Roughly 4 months ago, a rarely seen non-polio enterovirus D-68 (EV-D68) appeared in America’s Midwest and quickly spread across the nation, causing a wide spectrum of predominantly respiratory illness, mostly in young children and adolescents (see Kansas City Outbreak Identified As HEV 68).
At roughly the same time, doctors noticed a coincident rise in cases of neurological illness with AFP (acute flaccid paralysis) or limb weakness – often associated with a recent respiratory illness – across the country.
While a causal link wasn’t established, due to the timing and the fact that other enteroviruses have been linked to neurological illnesses, there was a high degree of suspicion that the two illnesses were linked.
In September the CDC issued a HAN: Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children, alerting doctors around the country to be aware of this trend, and providing information on reporting cases, and since then we’ve seen several NCIRD (National Center for Immunization and Respiratory Diseases) updates on the investigation.
For the latest developments into this story we turn to Robert Roos, News Editor for CIDRAP, who last night wrote about the CDC’s investigation into this paralytic illness – now dubbed acute flaccid myelitis (AFM).
Following Robert’s report, I’ve excerpts from the CDC’s latest update.
Dec 02, 2014
With the recent outbreaks of enterovirus D68 (EV-D68) respiratory infections and mysterious polio-like illnesses in US children fading, it seems increasingly likely that the two are related, says an expert with the Centers for Disease Control and Prevention (CDC).
The CDC has reported 1,121 EV-D68 cases in 47 states since August, a number that has not increased since Nov 20, with nearly all cases in children. Meanwhile, the total for the unexplained polio-like cases, involving sudden onset of weakness in one or more limbs, reached 90 on Nov 28, which was 2 more than a week earlier. Two reported cases were still being verified.
James J. Sejvar, MD, a neuroepidemiologist with the CDC, said the latest known onset of a case of the polio-like illness occurred about 3 weeks ago. "We're continuing our surveillance and trying to identify new cases, but the good news is that it does appear that new cases have kind of ceased at this point," he told CIDRAP News.
The CDC NCIRD update as of November 28th.
Since September 2014, CDC and partners have been investigating reports of children across the United States who developed a sudden onset of weakness in one or more arms or legs with MRI scans that showed inflammation of the gray matter—nerve cells—in the spinal cord. This illness is now being referred to as acute flaccid myelitis.
- From August 2 to November 26, CDC has verified reports of 90 children in 32 states who developed acute flaccid myelitis that meets CDC’s case definition. CDC is working with healthcare professionals and state and local health departments to investigate all the cases reported since August. CDC is also in the process of verifying two additional reports.
- CDC and partners are working to better understand these cases of acute flaccid myelitis, including potential causes and how often the illness occurs. However, such investigations take time.
Neurologic Illness with Limb Weakness
- A sudden onset of weakness in the arms or legs can result from a variety of causes, including viral infections, environmental toxins, and genetic disorders. Guillain-Barre syndrome, a disorder caused by an abnormal immune response, can also cause neurologic illness.
- Every year, children in the United States develop neurologic illness with limb weakness, and often the causes are not identified.
- The acute flaccid myelitis cases reported this year, which include MRI scans that show an inflammation predominantly of the gray matter—nerve cells—in the spinal cord, are most similar to illnesses caused by viruses including
- enteroviruses (polio and non-polio),
- West Nile virus and similar viruses, and
What CDC is Doing
- requesting that healthcare professionals be vigilant for and report cases of acute flaccid myelitis to CDC through their state or local health department
- verifying reports of cases of acute flaccid myelitis using our case definition
- working with healthcare professionals and state and local health departments to investigate and better understand the cases of acute flaccid myelitis, including potential causes and how often the illness occurs
- testing specimens, including stool, respiratory and cerebrospinal fluid, from the children with acute flaccid myelitis
- working with experts in neurology, pediatrics, critical care medicine, public health epidemiology, and virology to provide interim considerations to help clinicians and public health officials manage care of children with acute flaccid myelitis that meet CDC’s case definition
- providing information to healthcare professionals, policymakers, general public, and partners in various formats, such as the Morbidity and Mortality Weekly Report, health alerts, websites, social media, and presentations
Information for Parents
Being up to date on all recommended vaccinations is the best way to protect yourself and your family from a number of diseases that can cause severe illness and death, including polio, measles, whooping cough, and acute respiratory illnesses such as influenza.
You can help protect yourselves from infections in general by
- washing your hands often with soap and water,
- avoiding close contact with sick people, and
- disinfecting frequently touched surfaces.
You can protect yourself from mosquito-borne viruses, such as West Nile virus, by using mosquito repellent, and staying indoors at dusk and dawn, which is the prime period that mosquitoes bite.
If your child appears very sick or seems to have a sudden onset of weakness in arms or legs, parents should contact the pediatrician to have their child assessed for possible neurologic illness.