What is the AFM Outbreak? Reports of a Polio-like Disease That is On the Rise in Children
Reported cases have been on the rise for a rare, polio-like disease that mainly affects children. The disease, called acute flaccid myelitis (AFM), is “a rare but serious condition” that affects the nervous system, says the Center for Disease Control (CDC). At the time of writing, the confirmed cases for the AFM outbreak in 2018 have risen to 90 within the United States alone. This count had been standing at 62 as of October 17, 2018.
The recently confirmed 90 cases are from the total 252 reported cases of patients under investigation (PUIs) in 2018. These 90 cases were noticed through 27 states.
This is significant and largely differing from the usual rate of AFM, which stands at less than one in a million – making the disease an extremely rare occurrence. Since 2014, when AFM was first reported and put on CDC’s surveillance watchlist, there have been 414 confirmed cases of the disease throughout 44 states (including the recently confirmed 90 cases).
What Does AFM Do?
AFM especially targets the spinal cord and its “gray matter” area, which causes the patient’s muscles and reflexes to grow extremely weak, affecting their limbs and their movements, which leads to a sudden onset of paralysis. While the symptoms are largely similar to polio, AFM is not caused by poliovirus, as none of the reported patients have tested positive for it. Apart from polio, AFM’s symptoms are also similar to those of transverse myelitis and Guillain-Barre syndrome.
Around 90% of confirmed cases have been in individuals 18 years and younger, with the average age of patients being recorded as 4 years old.
When was the First Case of AFM Reported?
Information about the current onset of the increase was first reported by CDC in October 2018. The government agency noticed a sudden increase in AFM cases, a pattern that seemed to have been noticed in the fall of 2014 and 2016 as well.
What Causes AFM?
Since the first diagnosis of AFM only dates back to 2014, the long-term effects of AFM are not known and remain under investigation. The CDC is also not currently aware of the actual cause of the disease.
However, the CDC has noticed that out of the 414 cases of AFM, the spinal fluid of 4 patients showed the presence of coxsackievirus A16, EV-A71, and EV-D68. This suggests a pattern of viral infections – however, this is with the absence of any germ pathogen in the spinal fluid of the remaining 410 patients.
Due to this, the CDC does list enteroviruses as a possible cause. This is also significant since enteroviruses are known to add 10-15 million infections each year, including diseases such as polio.
The agency has also discerned that more than 90% of patients reported fever or mild respiratory illness before showing the symptoms of AFM.
The time duration during which these cases have shown a spike in 2014, 2016, and now in 2018 also remains of note. Most patients showed first signs of AFM between August and October, which is the same time of the year that most viruses make their presence known.
As you may have observed by the years listed, AFM also seems to show increased occurrence every 2 years. While this does not point out anything of note until now, this information is useful to know nonetheless.
Who is at Risk of AFM?
Since AFM is not confirmed to be a pediatric disease as of yet even with 90% of cases being patients under 18 years of age, it should be maintained that the risk of AFM could be posed to any individual with children being a high-risk target, especially those who are around 4 years old.
With the disease showing signs of stemming out through an infection, adults and children with a greater tendency of exposure to external environments may be at a higher risk. But this has not been confirmed by any government agency due to the cause still being under investigation.
However, as soon as someone, especially a child, starts showing signs of fever or respiratory illness during this time of year and especially during this current onset of AFM, then getting them to the nearest ER and asking the medical team about assistance particular to AFM would be prudent.
How is AFM Diagnosed?
Since AFM came to surface in 2014, the diagnostic procedures of the disease may vary from the kind of ER, doctor, or hospital you visit. With that being said, the most common line of diagnosis for AFM will start from an assessment of the patient’s nervous system.
Whether the weakness and paralysis is too significant or if you or your child are going through fever with possible mild respiratory illness during this crucial time of increase in AFM cases, then asking your medical team to consider the diagnosis protocol with AFM would help you determine if you or your child has the disease.
The initial symptoms of AFM include but are not limited to facial drooping, drooping eyelids, problems in swallowing, and pain and weakness in the limbs.
The assessment of the nervous system could involve a series of tests, including but not limited to MRI (magnetic resonance imaging) of the brain and imaging tests of the spinal cord. A cerebrospinal fluid sample would be drawn out from a patient’s spinal cord, and a few lab tests would be performed. Nerve conduction tests would also be performed to see if the patient’s nerves are sending required signals along a nerve fiber or not.
The doctor would also examine the physical area that has been affected by the onset of weakness and paralysis to check the severity of the symptoms, which would also help in determining the diagnosis. Since AFM is closely related to polio, transverse myelitis, and Guillain-Barre syndrome in terms of symptoms, whether or not the patient has AFM could only be determined after going through these series of tests.
That is why it is extremely important that these series of tests are performed on a patient as soon as the assessment of initial symptoms is done. While these tests are being performed, it is likely that your case would be reported to the CDC as being under investigation.
Is There a Cure for AFM?
Unfortunately, AFM is still being investigated for the kind of disease that it is, and thus a cure is not available at this point in time. With that being said, there might be additional procedures and processes that could be performed to alleviate the symptoms.
Such steps may include physical therapy to help with the limb weakness since a patient with AFM should be treated with the same basic standards of care as patients with severe neurologic disease. However, the use of medications in the treatment of AFM seems to be futile for now, since no targeted treatments have shown any signs of improvements in patients who have shown signs of AFM so far.
This conclusion about the use of medication was reached after a series of tests and studies on the treatment of AFM using various methods of the administration of specialized medication that seem to work on other severe neurological disorders. The use of certain classes of medication, such as plasmapheresis and immunosuppressive biologic modifiers, is actually not recommended by the CDC and the agency asks not to use these medications for treatment of AFM at all.
For now, AFM remains elusive to treat with only indirect interventions that can be made by medical professionals to alleviate the symptoms, not treat the disease itself.
What Happens to Patients with AFM?
Since the long-term effects are also unknown, it cannot be said whether AFM is a degenerative disease that shows more profound effects as the years go by, or if it stays at the same frequency and intensity of symptoms with its progression.
With that being said, the CDC is actively working on investigating these and other related factors. While it remains to be seen how soon a cure or a line of treatment could be introduced for AFM, if at all, medical professionals are doing all they can to improve the quality of life of the patients who are affected by this disease, more than 90% of whom are children.
In the meantime, if you happen to determine any of the related symptoms within yourself or a loved one, then make sure to seek emergency medical help right away. It is crucial to diagnose AFM as soon as the symptoms start showing, as only a swift response to the disease could lead to a timely and collective process for its treatment.
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