Now 62 Cases Of Acute Flaccid Myelitis: What Is Going On?

If you thought 38 cases of a "polio-like" disease in 2018 was concerning, how about 62 cases of a disease that can leave kids suddenly paralyzed?

The Center for Disease Control and Prevention (CDC) has just released updated counts of confirmed acute flaccid myelitis (AFM) cases for the year. In less than a month, the confirmed case count has jumped up by over 60% (from 38 to 62) and the number of states that have had such cases has increased from 16 to 22.

The CDC didn't specify which states are on the list but various news outlets have reported cases occurring in Colorado, Illinois, Michigan, Minnesota, and Pennsylvania. This includes 6 cases since September 20th in the "duck-duck-grey duck" state, according to this CBS This Morning report:

AFM is still very rare, so no need to hit the panic button just yet. (Is it ever good to push a button labelled "Panic"?) However, concerns about AFM are not new. In 2014, the CDC noticed that the number of AFM cases was increasing. Therefore, since then, the CDC has been making greater efforts to track the number of cases. The table below from the CDC shows the confirmed case counts and the number of states from where they came since August of 2014:

Number of confirmed AFM cases by year of illness onset table
Year Number confirmed cases Number of states with confirmed cases
2014 (Aug-Dec) 120 34
2015 22 17
2016 149 39 (includes DC)
2017 33 16
2018 (Jan-Oct) 62 22

Most of the confirmed AFM cases have been children. But just because you have made it past your 18th birthday doesn't mean that you can thumb your nose at the disease. Children, at least in this case, don't seem to be that special. Adults can still get AFM.

How accurate are these numbers? Hard to say. AFM is not currently an official "reportable disease," meaning that health professionals are not obligated to tell public health officials when they suspect a case. Therefore, not every AFM diagnosis may eventually make it to the CDC's records.

Plus, health professionals may not catch or properly diagnose all cases of AFM. There is a wide variety of ways that AFM can appear and proceed. "Acute" means "sudden onset." The word "flaccid" stands for "soft, limp, and weak." And the last word is a combination of the term for spinal cord, "myel-" and the suffix for inflammation: "itis." Thus, AFM is the sudden onset of weakness associated with inflammation of the spinal cord, which can be seen on magnetic resonance imaging (MRI). But this sudden weakness and loss of muscle tone can affect many different combinations of your body such as your arms, legs, face, mouth, eyes, or breathing muscles. Also, the severity can range from mild weakness to paralysis. Such symptoms may be temporary or last for years, possibly even being permanent.

You can see, for example, how mild weakness that quickly gets better may not even raise concerns about AFM. Heck who knows how many people just try to "walk off" mild symptoms of AFM without ever seeing a doctor.

Furthermore, AFM is still an enigma, wrapped in mystery, bundled in a conundrum, and bowtied with a paradox. The current scientific theory is that the disease results from a viral infection. As this study in Eurosurveillance indicates, a major suspect is the enterovirus D68 (a virus with a letter a number attached to it always sounds scarier.)  Other potential culprits are West Nile viruses and adenoviruses. But it's not clear why some who get infected with these viruses end up developing AFM and why most do not. Moreover, not all AFM cases have been preceded by clear viral infections. Since the disease has been so rare, there just hasn't been enough data to draw strong conclusions.

So what should you do about this recent bump in AFM cases? Again, don't panic. As I have mentioned before, panic is only good at the disco, and AFM still only infects about one in a million people. Instead, take the usual precautions to prevent viral infections. That means getting all the recommended vaccinations, protecting yourself from being bitten by mosquitoes (e.g., no gardening in a thong at dusk), and washing your filthy, filthy hands thoroughly and frequently.

Meanwhile, if you or your children develop sudden onset weakness, contact your doctor. Even though there is currently no clear treatment for AFM, treatments such as physical therapy could help reduce the impact of the disease and regain function.

It isn't clear whether this recent jump in reported AFM cases represents a true surge in the disease or just more reporting due to heightened awareness. Sometimes such diseases can be like body odor. If you are looking for it, you may be more likely to find it. Stay tuned and see what happens to the case count this month and next. November should be an interesting month in more ways than one.

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