Polio-like symptoms in children

NICK EICHER, HOST: Coming up next on The World and Everything in It: a mystery illness affecting hundreds of children.

AUDIO: A frightening illness is causing polio-like symptoms … a rare polio-like illness … health officials know very little about the disease … Acute Flaccid … Acute Flaccid Myelitis … AFM, Acute Flaccid Myelitis … It can cause at least partial paralysis … such a mysterious illness until now. AFM can leave a child paralyzed.

EICHER: The Centers for Disease Control and Prevention first reported a spike in AFM in 2014.

It’s a neurological condition that causes inflammation in the gray matter of the spinal cord. And it mainly affects young children.

REICHARD: In 2016, the CDC reported another spike in the disease and now two years later it’s popped up again.

So far this year, there are 116 confirmed cases of AFM in 31 states and another 170 cases are under investigation.

But as WORLD Radio’s Sarah Schweinsberg reports, what’s causing the illness has doctors stumped.

SARAH SCHWEINSBERG, REPORTER: Samuel Dominguez is an infectious disease doctor at Children’s Hospital Colorado. He started treating AFM patients in 2014. This year, his hospital has treated a dozen patients with the illness.

Dr. Dominguez says children are diagnosed with AFM when they exhibit weakness in their arms and legs and inflammation in the spinal cord.

DOMINGUEZ: So initially most patients will complain of some pain in the arm or the leg, and sometimes neck pain and often fevers.

As the illness progresses, the patient can no longer fully move their affected limbs. The muscles in the face can also weaken, causing life-threatening complications.

DOMINGUEZ: In the most severe form, it can also affect a patient’s ability to eat or breathe on their own. So they will need to be in the intensive care unit with supportive care.

While doctors have been able to classify the the symptoms of AFM, what’s causing the illness remains unclear.

In a teleconference earlier this month, the CDC’s Dr. Nancy Messonnier told reporters doctors have no conclusions at this point.

MESSONNIER: We have not been able to find a cause for the majority of these AFM cases.

But doctors do have some clues. One is that most AFM patients had a fever or respiratory infection three to 10 days before their limbs began to weaken. That has made the CDC suspect one or more viruses are involved, but which one?

MESSONNIER: We have not determined what pathogen or immune response cause the arm or leg weakness and paralysis in these patients.

The CDC says it also doesn’t understand the long-term effects of AFM. Some patients recover quickly while others struggle with ongoing paralysis.

To try and solve this medical mystery, the CDC has assembled a team of 50 physicians and researchers.

Priya Duggal is a member of that team and directs the genetic epidemiology program at the Johns Hopkins Bloomberg School of Public Health.

She says the head-scratcher is that AFM patients have tested positive for several different common viruses. So Duggal is looking for a link between patients. She thinks the answer may lie in their genetics.

DUGGAL: So we think it’s possible there’s a viral trigger and there’s an underlying genetic predisposition. So we think there has to be something special because if a lot of people are getting exposed why are only such a small number actually getting paralysis?

So far, Duggal and her team have collected saliva samples from more than 60 AFM patients and their families. She’s hopeful that if patients share a genetic link, doctors can treat them more effectively. Right now, physical therapy offers the only hope to help AFM patients recover.

DUGGAL: It may give us insight into the biology and the mechanism of what’s happening and perhaps there are already existing treatments that could target this or perhaps there are treatments we could think about.

There’s one other mystery: Why are the number of AFM cases spiking every other year? Duggal says for the time being that question may remain unanswered.

DUGGAL: It’s really not clear to us why it’s every two years.

Duggal says one factor that’s making this medical conundrum hard to solve is that the CDC has yet to require doctors to report AFM cases.

DUGGAL: I think mandatory reporting would give us a sense of how many cases are actually occurring. What is this percentage, what is this number? Is this a growing number? Is this greater than what it was in 2014 or is this just better reporting that we’re seeing in 2018?

The odds of a child developing AFM are incredibly low. Less than two in a million children in the United States will get AFM every year. So far the CDC has no reports of deaths among AFM patients in 2018. But it’s not clear how many children might have died from past cases of AFM since some have suffered long-term health effects.

Priya Duggal says the best protection against the illness is good hygiene and handwashing, since the viruses that may lead to AFM are contagious.

Reporting for WORLD Radio, I’m Sarah Schweinsberg.

(Photo/Associated Press, David Goldman) The Centers for Disease Control and Prevention in Atlanta.

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