Since 2014, outbreaks of acute flaccid myelitis (AFM) have occurred in the United States every two years between August and November. The U.S. Centers for Disease Control and Prevention have warned parents to be extra cautious in the next few months since 90% of AFM cases occur in children.
Acute flaccid myelitis is a mysterious condition affecting the nervous system and has similar symptoms to polio. The neurologic disease affects the gray matter in the spinal cord. Symptoms include loss of reflexes, drooping eyelids, weakened arms and legs, and slurred speech.
Experts have noticed an increasing trend of AFM cases every two years - from 120 cases in 2014, then 153 in 2016, to 238 two years ago. What causes the disease remains unknown but scientists believe that it emerges from viruses since patients have respiratory symptoms before getting AFM.
Respiratory Problems
Several studies revealed that most likely, enterovirus-D68 may be responsible for AFM peaking in the U.S. every two years. EV-D68 is a non-polio enterovirus that causes respiratory problems.
In some cases, the illness results in respiratory failure and is potentially fatal. Almost 50% of AFM cases require intensive care with 25% of patients with severe cases needing the help of a ventilator to breathe.
CDC Director Robert Redfield said, 'Physicians should not delay in hospitalizing patients when they suspect AFM.' Although the illness is rare, it is quite serious and hundreds of children across America are anticipated to acquire the illness in the next few months.
With the ongoing coronavirus pandemic and upcoming flu season, AFM will make things a lot more complicated. Dr. Thomas Clark from the CDC's Division of Viral Disease expressed his concern that in the midst of the current pandemic, 'cases of AFM might not be recognized or parents might be worried about taking their child to the doctor.'
AFM, Covid-19 & Flu Season
With AFM due for another peak this year, Dr. Robert Glatter from Lenox Hill Hospital, New York City, is also concerned with the polio-like illness appearing during the pandemic. 'It's still unclear if or how COVID-19's recommended social distancing measures and attention to mask-wearing and hand hygiene will impact how many enteroviruses we end up seeing,' he said.
Redfield explained that AFM progresses quickly, paralyzing patients for hours or days. Some even become permanently disabled.
In the CDC's report, 'parents and doctors should suspect AFM' if patients complain about the neck, back, and limb pain or weakness especially if it follows a fever or other respiratory symptoms. It is anticipated that cases will peak in September, similar to 2018 when more than 30% of the AFM cases were reported during this month.
Due to the pandemic, non-coronavirus ER visits have dramatically dropped this year. Glatter said that it is critical for parents to know at this time how important it is for their children to receive immediate medical attention if AFM symptoms do occur. 'Recognition and early diagnosis are critical. CDC and public health partners have strengthened early disease detection systems, a vital step toward rapid treatment and rehabilitation for children with AFM,' said Redfield.
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