Possible Link Between Virus And Acute Flaccid Myelitis, The 'Polio-Like' Disease

Apr 29, 2019

Six months after rushing her 4-year-old to Cincinnati Children's with sudden paralysis, Alex Voland says Elijah is making progress but still struggles to move his right leg. He was diagnosed in October with a rare disease called acute flaccid myelitis. Its cause is unknown though researchers may have found a link.

Heidi Moline, M.D., chief pediatrics resident at the University of Minnesota, announced earlier this month she's identified a link between acute flaccid myelitis (AFM) and the virus enterovirus D68 (EV-D68). EV-D68 was found in spinal fluid of one of six patients with confirmed cases of AFM.

Symptoms of AFM include rapid onset of muscle weakness and paralysis, leading to concerning headlines about a mysterious "polio-like" disease.

The Centers for Disease Control and Prevention (CDC) launched an investigation in 2014 after identifying a surge in AFM diagnoses. Researchers at Cincinnati Children's Hospital Medical Center are part of the team.

"What CDC and others are trying to do is really link those two in a definitive manner," says Paul Spearman, M.D., director of infectious diseases at Cincinnati Children's. "The evidence is strongly suggestive but not definitive that EV-D68 is the responsible virus."

Spearman is cautious about the recent findings, saying more studies are needed.

"The current (CDC) study is an ongoing study ... We probably won't have the best answer to this this year. It's going to take longer than that to define the cause of the upsurge in cases of acute flaccid myelitis."

Statistics show show the disease following a two-year epidemic curve, meaning there will likely be fewer cases this fall. The number of confirmed cases fell in 2015 following the initial 2014 surge, then increased and decreased again in 2016 and 2017 before the 2018 spike that put AFM in the media spotlight last fall.

That every-other-year cycle does point to an epidemiological link between AFM and an enterovirus.

"We know some enteroviruses have every two to three year cycles like this, and one of them that does that is EV-D68," Spearman says.

He says parents should be educated about AFM but not panicked.

"This is still rare. Less than two per million per year of kids in the U.S. [get AFM] is what the CDC says," he points out.

Symptoms

According the Cincinnati Children's, symptoms generally begin several days after a child exhibit signs of a cold.

Symptoms include sudden onset of muscle weakness, with loss of muscle tone and reflexes, resulting in:

  •     extremity weakness/paralysis (ranging from affecting one extremity to affecting all four extremities)
  •     respiratory weakness
  •     difficulty controlling the bowel and bladder
  •     drooping eyelids, or
  •     difficulty with swallowing or slurred speech due to facial weakness
     

If AFM is viral, the best way to protect against it is practicing standard precautions such as proper hand-washing, avoiding those who are ill, and staying home if you're ill, as well as getting children vaccinated against the flu.

If your child's cold symptoms don't improve after seven to 10 days, contact your physician.