En español | The Centers for Disease Control and Prevention (CDC) is bracing for a potential outbreak of a rare but life-threatening disease in children that typically strikes between August and November, and is warning parents, grandparents, caregivers and clinicians to be on the lookout for its symptoms.
Acute flaccid myelitis, or AFM, attacks the nervous system and can quickly lead to paralysis; some patients even require a ventilator to help them breathe. Cases are expected to spike this year because the virus that most commonly causes AFM — enterovirus D68, or EV-D68 — “tends to come in two-year cycles,” CDC Director Robert Redfield, M.D., explained in a recent call with reporters — and the last outbreak occurred in 2018.
"This means it will be circulating at the same time as flu and other infectious diseases, including COVID-19, and could be another outbreak for clinicians, parents and children to deal with,” Redfield said.
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The warning signs of AFM
The biggest warning sign to pay attention to is weakness in the arms or legs. Often this will follow a fever or other symptoms of respiratory illness. Muscle weakness or “droopiness” in the face may also signal AFM, explains Roberta DeBiasi, M.D., chief of the Infectious Diseases Division at Children's National Hospital in Washington, D.C. The same goes for altered ability to breathe, gait difficulty, and severe back or neck pain.
"That would be an emergency; don't wait three days, just go in and get checked out,” DeBiasi says of AFM symptoms. The CDC stresses that delays in care can put patients at serious risk, “as this condition can progress rapidly to respiratory failure,” Redfield said.
The last outbreak, in 2018, resulted in 238 cases of AFM in 42 states. Most cases were in young children; the average age was 5. More than half of patients were admitted into intensive care, and 23 percent required ventilation or the use of machines to help them breathe, according to the CDC. Some children recover from the disease; however, many are left with a permanent disability. While AFM is often referred to as a “polio-like” condition, the CDC says all patients it has tested since 2014 have come back negative for the poliovirus.
The message from the CDC's warning isn't that parents and grandparents should worry over every fever a young child gets this fall, “because the vast majority are going to be a plain old boring viral infection,” DeBiasi says. “The reason we're telling you about it is so that if you see these unusual symptoms, you won't doubt yourself and say, ‘Well, I'm just going to wait, you know, a week and see if it goes away.’ You should be empowered to know you need to take the child to an emergency room,” she adds.
Experts are not sure why some kids develop AFM when the majority of people who have a respiratory illness recover with no neurologic symptoms. Most people who get infected with enteroviruses — a large family of viruses — do not get sick or they have common cold-like symptoms. Another enterovirus — enterovirus A71, or EV-A71 — has also been linked to some cases of AFM.
While there is no “specific” way to prevent AFM, the same preventive actions that reduce a person's risk for a coronavirus infection — frequent handwashing, physical distancing, mask wearing, and cleaning and disinfecting high-touch surfaces — can also help prevent infections from enteroviruses, CDC officials say.
Coronavirus could complicate cases this year
It's not fully understood how the coronavirus will impact AFM cases this year. On one hand, the U.S. may see fewer cases as more students participate in virtual learning and avoid crowds and public outings. However, experts also are concerned that the intense focus on the pandemic could complicate AFM care this year.
For instance, adults worried about coronavirus transmission in health care settings may delay a necessary trip to the hospital. Emergency room visits dropped 42 percent during the early part of the U.S. outbreak, according to a CDC report. What's more, COVID-19 could distract clinicians from properly identifying and diagnosing AFM this year.
"So that's why we're here, reemphasizing that we are prepared for an AFM outbreak this year — starting soon, if it's consistent with previous years — and helping physicians think about and understand the signs and symptoms of AFM,” said Tom Clark, M.D., a pediatrician and deputy director of the CDC's Division of Viral Diseases. “AFM is a medical emergency, and any signs of limb weakness in their kids that develop suddenly, they need to get to the doctor.”