The US Centers for Disease Control and Prevention (CDC) announced Wednesday that they had confirmed 62 cases this year of acute flaccid myelitis, or AFM, in 22 states, with 90 percent of the people acquiring it being under the age of 18 and the average victim's age being a mere four years old. On Saturday, Sputnik reported on the worrisome number of 38 cases of the strange syndrome, which affects the spinal cord.
The CDC first took notice of AFM in 2014 and before last week had only tracked around 362 cases of it in total.
The surge in cases is just as baffling as the syndrome itself: a wide variety of potential causes have been proposed, ranging from the polio virus — which the US eradicated through vaccines decades ago — to influenza, environmental toxins and West Nile Virus. Epidemiologists aren't even sure if it's communicable or not.
"We know this can be frightening for parents," Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the CDC, told the press Wednesday. "I know many parents want to know what the signs and symptoms are that they should be looking for in their child. I encourage parents to seek medical care right away if you or your child develop sudden weakness or loss of muscle tone in the arms or legs."
There's no medicine you can take to treat or cure it, either. Hospitals can provide supportive care for people who acquire AFM, with doctors monitoring bodily functions in case patients require breathing assistance before their bodies begin to fight the illness on their own.
"About half of kids with AFM will strengthen up enough on their own that they won't require any form of surgical intervention for their nerves. The other half won't," Dr. Mitchel Seruya, director of the Brachial Plexus and Peripheral Nerve Center at Children's Hospital Los Angeles, told CBS News October 11. Doctors at Children's Hospital Los Angeles have attempted to pioneer a nerve transplant treatment, which requires intensive physical therapy afterward, to restore muscle control, Sputnik reported.
Sputnik spoke Wednesday with Dr. Anthony Fauci, director of the Institute of Allergy and Infectious Diseases at the National Institutes for Health (NIH), about the mysterious but rapidly spreading syndrome, what they know about it so far and what's being done to combat it — if anything can be done.
Fauci told Sputnik that myelitis is "an inflammation of the nervous system, particularly the spinal cord." Now, he says, there is a worrying rash of of children "who are coming down with this very puzzling syndrome of acute weakness and even paralysis of the arms and legs and even some of the cranial nerves that, for example, give you facial drop or lid drop or difficulty swallowing. But it's mostly peripheral, where they can't walk or can't use their arms."
"We don't know what the etiology of this is," Fauci told Sputnik. "It is suspected that it is a syndrome that follows an unidentified infection. We thought a few years ago that we knew what particular infection it was, but then as we got more and more information, it was clear that we really do not know what the etiological agent is — we don't know what causes it. It's acting very much like a post-viral neurological syndrome, but we can't say for sure that it is because we don't have any definitive isolation. For example, when you do a spinal tap on a child and we try to identify what the agent is — we can't, because we don't see anything that's identifiable."
"It's acting very much like polio, but it is not polio, so it's one of those things that's very frustrating."
Fauci emphasized that, while parents might understandably be worried, AFM is "very rare. It's one in a million… the only thing we can recommend, since we don't have a treatment and we don't know what it is at this point, is to do those things that you would generally do to avoid infections that can spread from one person to another. These include washing one's hands very carefully and frequently, keeping children up to date on their vaccines, avoiding people who are sneezing or coughing and generally trying to live in a healthy way. "That's the kind of thing you want to do to avoid any kind of viral or other type of infection that might be going around," he recommended.
Because the disease attacks the spinal cord, Fauci said that a spinal tap — when a needle extracts cerebrospinal fluid from the spinal canal — is how researchers are looking for potential causes of AFM. However, "We're coming up with nothing. So here's the important thing — we don't know if it's a single agent that's causing this, a common denominator, or if it's a variety of aberrant responses of some children to any of a number of infections. So that it isn't one infection causing the same thing, it's that some children — genetically or otherwise — have a propensity to respond in a very aberrant way to infection with any of a number of viruses. So that's the big puzzle, because if it were a virus that was a single virus — that's easily spread and everybody who got infected with the virus would get this syndrome — then you'd probably see a lot more cases, and you'd see clustering."
However, that's not the case. Messonnier said Wednesday that "we are not seeing geographic clustering in 2018, nor have we seen it in 2016 or 2014. We are looking for clues, but we really haven't seen it in the geography."
Fauci noted that "it may be that some children just have a propensity to have this, whereas other children who get exposed to the same agent can not get any problem at all."
The NIH director said an environmental trigger was one possibility. "See, we're leaving everything open. It is certainly quite possible that there's something environmental — we don't know. When you're in the dark about something and you're trying to gain information, you can't rule something out unless you have definitive proof of a diagnosis. For example, we've ruled out polio. Because we have a good test for polio, and it isn't polio. But we don't know what else it might be or what other possible combinations of things it might be, including an environmental factor."
While some research has suggested in the past that that EV-D68, an enterovirus from the same family as polio, might be responsible for AFM, Fauci discounted that conclusion.
"We thought that because they simultaneously spiked that there was a causal relationship, but when we searched to see if we could identify enterovirus D68 in these individuals, we didn't have any uniform results. Then two years later, when we had another outbreak in 2016, there was much less of an association with enterovirus D68, so we came to the conclusion that we can't definitively prove that there's a direct causal relation to anything right now. But we just know that what we're seeing is obviously some sort of what might be a post-viral or a post-environmental exposure syndrome that is very, very common in this manifestation."
Fauci said that while the CDC does large-scale disease tracking, at the NIH, "we do the fundamental basic research, like, for example, trying to develop an animal model so we can replicate this so that we might be able to study its pathogenesis. Trying to determine if there is any possibility that a combination of one or more viruses can do this, as well as, if we do get an agent, we're trying to determine by molecular techniques: are we missing agents, and do we need more sensitive diagnostics? So there's a whole bunch of things that we're doing from a fundamental basic research nature."
