Kansas City,
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September
2016
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04:42 PM
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The Washington Post: A mysterious polio-like illness that paralyzes people may be surging this year

Before dinner on July 29, 3-year-old Carter Roberts of Chesterfield, Va., seemed perfectly healthy. That evening, he vomited. When he woke up the next morning with a slight fever of 99 degrees, his mother, Robin Roberts, figured that he was coming down with a cold. The next morning, she found him collapsed on his bedroom floor.

“Mommy,” she recalls him saying. “Help me, help me.”

Carter could barely stand when she picked him up, and his neck was arched backward. “What was most alarming,” she said, “is he had no control over his right arm whatsoever.”

In the hospital, Carter lost control of his right arm, then over his legs and other muscles within a few days. He now can only wiggle a toe and move the left side of his face. He has been diagnosed with a mysterious, polio-like illness called acute flaccid myelitis, a condition that seems to be surging this year.

Through July, 32 new cases of AFM have been confirmed across the United States this year by the Centers for Disease Control and Prevention, a sharp rise compared with last year, when just seven cases had been confirmed by that month. The numbers have risen steadily since April. In past years, most cases have occurred between August and December, with a peak in October.

Source: Centers for Disease Control and Prevention

Among the many unanswered questions about the condition are what causes it, how best to treat it and how long the paralysis lasts. Although most cases occur in children, AFM occasionally affects adults.

The CDC official who leads the surveillance efforts said that confirmed numbers for August will not be available until the end of this month, but the number of reports she is receiving from doctors around the country continues to rise.

“CDC is looking at these trends very carefully,” Manisha Patel said. “We have sent out several health alerts to states to let them know we are seeing an increase in reporting and to encourage them to communicate with doctors to report these cases in a timely fashion.”

The CDC began tracking AFM in 2014, when 121 cases were confirmed. That year, the CDC counted only children affected by the disease. Their average age was 7. Most had a fever or a respiratory illness a few days before developing paralysis. Many had to be placed on respirators. Although 85 percent of the children recovered partially, only three of them recovered fully.

Health officials and physicians around the country said they are concerned that the rising number of cases through July could foretell a repeat of 2014.

Beyond saying that confirmed cases have been reported in 17 states through July, Patel declined to reveal which states have been involved. But conversations and emails with physicians around the country indicate that at least four cases have occurred in California and at least three in Massachusetts, and that others have been seen in Florida, Texas, Pennsylvania and New York, as well as Virginia.

Jean-Baptiste Le Pichon of Children’s Mercy Hospital in Kansas City, Mo., said that doctors on a U.S. email list for pediatric neurologists reported five new cases of AFM in just the past few days. “There is definitely an explosion of cases,” Le Pichon said.

No treatment other than physical therapy has yet been shown to markedly improve outcomes, although some doctors have reported that treatment with intravenous immunoglobulin (IVIG), used to treat some other viral infectious diseases afflicting the nervous system, might help. It’s also been suggested that Prozac could prove beneficial. The degree of paralysis in the first month has generally improved only slightly over the course of a year.

“After about a year or so, what you’ve got is what you’ve got,” said Max Wiznitzer, a pediatric neurologist at Case Western Reverse University in Cleveland.

Most perplexing is what causes the disease. The 2014 outbreak of AFM occurred at the same time as a far larger outbreak of enterovirus D68 across the United States. The vast majority of patients infected with the virus developed only a respiratory illness. Some physicians were convinced that EV-D68 was the cause, not only because both outbreaks occurred at the same time but also because of a study that identified a particular strain of EV-D68 in the airways of children with AFM. But officials at the CDC and some doctors, including Wiznitzer, insist that the cause remains unproved.

So far this year, no similarly widespread outbreak of EV-D68 respiratory infections has been reported, although cases of it and other enteroviruses have been seen in some areas.

On Friday, Le Pichon, in Kansas City, said, “I just got confirmation that we have an epidemic of enterovirus breaking out here and at least a few cases [of enterovirus] have typed positive for EV-D68.”

 

Read the full story via The Washington Post.