Polio-Like Virus Spreads Fear

By Dr. Joy Martinez, Contributing Carolinian Columnist

To a generation of people, this sickness seems familiar, the sudden appearance of weakness in the arms or legs, loss of muscle tone and reflexes, paralysis. 

Symptoms including pain, drooping face and eyelids, difficulty moving eyes and swallowing, and slurred speech. In severe cases, patients have trouble breathing because of muscle weakness and their lives end with the onset of respiratory failure. 

Ninety percent of cases are affecting children, with the average age of four. It almost seems polio has made a resurgence. What is this disease potentially affecting over 250 people in 29 states, including North Carolina?

Acute Flaccid Myelitis (AFM) is a rare but serious condition experiencing an uptick or increase in incidents this year. The Centers for Disease Control and Prevention began tracking the disease in the U.S. in 2014, when a large number of cases were reported.

The number of AFM cases appears to rise every other year. Last year there were just 33 confirmed cases in 16 states, while 2015 saw just 22 confirmed cases in 17 states. The number of confirmed cases has risen by 60 since the first week of November.

AFM has no known cause. The enterovirus D68 along with other viruses that cause respiratory and diarrheal illness has been linked to the disease. In most cases, patients had a mild respiratory illness before developing the disease.

AFM can be difficult to diagnose because it shares many of the same symptoms as other neurologic diseases, like traverse myelitis and Guillain-Barre syndrome. 

With the help of testing and examinations, doctors can distinguish between AFM and other neurologic conditions. MRI (magnetic resonance imaging) to look at a patient’s brain and spinal cord, lab tests on the cerebrospinal fluid (the fluid around the brain and spinal cord), and tests of nerve conduction (impulses sent along a nerve fiber) and response have helped in diagnosis.

As with other types of brain and spinal cord injury, the best results often come with early mobilization, so rehabilitation begins early, sometimes even while a child with AFM is in the intensive care unit. Pediatric physical therapists are trained to make children with weak limbs feel like they are champions, whether they are infants, toddlers, or older children.

And the CDC recently announced a new task force on acute flaccid myelitis. 

“This task force will ensure that the full capacity of the scientific community is engaged and working together to provide important answers and solutions to actively detect, more effectively treat, and ultimately prevent AFM and its consequences,” said CDC director Robert Redfield, M.D., in a statement. The first public report is expected in early December. 

How do you protect your children (and yourself) against AFM? Since physicians and providers don’t know the cause of most of these AFM cases or what triggers this condition, there is no specific action to take to prevent AFM.

The first line of defense is to stay up to date on vaccinations. Polio vaccine contains inactivated (not live) virus, and protects against poliovirus, a known precursor to AFM along with the enteroviruses, enterovirus A71 (EV-A71), and West Nile virus.

Encourage frequent hand-washing and ensure children are wearing mosquito repellant. Finally, avoid close contact with people who are sick, and clean and disinfect frequently touched surfaces, including toys.