What to Know About AFM: The Polio-Like Disease Experts Think Will Return This Fall

  • The CDC warns that we may soon experience a peak in cases of acute flaccid myelitis (AFM), a condition similar to polio that strikes the nervous system and primarily affects children.
  • This illness has spiked every 2 years since 2014. The number of cases has grown with each outbreak, as has the number of states affected.
  • While the cause is still unknown, a recent study finds strong evidence that a type of virus called enterovirus D68 (EVD68) causes AFM.

The Centers for Disease Control and Prevention (CDC) warns 2020 could be a peak year for a dangerous condition that can have symptoms in common with COVID-19.

It’s called acute flaccid myelitis (AFM).

In a new Vital Signs Report, CDC experts advise healthcare providers to look for signs of a potential outbreak beginning late summer and early fall 2020.

“As we head into these critical next months, CDC is taking necessary steps to help clinicians better recognize signs and symptoms of AFM in children,” CDC Director Dr. Robert Redfield said in a statement.

“Recognition and early diagnosis are critical. CDC and public health partners have strengthened early disease detection systems, a vital step toward rapid treatment and rehabilitation for children with AFM,” he said.

This illness has spiked every 2 years since 2014, and the number of cases has grown with each outbreak, as has the number of states affected.

AFM primarily affects children

AFM is an uncommon but serious neurological condition that affects the spinal cord, specifically an area called the gray matter, according to the CDC.

It can affect reflexes, weaken muscles, and even cause paralysis.

The CDC says its seen more cases of AFM, also called a “polio-like illness,” since 2014, and more than 90 percent of cases have been seen in children.

While the cause is still unknown, a recent study finds strong evidence that a type of virus called enterovirus D68 (EV-D68) causes it.

Polio is also caused by a type of enterovirus.

“The increase in AFM cases we saw in 2014 occurred during a national outbreak of children with enterovirus D68,” Dr. Robert Glatter, emergency physician at Lenox Hill Hospital in New York City, told Healthline. “However, the CDC did not consistently detect EV-D68 in every child with confirmed AFM.”

AFM rare, but pandemic might delay treatment

“Since the outbreak in 2014, the CDC started surveillance. Since then, it has become a rare condition, happening one in a million times,” said Dr. Alla Al-Habib, a neurologist at Texas Health Presbyterian Hospital in Plano, Texas.

Al-Habib adds that while the condition is thought to be related to “non-polio enteroviruses,” others think it might be connected with West Nile virus and sometimes “even genetics and poisons.”

Al-Habib is concerned that the current pandemic could delay treatment for those affected, as people try to avoid infection with the new coronavirus.

“Now, in the middle of the COVID-19 pandemic, physicians and scientists are concerned that patients may not go to the hospitals for evaluation,” Al-Habib said. “This can worsen the patient’s condition and complicate or even delay the recovery process.”

For those affected, timely care is critical

“While there are no specific therapies for AFM, supportive care is very crucial with hospitalization for monitoring, mainly to monitor rapid weakness deterioration and respiratory failure,” explained Al-Habib, since around 30 percent of patients “may need ventilatory support.”

A lack of treatments specifically for this disease doesn’t mean that medical professionals are powerless to help.

“As in many neurological conditions that we don’t have specific treatment for, we try to treat with immune-modulating therapy like IVIG [intravenous immunoglobulin], plasmapheresis, and with steroids,” Al-Habib said.

However, “there’s no indication that plasma exchange/IVIG or steroids should be either preferred or avoided in the treatment of AFM,” Al-Habib continued, since there’s no clear human evidence whether it’s effective or not for AFM.

Avoid infection with enterovirus to reduce risk

Enteroviruses are typically spread by either contact with secretions, such as mucus, saliva, and feces, and “by larger droplets” from someone with an infection, explains Glatter. “A person with enterovirus is contagious for about 10 days after symptoms develop,” he said.

He emphasizes the importance of adhering to hygienic practices like handwashing, avoiding people who are sick and coughing into an elbow. With the rise of COVID-19, wearing a face mask may also help decrease risk of developing AFM.

Additional steps to reduce the risk of AFM include staying up to date on vaccinations and taking precautions to reduce the risk of mosquito bites.

There can be long-term effects if someone does develop AFM.

“Unfortunately, there are no collective data or any systemic reviews, but most of the patients seem to end up with some persistent and residual symptoms,” Al-Habib said. “Their recovery seems incomplete, most of the time. However, there are chances for improvement with rehabilitation.”

Glatter cautions that while some people do rapidly recover, others remain “paralyzed and require a high level of ongoing care to support their breathing and monitor for neurological deterioration.”

AFM symptoms

Glatter says the symptoms of AFM are “quite similar” to poliovirus, West Nile virus, and adenoviruses, so it’s very difficult to diagnose the condition.

However, symptoms can include:

  • a sudden facial droop
  • difficulty keeping the eyes open
  • slurred speech

“AFM can also affect the respiratory muscles, leading to difficulty breathing and the need for a ventilator in severe cases,” Glatter advised.

But there’s no need to panic.

“Parents should also understand that while there have been an uptick in cases since 2014, the disease is still quite rare,” Glatter said, adding that EV-D68 can also “lead to a mild to severe respiratory illness or minimal to no symptoms at all.”

He says parents need to “remain vigilant for signs of muscular weakness or difficulty breathing that develop during and after recovery from an upper respiratory infection,” because we don’t yet have a clear picture of which children may be at risk for developing AFM.

The bottom line

The CDC warns that we may soon experience a peak in cases of acute flaccid myelitis (AFM), a condition similar to polio that strikes the nervous system and primarily affects children.

Experts say the condition shares symptoms in common with COVID-19 and other diseases, so diagnosis is difficult, but people must remain vigilant so they can treat it as quickly as possible.

Experts emphasize that AFM is still a rare condition, but following precautions against enterovirus infection may reduce risk.


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