Rise in Acute Flaccid Myelitis Among Children in the US

Oct 10, 2018 | Kara Sewalk | Outbreak News

 

As of September 2018, the Minnesota State Health Department has reported six cases of Acute Flaccid Myelitis (AFM) in children under the age of 10 years old. According to the Centers for Disease Control and Prevention (CDC), AFM is a rare condition that affects the nervous system, specifically causing weakening nerves and muscles [1]. Other symptoms include, but are not limited to: neck weakness or stiffness, drooping eyelids or facial droop and difficulty swallowing or slurred speech [2]. In severe cases, AFM may result in paralysis [3].

 

There is concern from public health officials and parents that this “polio-like” illness is spreading. So far in 2018, the CDC has recorded 38 confirmed cases of AFM throughout 16 states. A national uptick of AFM was first widely observed in 2014 [4], when 120 children were diagnosed with the rare condition, primarily due to infection from enterovirus D68 (EV-D68). And an alarming 149 confirmed cases of AFM were identified in 2016 [5].

 

The Minnesota Health Department issued an alert warning hospitals and clinics to be on the lookout for patients experiencing symptoms related to AFM [2].

 

There are a variety of possible causes of AFM, including: viruses, environmental toxins, and genetic disorders [1]. It is not yet understood why AFM affects primarily children, however investigators believe cases this year are related to the 2014 national rise of respiratory illnesses in children caused by a virus known as EV-D68.

 

The state of Colorado has also seen a rise in AFM diagnoses, with 14 confirmed cases to date this year. The Colorado Department of Public Health has reported that 11 of these cases tested positive for enterovirus A71 (EV-A71), one case tested positive for EV-D68, and two cases tested negative for any type of enterovirus [6].

 

The identified viruses, EV-D68 and EV-A71, are two of 100 non-polio enteroviruses.  While not widely reported, a mix of enteroviruses circulate each year, and different types can be common in different years. Both are largely circulated in the summer and autumn months. EV-D68 causes respiratory illness, and is diagnosed through lab tests from a person’s nose, throat or blood [7]. EV-A71 is found in respiratory secretions as well, and causes mild illnesses, such as hand, foot and mouth disease or no symptoms at all. It rarely can cause neurologic disease, such as meningitis, or AFM. EV-A71 is diagnosed from a person’s nose, throat, poop or cerebrospinal fluid [8].

 

According to Minnesota health officials, the particular viruses in the six cases found in the state have not yet been identified. There is no specific treatment for AFM, and all treatment recommendations are done on a case-by-case basis. [9].

 

Because AFM can develop as a result of a viral infections, public health officials recommend parents and children take basic steps to limit or avoid infection, including: hand washing, covering your cough or sneeze, stay home when sick, stay up to date on vaccinations, and protect yourself from mosquito bites if you spend time outdoors [2,5].

 

Sources:

  1. https://www.cdc.gov/acute-flaccid-myelitis/index.html
  2. http://www.health.state.mn.us/news/pressrel/2018/myelitis100518.html
  3. https://abcnews.go.com/US/children-hospitalized-minnesota-coming-rare-polio-disease/story?id=58360531
  4. http://www.healthmap.org/site/diseasedaily/article/enterovirus-d68-and-paralysis-10314
  5. https://www.cdc.gov/acute-flaccid-myelitis/afm-surveillance.html
  6. https://www.colorado.gov/pacific/cdphe/AFM
  7. https://www.cdc.gov/non-polio-enterovirus/about/ev-d68.html
  8. https://www.cdc.gov/non-polio-enterovirus/about/ev-a71.html
  9. https://www.nbcnews.com/health/health-news/rare-polio-condition-appears-u-s-again-n917841
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