Published Date: 2018-10-24 10:15:53
Subject: PRO/EDR> Acute flaccid myelitis - North America (06): USA, increase in cases
Archive Number: 20181024.6106438

ACUTE FLACCID MYELITIS - NORTH AMERICA (06): USA, INCREASE IN CASES
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Date: Mon 22 Oct 2018
Source: CIDRAP (Center for Infectious Disease Research and Policy) [edited]
http://www.cidrap.umn.edu/ news-perspective/2018/10/news- scan-oct-22-2018


In an update today [22 Oct 2018], the US Centers for Disease Control and Prevention (CDC) said state and federal health partners are investigating 28 more suspected acute flaccid myelitis (AFM) cases, raising the overall number of patients under investigation to 155.

The number of confirmed cases remained at 62 in 22 states. The latest numbers reflect cases reported to the CDC as of [19 Oct 2018]. Confirming an AFM requires a review of a patient's clinical syndrome based on a diagnostic algorithm and radiographic findings.

On [16 Oct 2018], the CDC announced that health officials are investigating a spike in AFM similar to increases seen in the late summer and fall of 2014 and 2016. Symptoms of AFM, which is still extremely rare, include a polio-like sudden onset of limb weakness and decreased muscle tone that results from inflammation of gray matter in the spinal cord.

Though a large AFM epidemic occurred in 2014 alongside a national outbreak of severe respiratory illness from enterovirus D68 (EV-D68), testing of patient samples hasn't consistently found a common cause. Last week [week of 15 Oct 2018] CDC officials said that, besides infectious diseases, they are looking at other potential causes, such as environmental toxins.

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[According to the update above, the AFM case numbers are increasing, which provides a challenge for healthcare workers as well as public health authorities. The case numbers available since 2014 indicate that the surge in AFM cases is seen in waves about every 2 years: 120 cases in 34 states in 2014; 22 cases in 17 states in 2015; 149 cases in 39 states in 2016; 36 cases in 16 states in 2017; and so far in 2018, 62 cases in 22 states.

Although a cause has been identified in some cases including enterovirus, West Nile virus, possible environmental toxins or autoimmune condition, a singular cause has not been determined.

Diagnosing AFM involves a physical exam to assess how well the patient's nervous system is functioning, as well as tests including an MRI of the patient's brain and spinal cord and lab tests of their cerebrospinal fluid. Unfortunately, the current treatment options for AFM are extremely limited -- and there is actually not a specific treatment, according to the CDC. But neurologists can make recommendations, on a case-by-case basis, such as physical therapy to manage muscle weakness. It is still a rare condition with many factors poorly understood, including the host risk and immune factors and etiological agents. - Mod.UBA

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