10 Additional ‘Polio-Like’ Cases Confirmed In Just One Week

The Centers for Disease Control and Prevention (CDC) has confirmed 10 additional cases of Acute flaccid myelitis (AFM) in just a few days. 

These 10 new cases bring the total to 90 confirmed AFM cases from 27 states, as of November 13, 2018. 

Unfortunately, over 90 percent of the 2018 AFM cases are children. 

For all of 2018, there has been 252 AFM reports that the CDC has received regarding Patients Under Investigation (PUIs). 

This new total compares with just 33 AFM cases from 16 states during 2017. 

Separately, from South East Scotland, a new report published on November 13, 2018, says 5 cases of AFM were confirmed in previously healthy developing children (2–6y).

All of these children presented significant neurological symptoms. At 18‐month follow‐up, 2 of these 5 cases were ventilator‐dependent. 

These cases represent one of the largest reported pediatric clusters of AFM associated with EV‐D68 in Europe. 

In a related paper, researchers from the Netherlands published a review article on EV-D68, noting that studies showing ‘its neurotropic nature and change in pathogenicity has established it as a probable cause of AFM.’ 

"The EV-D68 storyline shows many similarities with poliovirus a century ago, which leads to discussions whether EV-D68 could be ascertaining itself as the 'new polio,' " these researchers wrote. 

The Netherlands reported 2 AFM cases during the Fall of 2018.

Acute flaccid myelitis is a rare but serious condition that affects the nervous system. 

AFM specifically impacts the area of the spinal cord called ‘gray matter’, which causes the muscles and reflexes in the body to become weak, says the CDC. 

Most people will have a sudden onset of arm or leg weakness and loss of muscle tone and reflexes. Some people, in addition to arm or leg weakness, will have additional symptoms including:

• facial droop/weakness,
• difficulty moving the eyes,
• drooping eyelids, or
• difficulty with swallowing or slurred speech.

These AFM cases are not caused by poliovirus, as all of the PUIs tested negative for poliovirus. 

The CDC did detect coxsackievirus A16, EV-A71, and EV-D68 in the spinal fluid of four of 414 confirmed cases of AFM since 2014, which points to the cause of their AFM. 

For all other patients, no germ has been detected in their spinal fluid to confirm a cause. 

The CDC says ‘respiratory illnesses and fever from viral infections such as enteroviruses are common, especially in children, and most people recover.’ 

"We don’t know why a small number of patients develop AFM, while most others recover."

The CDC is investigating the following potential causes:

• A direct infection of a virus on the motor neurons (nerves that make the muscles move),
• An indirect infection where a virus may lead to an inflammatory or immune response directed toward motor neurons,
• Host genetic factors in which certain children may be more susceptible than others.

While the CDC does not know the cause of these AFM cases, it’s always important to practice disease prevention steps, such as staying up-to-date on vaccines, such as polio.