- People in at least 36 states have come down with a rare polio-like illness called acute flaccid myelitis (AFM) this year, and most cases occur in kids.
- On December 19, health officials announced there have been 28 cases of “acute flaccid paralysis” England, too. The country typically only sees a handful of cases every year.
- AFM may lead to paralysis and, very rarely, death.
- The signs of AFM include sudden arm or leg weakness, drooping eyelids, facial weakness or drooping, difficulty swallowing, or slurred speech.
- Anyone displaying those signs should get medical help right away.
This year, people in at least 36 US states have come down with acute flaccid myelitis, a rare polio-like illness that can cause paralysis, according to the latest data from the Centres for Disease Control and Prevention (CDC).
So far in 2018, there have been 165 confirmed cases of the illness, with another 155 possible cases under investigation.
But this year saw a record number of confirmed AFM cases, the Associated Press reported on December 7, surpassing the previous record high of 149 reported in 2016. (Earlier this month, CDC officials released a statement saying they expect AFM cases to decline as 2018 draws to a close.)
Similar cases appear to be on the rise in England. On December 19, Public Health England released a statement saying 28 cases of “acute flaccid paralysis” have been reported in the country in 2018. Typically, the statement added, the country sees only a “handful” of cases for investigation each year.
AFM is truly rare – one Minnesota health official told CBS News kids have “about one in a million” chance of getting it – but it is crucial that any child displaying the signs get medical attention right away, the CDC says.
INSIDER spoke with pediatrician Dr. Natasha Burgert to learn more about AFM and its telltale symptoms. Here’s what you need to know.
The CDC says we still haven’t found a definitive cause of AFM
AFM affects the nervous system, particularly the spinal cord, causing muscles and reflexes across the body to become weak, the CDC explains. It’s often described as “polio-like” because polio also affects the nervous system, causing neurological changes, Burgert said.
AFM can happen in adults but tends to be more common in kids, she added.
It’s thought that AFM may be a communicable disease.
“Because there does seem to be a seasonal pattern and it does seem to happen in clusters, that makes us lean towards it being a communicable disease or an infectious disease,” Burgert said.
And, since 2014, more than 90% of AFM patients in the US have had a mild respiratory sickness or fever consistent with a viral infection shortly before they developed AFM, according to the CDC.
The CDC says it’s not clear why a small number of people who get these respiratory illnesses go on to develop AFM, while others recover.
Some experts in the field have pointed to one virus in particular – enterovirus D68, or EV-D68 – as a leading suspect behind many AFM cases, according to a report published October 29 by NBC News. The report noted that the 2014 nationwide uptick in AFM cases coincided with a widespread outbreak of EV-D68 illnesses.
But the CDC maintains that a definitive cause still hasn’t been found.
The agency has tested the spinal cord fluid of AFM patients to determine what’s behind the condition. Because AFM affects the spinal cord, finding a pathogen, or germ, in the spinal fluid would be “good evidence” that particular germ is the cause, the CDC website says.
Since 2014, the CDC has detected three viruses (EV-D68, EV-A71, and coxsackievirus A16) in the spinal fluid of 4 AFM patients. But in the more than 400 other patients who have contracted AFM during that time frame, no pathogens have been detected in their spinal fluid. This may be because the body clears away the pathogen, or because it’s “hiding in tissues that make it difficult to detect,” the agency adds.
There may be other explanations, too: AFM may be caused by an immune response to infection, rather than the infection itself, or there could be a genetic factor that makes some people more likely to get it, according to the CDC.
For now, the agency is continuing to investigate possible causes of AFM.
“The absence of a pathogen in most AFM cases means we haven’t found the definitive cause yet,” its website says.
“That’s why it’s so scary,” Burgert said. “This is a potentially life-threatening illness and we don’t know the cause, and if we don’t know the cause, we can’t predict it.”
Anyone with AFM symptoms should see a doctor ASAP
Most people with AFM will experience sudden arm or leg weakness with a loss of reflexes and muscle tone, according to the CDC. Some people may also have facial drooping and weakness, drooping eyelids, difficulty swallowing, and slurred speech.
These signs may be a little harder to spot in young children, Burgert said, since they aren’t always able to articulate their symptoms.
“Since we know that this disease involves loss of muscle tone, I’m watching how [kids] are walking, how they’re drawing, how they’re using their utensils. For example, if they’re right-handed and now they’re only using their left arm, that’s going to be a huge red flag,” she said. “I would also look at their smile. A kid’s smile should always be symmetric.”
The most serious symptom of AFM is respiratory failure, the CDC says, which can happen when the muscles you use to breath become weakened. This is what makes AFM a potentially deadly disease, Burgert said.
But she stressed that breathing difficulties won’t be the first sign of AFM. The initial symptoms like limb and facial weakness do come on suddenly, but it takes some time for the disease to progress to the point where it affects breathing.
“Any astute parent with an appropriate level of concern will be able to reach hospitals and clinics for evaluation before that would happen,” Burgert said. “It’s not like they’re going to stop breathing in the middle of the night [because of AFM]. We just have to be attuned to the first signs.”
Finally, even though most AFM cases are preceded by a respiratory infection or fever, that doesn’t mean every kid who gets temporarily sick will end up with AFM.
“It’s important to know that this is still very rare and that the vast, vast majority of kids are going to have these normal cold and flu viruses with no complications,” she said.
There’s no specific treatment, but people with AFM can get supportive care in the hospital
There’s no specific treatment for AFM, according to the CDC.
“It’s not something you can go to a hospital and get a medicine for right now,” Burgert said.
Instead, she explained, people with AFM get supportive care in the hospital. Doctors will monitor their bodily functions, for example, and make sure patients who need breathing assistance get it. This care continues until the body starts to fight the infection on its own, Burgert said. After that, it’s a matter of recovery.
Since AFM attacks the neurons in the spinal cord, affecting neurological function, recovery from the condition is an attempt to regain that compromised function, Burgert explained.
“For kids that’s less of a worry,” she said. “Kids are so malleable, and kids with amazing neurological deficits can still regain that function as their brain and nervous system are growing and changing. In adults, when we have a neurological injury, it’s a lot harder to repair.”
Recovery interventions may vary on a case-by-case basis, the CDC explains. For example, some doctors may recommend physical or occupational therapy to help a patient recover from arm or leg weakness. Unfortunately, we still don’t know the long-term health outcomes for people who get AFM.
It’s not exactly clear how to prevent it, either. But there are some steps that could help.
The CDC says that both polio virus and the mosquito-borne West Nile Virus may lead to AFM. The polio vaccine will protect kids against polio, of course, and to avoid mosquito bites, you can use insect repellent, stay inside at dusk and dawn when it’s more common to get bitten, and remove any standing water near your home, since mosquitoes can breed in it.
This post has been updated to include new data and information from the Centres for Disease Control and Prevention and Public Health England.
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