People who grew up in the 1940s and 50s remember the terror that the word “polio” caused. Polio struck tens of thousands of children every year, without warning. Adults talked in hushed sad tones about the terrifying symptoms of paralysis and children that had to be in an iron lung in order to breathe. When we saw other children in leg braces, we knew it was polio. A polio vaccine became available in the late 1950s.
A rare, polio-like paralyzing disease has been confirmed in 158 children, across 46 states including Arkansas, so far this year. Ninety percent of cases occur in children younger than age 18 with most cases in children between ages 2 to 8. Called acute flaccid myelitis or AFM, disease investigators at the Centers for Disease Control and Prevention (CDC), believe it is caused by a virus.
AFM affects the nervous system, specifically the spinal cord, and can cause problems with muscles and reflexes in the body. Children with AFM suddenly lose the ability to move their face, neck, back, arms or legs. They also lose muscle tone and reflexes. Some children also have drooping eyelids, difficulty moving their eyes, drooping face muscles, slurred speech or problems swallowing. The weakness ranges from minor to very severe. Paralysis can be total, partial or just weakness in one limb. AFM’s most severe symptom is breathing failure that can happen when the breathing muscles become weak. These children must be placed on a ventilator (breathing machine).
For about 90 percent of AFM victims, symptoms start about a week to 10 days after having a cold and fever. Although many children fully recover from the paralysis, an increasing number have lasting paralysis. Almost half of children with AFM are admitted to hospital intensive care units where they are placed on a breathing machine or feeding tube because they cannot swallow.
A confirmed diagnosis of AFM must rule out poliovirus and include an MRI scan showing lesions in the area of the spinal cord that controls muscles. AFM causes inflammation of the spinal cord. AFM can kill cells that do not regenerate and the damage to the cells is irreversible. Physical therapy can help patients restore muscle function.
The first three cases of AFM were reported in 2012. By 2014, 120 cases were confirmed; 149 cases were confirmed in 2016. The CDC has confirmed almost 500 cases since 2014. The every-two-year outbreak of AFM also has researchers stumped. There were far fewer cases in 2015 and 2017.
About 20 other countries have reported AFM but not in the two-year cycles like the United States has experienced. Most cases occur from August through October, with a marked decrease by November.
CDC researchers think it is possible that the process that triggers AFM in some people may also trigger other serious nervous system complications that could lead to death. No deaths have been reported this year but there has been at least one death linked to AFM since 2012.
Of the nearly 500 cases investigated, only 14 patients had a similar virus in their lab tests. No germ has been detected in the other victims’ spinal fluid to confirm a cause, the CDC reports. The EV-D68 virus has been suspected as one cause. However, EV-D68 has caused infections in children for some years and many Americans have antibodies to EV-D68. Researchers do not know why this virus would suddenly start causing paralysis. Other causes under investigation include genetic disorders, environmental toxins, or West Nile virus or other viruses.
While most patients fully recover from a cold or fever, others develop AFM. Researchers are investigating immune response to an infection and genetic factors that may make some people more susceptible to developing AFM. It is difficult to diagnose because AFM has many of the same symptoms of transverse myelitis and Guillain-Barre syndrome.
AFM is not contagious but the viruses that may be causing AFM are contagious. There is no known cure or vaccine, nor any guidelines on how to best treat children. Physical therapy seems to provide significant recovery from AFM and prevent complications from being immobile.
Besides EV-D68, other viruses known to cause AFM include enteroviruses, such poliovirus and enterovirus (EV-A71) and West Nile virus.
To help protect yourself and your children:
- Report any of the AFM symptoms listed above immediately to your doctor. It is important that tests be done as soon as possible after the patient develops symptoms to limit the damage caused by inflammation.
- Get vaccinated against polio, including booster shots.
- Protect against mosquito bites that can carry West Nile virus. Use mosquito repellent, stay indoors at dusk and dawn when bites are more common, and remove standing or stagnant water where mosquitoes can breed.
- Wash your and your children’s hands with soap and water to protect against all viruses. Also, stay away from close contact with people who are sick. Frequently disinfect surfaces they touch including toys.
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