Five Questions: The Rare, Polio-like Illness Affecting Children

A rare illness that can lead to paralysis or death, acute flaccid myelitis (AFM), is making headlines across the nation, with one of the newest cases confirmed last week by a hospital in Jacksonville, Florida. Like most people diagnosed with the neurological condition that has been compared to polio, the Jacksonville patient is a child, a 3-year-old girl whose mother first noticed something amiss when her daughter collapsed while walking.

Paige Kalika, D.O.
Paige Kalika, D.O.

The toddler had one of the classic symptoms of the illness, which usually affects the spinal cord, and often follows a viral infection: sudden muscle weakness in the arms or legs.

How many other AFM cases have been confirmed in Florida is unknown. The collection of information on suspected cases is relatively new, and states are not required to send the information to the Centers for Disease Control and Prevention (CDC), which began noticing an increase in AFM cases across the nation in August 2014.

Since then, the CDC has confirmed 386 cases of AFM, including 62 cases in 22 states this year. Most of the cases involve children, and while the CDC says it doesn’t know the cause of most of them, it is urging parents to practice disease-prevention steps, such as ensuring their children are up to date on vaccines, washing their hands, and protected from mosquito bites.

Though the illness is alarming, Paige Kalika, D.O., a pediatric neurologist with Uhealth – the University of Miami Health System, emphasizes that it is also extremely rare, affecting less than one in 1 million people. Here she answers some questions about AFM:

There has been an uptick in the number of cases of acute flaccid myelitis since 2014, but the condition is not new. Where did it comes from, and how long have doctors known about it?

AFM most often seems to be a complication of a viral infection. While most viral infections are mild and self-limited, some people are more seriously affected because of environmental factors, genetic susceptibility, or just plain bad luck. AFM has long been known as one of those rare but serious complications. While there is a spike in reported cases, it is important to remember that it remains extremely rare. You are significantly more likely to be struck by lightning (about 1 in 14,600 people are, according to the National Weather Service) than to contract AFM, which affects less than one in 1 million people.

What are the first symptoms parents should look for, and what should they do about them?

The classic presentation is sudden or rapid onset of weakness of the arms, legs, or facial muscles. If you notice this, please bring your child to the nearest emergency department immediately. If you have concerns that your child isn’t looking or acting quite right, please check with your pediatrician.

Is AFM contagious?

While AFM most often appears as a complication of a viral infection, and the virus itself may be contagious, AFM itself does not appear to be contagious. The vast majority of people who catch these viruses will suffer only mild respiratory infections or stomach bugs.

What are the treatments for AFM and the prognosis for a vaccine?

Treatment is not clearly established yet, but depending on symptoms, some children are treated with IVIG (immune globulin), steroids, or plasmapheresis. Supportive care is very important. Starting physical and occupational therapy early in the course of the disease and continuing rehabilitation for as long as physical deficits remain is crucial.

Unfortunately, as not all AFM cases have an identifiable cause, there is no vaccine on the horizon yet. As we learn more about AFM, we will be able to develop better strategies to prevent and treat this condition.

Once someone is diagnosed with AFM, what are the prospects for recovery? If the illness progresses to paralysis, is that condition permanent, or can it be reversed?

Unfortunately, there is still a lot that we don’t know about this condition. So far, some children have made full recoveries while others have improved only partially or very little. We are working to learn more about the course of the disease and its recovery, as well as further treatment options. What we do know is that a child’s weakness and paralysis can continue to improve even years after contracting AFM, so families should remain optimistic and continue to persevere with therapy.

Tags: acute flaccid myelitis, AFM