News of acute flaccid myelitis, a mysterious illness mostly affecting kids, being confirmed in the Louisville area is raising questions among parents.
The Louisville Metro Department of Public Health & Wellness is aware of one local case of the polio-like illness, which can cause sudden weakness in the limbs and other neurological symptoms. Norton Healthcare has seen three, including a local patient, another from Indiana and one from Kentucky but outside Louisville.
Although the condition is very rare, Health & Wellness is advising families to make sure their children’s vaccinations are up to date, especially against polio; to avoid mosquito bites because West Nile may be a factor; and to practice good hand washing.
However, the department noted: “Every year many more people get the flu and get seriously ill. Last year 49 people in Louisville died from the flu — so get your children (6 months and older) and yourself immunized against the flu.”
This week, the U.S. Centers for Disease Control and Prevention noted that there had been 62 confirmed cases in 22 states this year. It recently received increased reports of suspected AFM cases with onset of symptoms in August and September.
“Despite extensive laboratory testing, we have not determined what pathogen or immune response caused the arm or leg weakness and paralysis in most patients,” CDC official Dr. Nancy Messonnier said in a news briefing. “We don’t know who may be at higher risk for developing AFM or the reasons why they may be at higher risk.”
Also, “we don’t fully understand the long-term consequences of AFM,” she said. “We know that some patients diagnosed with AFM have recovered quickly and some continue to have paralysis and require ongoing care. And we know of one death in 2017 in a child that had AFM.”
Here’s a six-question Q&A, with answers from CDC, that might answer some of your questions.
Q. What is acute flaccid myelitis?
A. “Acute flaccid myelitis (AFM) is a rare but serious condition. It affects the nervous system, specifically the area of spinal cord called gray matter, which causes the muscles and reflexes in the body to become weak.”
Q. Is it a new condition?
A. “This condition is not new, but the increase in cases we saw starting in 2014 is new. Still, CDC estimates that less than one in a million people in the United States will get AFM every year.”
Q. What are the symptoms?
A. Most people will have sudden onset of arm or leg weakness and loss of muscle tone and reflexes. Some people, in addition to arm or leg weakness, will have:
- facial droop/weakness,
- difficulty moving the eyes,
- drooping eyelids, or
- difficulty with swallowing or slurred speech.
Numbness or tingling is rare in people with AFM, although some people have pain in their arms or legs. Some people with AFM may be unable to pass urine. The most severe symptom of AFM is respiratory failure that can happen when the muscles involved with breathing become weak. This can require urgent ventilator support (breathing machine). In very rare cases, it is possible that the process in the body that triggers AFM may also trigger other serious neurologic complications that could lead to death.”
Q. What causes the condition?
A. “AFM or similar neurologic conditions may have a variety of possible causes such as viruses, environmental toxins, and genetic disorders.
Certain viruses that can cause AFM or similar neurologic conditions are
- poliovirus and non-polio enteroviruses,
- West Nile virus (WNV) and viruses in the same family as WNV, specifically Japanese encephalitis virus and Saint Louis encephalitis virus, and
Oftentimes, despite extensive lab tests, the cause of a patient’s AFM is not identified.”
Q. What can be done to prevent it?
A. “Poliovirus and West Nile virus may sometimes lead to AFM.
- You can protect yourself and your children from poliovirus by getting vaccinated.
- You can protect against bites from mosquitoes, which can carry West Nile virus, by using mosquito repellent, staying indoors at dusk and dawn (when bites are more common), and removing standing or stagnant water near your home (where mosquitoes can breed).
While we don’t know if it is effective in preventing AFM, washing your hands often with soap and water is one of the best ways to avoid getting sick and spreading germs to other people.”
Q. How is the condition diagnosed?
A. “AFM is diagnosed by examining a patient’s nervous system in combination with reviewing pictures of the spinal cord. A doctor can examine a patient’s nervous system and the places on the body where he or she has weakness, poor muscle tone, and decreased reflexes. A doctor can also do an MRI (magnetic resonance imaging) to look at a patient’s brain and spinal cord, do lab tests on the cerebrospinal fluid (the fluid around the brain and spinal cord), and may check nerve conduction (impulse sent along a nerve fiber) and response. It is important that the tests are done as soon as possible after the patient develops symptoms.
AFM can be difficult to diagnose because it shares many of the same symptoms as other neurologic diseases, like transverse myelitis and Guillain-Barre syndrome. With the help of testing and examinations, doctors can distinguish between AFM and other neurologic conditions.”
The Kentucky Cabinet for Health and Family Services released the following video, featuring Dr. Mel Bennett of the state Department for Public Health: