Aug. 5, 2020 — The new coronavirus isn’t the only virus to worry about this fall. Doctors are asking parents to keep an eye out for signs of a rare but serious condition that can cause permanent paralysis and breathing problems in children called acute flaccid myelitis, or AFM.
Since 2014, AFM clusters have popped up every 2 years across the U.S. The last outbreak — which sickened at least 238 kids — was in 2018. Doctors who study the spread of disease believe we could see another uptick in AFM cases from August to November this year.
View this post on Instagram New #VitalSigns focuses on acute flaccid myelitis (AFM). It’s an uncommon but serious condition that causes arm or leg weakness and paralysis, mostly in children. Outbreaks have occurred in the US every 2 years since 2014. Most patients developed #AFM in August to November, with respiratory symptoms or fever less than a week before limb weakness started. CDC is preparing for a possible outbreak in 2020. AFM is a medical emergency and patients must be hospitalized and monitored. https://bit.ly/VS-AFM . #CDC #PublicHealth #limbweakness #AcuteFlaccidMyelitis #knowAFM #AFMawareness A post shared by Centers for Disease Control (@cdcgov) on Aug 4, 2020 at 10:06am PDT
“This means it will be circulating at the same time as flu and other infectious disease, including COVID-19, and could be another outbreak for clinicians, parents, and children to deal with,” CDC Director Robert Redfield, MD, said in a news briefing on Tuesday.
AFM is associated with a family of viruses called enteroviruses, particularly enteroviruses D68 and A71. Enterovirus D68 — a cousin of the virus that causes polio — is thought to be the cause of most cases in the U.S.
The virus attacks — and ultimately damages — nerves in the front of the spinal cord that control movement in the arms and legs. A CDC study of cases from 2018 found that more than 90% of patients who got AFM first had fever and cold symptoms about 6 days before they began to have a headache, muscle weakness, and perhaps pain in an affected arm or leg.
“Oftentimes it happens rapidly,” says Kevin Messacar, MD, a pediatric infectious disease specialist at Children’s Hospital Colorado in Aurora who has treated a number of AFM cases.
“So a child will wake up in the morning unable to move an arm or unable to walk due to weakness in the legs. A parent may notice a facial droop, or a child who has a soft voice, or is drooling or having difficulty swallowing. Those are all signs to take a child in immediately to an ER for evaluation,” he says.
Redfield said parents should be alert for the signs of AFM, and seek emergency care quickly for children who show any of these signs. He said parents shouldn’t be afraid to visit the emergency room, even in the midst of the pandemic.
“AFM can progress quickly,” he said. “And patients can become paralyzed over the course of hours or days and require a ventilator to help them breathe.”
There’s no specific treatment for AFM. Doctors help patients manage symptoms on a case-by-case basis. Physical therapy is often prescribed to help children regain some lost function, but most kids will have permanent deficits as a result.
Why does AFM come back every 2 years? Certain viruses tend to cycle through populations, causing outbreaks when there are enough new, susceptible hosts to strike. Young children tend to be most vulnerable to enteroviruses and AFM. So the condition tends to reappear when there are enough new babies and young children who haven’t made any immune protection against these viruses. In the CDC’s study, the average patient was just 5 years old. Kids aren’t the only ones at risk, though. The oldest patient in the study was 81.
Experts stressed that while it is important to be informed, there’s no reason to panic. AFM cases are very rare. Most kids get nothing more than a cold after catching an enterovirus. It could also be that all the mask wearing and social distancing we’re doing will have a side benefit: preventing cases of AFM along with COVID-19.
“What we don’t know is what effect the measures in place to control the spread of COVID-19 will have on AFM,” says Messacar.
“I don’t think anyone can predict what’s going to happen this year, but we’re all trying to be as prepared as we can in case the cases of AFM return,” he says.
Robert Redfield, MD, director, CDC, Atlanta.
Kevin Messacar, MD, pediatric infectious disease specialist, Children’s Hospital Colorado, Aurora.
Morbidity and Mortality Weekly Report, Aug. 4, 2020.
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