.m. ET: 5,405,029 — Total deaths: 344,997 — Total recoveries — 2,168,408Map.
  2. U.S.: Total confirmed cases as of 9:30 p.m. ET: 1,642,021 — Total deaths: 97,698 — Total recoveries: 366,736 — Total tested: 14,163,195Map.
  3. World: White House announces travel restrictions on Brazil, coronavirus hotspot in Southern Hemisphere Over 100 coronavirus cases in Germany tied to single day of church services — Boris Johnson backs top aide amid reports that he broke U.K. lockdown while exhibiting symptoms.
  4. Public health: Officials are urging Americans to wear masks headed into Memorial Day weekend Report finds "little evidence" coronavirus under control in most statesHurricanes, wildfires, the flu could strain COVID-19 response
  5. Economy: White House economic adviser Kevin Hassett says it's possible the unemployment rate could still be in double digits by November's election — Public employees brace for layoffs.
  6. Federal government: Trump attacks a Columbia University study that suggests earlier lockdown could have saved 36,000 American lives.
  7. What should I do? Hydroxychloroquine questions answeredTraveling, asthma, dishes, disinfectants and being contagiousMasks, lending books and self-isolatingExercise, laundry, what counts as soap — Pets, moving and personal healthAnswers about the virus from Axios expertsWhat to know about social distancingHow to minimize your risk.
  8. Other resources: CDC on how to avoid the virus, what to do if you get it, the right mask to wear.

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Updated 1 hour ago - Politics & Policy

Republicans sue California over mail-out ballot plan

California Gov. Gavin Newsom during a February news conference in Sacramento, California. Photo: Justin Sullivan/Getty Images

President Trump accused Democrats of trying "Rig" November's general election as Republican groups filed a lawsuit against California Sunday in an attempt to stop Gov. Gavin Newsom (D) from mailing ballots to all registered voters.

Driving the news: Newsom signed an executive order this month in response to the coronavirus pandemic ensuring that all registered voters in the state receive a mail-in ballot.