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| CDC AFM Website |
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While the United State's recent uptick in AFM cases has gotten the bulk of our attention, we've looked at outbreaks in other countries as well over the past few years, including:
PAHO Epi Alert: AFM Associated With EV-D68 Infection
Eurosurveillance: Acute Flaccid Paralysis Following EV-D68 Infection – France
Taiwan CDC: 1st Case Of EV-D68 With Acute Flaccid Paralysis
Not surprisingly, Canada is on the lookout for cases as well and Public Health Agency of Canada has their own surveillance page. While not as pronounced as here in the United States, the number of cases in Canada this year appears elevated as well.
Information for Canadians regarding reports of acute flaccid myelitis (AFM)
The Public Health Agency of Canada is aware of reports of increased cases of acute flaccid myelitis (AFM) among children in the United States and is monitoring the situation. PHAC has enhanced its ongoing surveillance of acute flaccid paralysis (AFP). This surveillance can also detect cases of AFM.
What is acute flaccid myelitis
Acute flaccid myelitis (AFM) is a term used to describe the sudden onset of weakness in one or more limbs. The weakness is a result of inflammation (swelling) of the spinal cord which carries messages to and from the brain.
The condition can be caused by auto immune diseases or exposure to environmental toxins. It can also be caused by a number of different infections, including enteroviruses or West Nile virus. Sometimes the condition has no known cause.
The long-term effects of AFM can vary. Some individuals with AFM have recovered quickly while others will continue to experience muscle weakness and require ongoing care. Acute flaccid myelitis can affect persons of all ages, however, most of the cases observed since 2014 have occurred in children.
Acute flaccid myelitis is usually diagnosed after a doctor reviews the patient's current symptoms and their medical history. A doctor will use the findings from magnetic resonance imaging, and may order other laboratory tests to confirm the diagnosis.
It is important to seek immediate medical attention if a child, or adult, experiences sudden onset muscle weakness. Other immediate life-threatening conditions, such as stroke, can cause similar symptoms. When in doubt, seek immediate medical attention.
Symptoms
Symptoms of acute flaccid myelitis usually include the sudden onset of weakness in the arms and/or legs or decreased or absent reflexes in the limbs. Occasionally symptoms are accompanied by facial weakness or drooping. Some patients report pain associated with the onset of symptoms.
Reduce your risk
Canadians are advised to reduce their risk by taking the same precautions they would during cold and flu season, including:
- Frequent handwashing;
- Coughing and sneezing into their arm, and not their hands;
- Keeping common surface areas clean, such as countertops;
- Avoiding touching their face with their hands; and
- Avoiding close contact with people who are sick.
Yesterday the CMAJ published the following review of AFM. I've only posted an excerpt, so follow the link to read it in its entirety.
Acute flaccid myelitis is a clinical syndrome characterized by rapid onset of muscle weakness
From January to November 2018, there were 90 confirmed cases of acute flaccid myelitis in the United States and 48 suspected cases in Canada.1,2 Injury to the anterior horn cells of the spinal cord causes abrupt-onset limb weakness, pain, paresthesias and areflexia.3 About 25% of patients develop cranial nerve or bulbar signs or both.4 It may resemble Guillain–Barré Syndrome, but can be distinguished by its typical appearance on magnetic resonance imaging (see point 3 below) and its motor distribution (asymmetric weakness in acute flaccid myelitis v. symmetric and ascending in Guillain–Barré Syndrome).3 Typically affecting children aged 4–15 years, it is usually preceded by a nonspecific viral prodrome3–5 (Box 16).Box 1: CDC case definition of AFM*,6
Clusters of acute flaccid myelitis occurred in North America in 2014, 2016 and 2018 during the late summer–fall months, coincident with peak enterovirus season.2,4 With the near eradication of polioviruses, EV-D68 and EV-A71 have emerged as the predominant viruses associated with acute flaccid myelitis.4 EV-D68 was likely responsible for the 2014 and 2016 clusters in North America,7 but no cause has been established for the 2018 cluster.
(Continue . . . .)
