Only One Child in Paralysis Outbreak Has Fully Recovered:POLIO OUTBREAK?

Only one child has fully recovered in 103 confirmed cases of children experiencing a sudden and mysterious onset of acute limb weakness called acute flaccid myelitis (AFM) since last August, the Centers for Disease Control and Prevention (CDC) announced yesterday.

The CDC said it is investigating whether AFM is linked to the recent outbreak of severe respiratory illness traced to enterovirus-D68 (EV-D68), the most common of the enteroviruses circulating in 2014. The CDC and state public health laboratories have confirmed 1153 cases of EV-D68, almost all of them involving children, and 13 deaths dating from the middle of last August to January 8. Millions of Americans likely have had mild EV-D68 infections that went untreated or untested.

Although enteroviruses in the past have rarely triggered neurological problems, they are related to the paralyzing polio virus.

In an article published in the January 9 issue of the Morbidity and Mortality Weekly Report, the CDC said the cerebrospinal fluid of 71 patients with AFM did not test positive for EV-D68 or any other pathogen. However, when the CDC tested upper respiratory tract samples of 41 patients for enteroviruses and rhinoviruses, it found EV-D68 in eight, or 20%, of them. In 19 patients whose upper respiratory tract samples were obtained less than 14 days from the onset of respiratory illness, seven (37%) tested positive for EV-D68.

The median age of the 103 children with AFM from August 2, 2014, to January 5 is about 7 years. Almost all of them were hospitalized, with some put on breathing machines. About two thirds of those who were observed after their illness reported some improvement in symptoms, and one third experienced no improvement.

The CDC is urging clinicians to be on the outlook for AFM cases and to report them to their state or local health department. The agency considers a patient to have AFM when he or she meets all of the following criteria:

• the patient is aged 21 years or younger;
• there is an acute onset of focal limb weakness;
• the onset occurred on or after August 1, 2014; and
• an MRI shows a spinal cord lesion largely restricted to gray matter.

Every year, children develop limb-weakening neurologic illness caused by, among other things, viral infections, environmental toxins, genetic disorders, and Guillain-Barré syndrome, according to the CDC. In many cases, however, the cause is never identified.

More information about AFM is available on the CDC website.