Fall Could Bring Rare Paralyzing Illness In Children

August 29, 2020

As if the COVID-19 pandemic wasn’t bad enough, health officials say we’ll have an outbreak of a rare, polio-like disease this fall.

According to a statement from the Centers for Disease Control and Prevention (CDC), cases of the disease, known as acute flaccid myelitis (AFM), spiked in the late summer and fall of 2014, 2016 and 2018, and officials expect the trend to continue in 2020.The CDC says AFM is a disease that affects the nervous system and causes muscle weakness, especially in the arms and legs, and can It develops rapidly and causes permanent paralysis.

Recent data suggest that enteroviruses – specifically a type called enterovirus D68 – are likely the primary cause of the AFM outbreak in the United States, according to a new CDC report published Tuesday (Aug. 4) in the journal Morbidity and Mortality Weekly Report. (Poliomyelitis is also caused by an enterovirus).

But COVID-19 is a wild card that could affect the AFM outbreak.

“We don’t know how COVID-19 and social distance affect enteroviruses,” said Dr. Robert Redfield, director of the CDC, in a news release. Social distancing measures have the potential to reduce the circulation of enteroviruses, in which case “there may be fewer AFM cases this year, or the outbreak may be delayed,” Redfield said.

Conversely, a pandemic could make it more difficult for health care professionals to identify and respond to AFM cases, Redfield said.

CDC officials aren’t taking any chances, and they’re urging doctors and parents to look for AFM. the disease should be suspected in children with sudden limb weakness, especially during the peak months of August through November. The limb weakness associated with AFM is often preceded by respiratory illness or fever and neck or back pain.

“AFM is a medical emergency that requires immediate care,” Redfield said. There is no specific treatment for AFM, but because symptoms can progress rapidly and require mechanical ventilation, patients suspected of having the disease should be hospitalized immediately, according to the report. What’s more, doctors may recommend physical or occupational therapy to help address the weakness in limbs caused by HFMD, which, according to the CDC, may lead to better results if administered during the initial stages of the disease.

While cases of HFMD have increased in recent years, the disease is still very rare. According to the CDC, 633 cases of AFM have been confirmed in the U.S. since officials began tracking the disease in 2014.So far in 2020, 16 cases have been reported and 38 are under investigation as of July 31. In previous years, AFM cases didn’t start rising until August.

The 2018 outbreak is the largest to date, with 238 confirmed cases in 42 states. The new report provides a detailed review of those 238 cases to help physicians quickly identify cases and refer them to appropriate care facilities.

The report’s authors found that 86 percent of the 2018 cases began experiencing symptoms between August and November, and 92 percent of the patients developed fever, respiratory illness, or both about a week before they experienced symptoms of weakness. Other common symptoms among patients were difficulty walking, neck or back pain, limb pain, and headache. The most common virus found in the patient samples was enterovirus D68. (Although the symptoms of HFMD and polio are similar, poliovirus was not found in any HFMD cases. Thanks to the polio vaccine, the disease hasn’t been seen in U.S. children since 1979, according to the CDC).

Nearly all patients (98 percent) were hospitalized in 2018, the CDC said, with about half of them admitted to the intensive care unit and about a quarter requiring mechanical ventilation to help them breathe.

Most patients were hospitalized within a day of limb weakness, but 25% were not hospitalized until two or three days later, and 10% were not hospitalized until four or more days later. This may indicate a delay in awareness in some cases.

There is concern that COVID-19 may make it more difficult to detect AFM this year, and parents may delay taking their children to the doctor.

“We are concerned that in a COVID pandemic, cases may not be recognized as AFM, or … . parents may be concerned about taking their children to the doctor if they have something as serious as limb weakness,” Dr. Thomas Clark, deputy director of the CDC’s Division of Viral Diseases, said in a news release. Officials “want parents to understand that many steps have been taken to provide safe health care,” Clark said.” Any sudden signs of physical weakness, (children) need to see a doctor.”