Federal
health officials took the unusual step on Tuesday of warning the public
about an increase in a mysterious and rare condition that mostly
affects children and can cause paralysis.
So far
this year, 127 confirmed or suspected cases of acute flaccid myelitis,
or AFM, have been reported to the Centers for Disease Control and
Prevention — a significant increase over 2017 and a worrying
perpetuation of a disease for which there is little understanding.
Of
the cases announced Tuesday, 62 have been confirmed in 22 states,
according to Nancy Messonnier, a top official at the CDC. More than 90
percent of the confirmed cases have been in children 18 and younger,
with the average age being 4 years old.
The
surge has baffled health officials, who on Tuesday announced a change in
the way the agency is counting cases. They also wanted to raise
awareness about the condition so parents can seek medical care if their
child develops symptoms, and so physicians can quickly relay reports of
the potential illness to the CDC.
“We
understand that people, particularly parents, are concerned about AFM,”
said Messonnier, director of the National Center for Immunization and
Respiratory Diseases. Despite extensive laboratory and other testing,
CDC has not been able to find the cause for the majority of the cases.
“There is a lot we don’t know about AFM, and I am frustrated that
despite all of our efforts, we haven’t been able to identify the cause
of this mystery illness."
The
increase in cases appeared to begin in 2014, when the CDC started
tracking the illness. Each year since then, usually in August or
September, the CDC has logged a spike in the illness. The spikes were
significantly higher in 2014, 2016 and 2018-to-date than in 2015 or
2017. The CDC knows of one child who died with the disorder in 2017.
Since
officials have been unable so far to determine how the disease spreads,
they are starting to count suspected cases as well as confirmed to
better anticipate increases over the coming months. It’s too early to
know whether the total for 2018 will surpass those previous years. But
the data reported Tuesday represents “a substantially larger number than
in previous months this year,” Messonnier said.
There
is no specific treatment for the disorder, and long-term outcomes are
unknown. The rare but serious disorder affects a person’s nervous
system, specifically the spinal cord. Neurological conditions like it
have a variety of causes, such as viruses, environmental toxins and
genetic disorders.
Among the cases under
investigation are five reported to Maryland health officials in recent
weeks, a health department spokeswoman said Tuesday. Maryland’s first
case was reported Sept. 21. No known cases have been reported in
Virginia or the District this year, but there were three confirmed cases
in Virginia in 2016, health department officials said.
Since officials have been unable so far to determine
how the disease spreads, they are starting to count suspected cases as
well as confirmed to better anticipate increases over the coming months.
It’s too early to know whether the total for 2018 will surpass those
previous years. But the data reported Tuesday represents “a
substantially larger number than in previous months this year,”
Messonnier said.
There is no specific treatment
for the disorder, and long-term outcomes are unknown. The rare but
serious disorder affects a person’s nervous system, specifically the
spinal cord. Neurological conditions like it have a variety of causes,
such as viruses, environmental toxins and genetic disorders.
Among
the cases under investigation are five reported to Maryland health
officials in recent weeks, a health department spokeswoman said Tuesday.
Maryland’s first case was reported Sept. 21. No known cases have been
reported in Virginia or the District this year, but there were three
confirmed cases in Virginia in 2016, health department officials said.
Messonnier
said it was important for parents and clinicians to remember that this
is a rare condition, affecting less than 1 in 1 million children under
18. “As a parent myself, I understand what it’s like to be scared for
your child,” she said. “Parents need to know that AFM is rare even with
the increase in cases we are seeing now.”
Still,
because this is a “pretty dramatic disease,” Messonnier said health
officials want to raise awareness about the symptoms to make sure
parents seek medical care immediately if their children show a sudden
onset of weakness or loss of muscle tone in their arms and legs.
Once
diagnosed, some patients have recovered quickly, but some continue to
have paralysis and require ongoing care, Messonnier said.
After
testing patients’ stool specimens, the CDC determined poliovirus is not
the cause of the AFM cases. Messonnier said West Nile virus, which had
been listed as a possible cause on CDC’s website, is also not causing
the illnesses. In some individuals, health officials have determined
that the condition was from infection with a type of virus that causes
severe respiratory illness.
So far, the CDC has
found no relationship between vaccines and children diagnosed with AFM
from the 2014 cases. Officials said they will be conducting additional
analysis on this year’s cases. “Our medical team has been reviewing
vaccine records when available during this year’s investigation and do
not see a correlation,” said CDC spokeswoman Kristen Nordlund. The
disorder has been diagnosed in unvaccinated children and also in
children who have received some of their recommended vaccinations, she
said.
The
agency doesn’t know who may be at higher risk for developing this
condition or the reasons they may be at higher risk. The CDC has tested
many different specimens from patients with this condition for a wide
variety of pathogens, or germs, that can cause AFM. No pathogen has been
consistently detected in the patients' spinal fluid.
There
appears to be no geographical clustering of the U.S. cases and no other
country has reported the pattern seen here so far of cases spiking
every two years, Messonnier said.
Parents can
best protect their children from serious diseases by taking prevention
steps, such as washing their hands, staying up to date on recommended
vaccines and using insect repellent to prevent mosquito bites.
There
is no specific treatment for AFM, but neurologists who specialize in
treating brain and spinal cord illnesses may recommend certain
interventions, such as physical or occupational therapy, on a
case-by-case basis.
Benjamin Greenberg, a
neurologist who has treated children with AFM at the University of Texas
Southwestern in Dallas, said AFM is “exquisitely rare.” But, if their
child is diagnosed, parents should prepare for extensive physical
therapy — therapy that isn’t always covered by insurance, he said. Some
children paralyzed by AFM have eventually regained their ability to
walk, but need time.
“Families really sticking with it are seeing slow but steady recovery,” he said.
CDC
is not releasing a list of the 22 states with confirmed and suspected
cases because of privacy issues. But some state health departments have
been making public their reported cases. States are not required to
provide this information to CDC, but they have been voluntarily
reporting their data.
Dana Hedgpeth and Justin Wm. Moyer contributed to this report.
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No cases of acute flaccid myelitis have been reported this year in D.C. or Virginia, officials say.
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