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The Ohio State University Helps Us Understand and Treat Acute Flaccid Myelitis

Updated on December 6, 2018
Patty Inglish, MS profile image

Patty uses advanced degrees in Preventive Medicine, Psychology, and TKM in research and treatment for public and private health agencies.

Infection Control Can Prevent Paralysis

When the curriculum for my advanced degree in preventive medicine was first offered at The Ohio State University, the material was highly focused on infection control, including in hospitals and the general public health realm.

The material has saved many individuals from serious infections and even death, but it may also help prevent the paralysis caused by a mysterious condition known to us as acute flaccid myelitis.

Acute means "sudden onset" and "severe", flaccid means "unmoving and limp", and myelitis means "infection of nerves" like the spinal cord.

A Troubling Paralytic Disease

Throughout the month of October 2018, media outlets reported a troubling increase in U.S. cases of acute flaccid myelitis (AFM).

This condition is similar to poliomyelitis, which was once called “infantile paralysis.” Polio was eradicated fully from America in the 1979, but AFM produces a similar paralysis in children and a few adults, although it is not caused by the same virus (poliovirus).

While medical experts and the news media reported a scrambling among professionals to find the causes of AFM, The Ohio State University looked more closely, as did the Centers for Disease Control and Prevention (CDC).

Until a Cause and Cure are Found

To date, the paralytic symptoms of AFM are treated with such methods as blood plasma replacement and immunoglobulin IV administration. Some patients recover to varying degrees, but others do not. Until better methods are discovered, it is best to practice infection control, including:

  • Wash your hands often and avoid people who are ill with respiratory illnesses. If you or children you have are sick, stay/keep them home. When sick around others, please cover your coughs and sneezes and wash your hands afterward. Use disinfectant wipes as well. Use disposable tissues instead of cloth handkerchiefs and discard them quickly.
  • If you change diapers of either children or adults, please wash your hands thoroughly before touching anything else, including your own face, eyes, nose, or mouth. In the bathroom, keep the toilet bowl lid closed when not in use and clean the toilet regularly, followed by thorough hand washing.
  • Do not lick your fingers and use them to turn pages in books in libraries and other public venues - even at home; do not use saliva-covered fingers to open plastic grocery store bags or money when you are a check-our cashier.; do not use saliva covered fingers to smooth out a anyone's hair, etc. Remember that you may not be sick, but may be a carrier of infection, in the manner of Typhoid Mary.
  • Do not sit on, allow anyone else to sit on, or change diapers on kitchen counters, dining room table tops, etc. Infectious elements pass (are shed through) one's clothing onto these surfaces. Use different cloths or paper towels to clean chair seats and table tops/counter tops. In fact, in one of my local suburbs, this is the law for restaurants and other eating/drinking places.
  • Do not drink from the same glass or cup or eat off the plate of another person, even a communal cup at church communion.
  • Do not taste dishes you are cooking and put the spoon back into the food. Do not dunk food into a dip at a party and stick the same piece of food back into the dip.
  • Instead of shaking hands with anyone, use the "fist bump." This includes friends and relatives.
  • Do not purchase wood or plastic cutting boards from thrift stores and flea markets. They may be already-used and harbor infectious elements in the accumulated cuts on the surface - even bleach will not eradicate them all. After purchasing new boards, make sure to prevent cross contamination by reserving one board for vegetables (and possibly beef or pork, but to be safe I have another board for those two) and a separate board for chicken (all fowls).
  • If you are pregnant, a senior citizen, or immuno-compromised, ask your doctor how best to be safe from infections.

If you have other useful advice in this vein, please list it for us in "Comments" below.

Click thumbnail to view full-size
Minneapolis MN: young Marvin Goldstein, an infantile paralysis patient, shows control of extensor muscles of the back at a class for technicians and doctors conducted by Sister Kenny, who successfully treated polio.An old way of treating paralysis through exercise.
Minneapolis MN: young Marvin Goldstein, an infantile paralysis patient, shows control of extensor muscles of the back at a class for technicians and doctors conducted by Sister Kenny, who successfully treated polio.
Minneapolis MN: young Marvin Goldstein, an infantile paralysis patient, shows control of extensor muscles of the back at a class for technicians and doctors conducted by Sister Kenny, who successfully treated polio. | Source
An old way of treating paralysis through exercise.
An old way of treating paralysis through exercise. | Source

What Does Acute Flaccid Myelitis Do?

AFM affects the spinal cord, a bit in the manner of multiple sclerosis, which causes scarring in spots in the spinal cord and the brain. AFM causes inflammation of motor nerves (neurons) and usually within gray matter, which can lead to partial or full paralysis. It may be an autoimmune disease like MS, and associated with some trigger stimulus, but that idea is still in debate.

While it occurs most frequently in young children, largely per-schoolers, a few adults succumb.

Resulting paralysis is said to be "quick-evolving", developing in about four to seven days.However, in 2018, we are hearing from distraught mothers telling us that their child goes to bed with a cold and awakens with paralysis of at least one limb and in one case, the entire body below the neck.

Although AFM may mimic other infections of the central nervous system, it is different in that the infection seems to occur cyclically with spikes in even-numbered years. To date, we do not know why, but because the infection rate is only about 1/1,000,000 people overall, government and private funding for related research are not likely to increase.

Explaining the Cyclical Nature of the Disease

No research has been done as of Autumn 2018 into the two-year life cycle of insects that might somehow be associated with AFM disease. These insects may be the vectors that carry infectious organisms like bacteria and viruses and include:

  • Two-year-cycle budworm: Choristoneura biennis, native to Eurasia. This insect eats pine trees in Western Canada and is not likely to be at fault.
  • Two-year cicada: This is a possibility. In addition, many cicadas have a one-year life cycle but appear in massive quantities at intervals, such as two years or longer.
  • Species Heteroptera: Aradus cinnamomea. This insect looks like a tick and some ticks carry diseases. This one is called the "pine flat bug", native to the Eastern Hemisphere at least from the UK across northern Europe to Siberia. It eats wood and spreads quickly if an infested woodpile is moved.
  • Species Lepidoptera: Dozens of different insects like butterflies and moths. A few are native to North America and some are native to both North America and Siberia. Could butterflies carry disease(s) that harm our children?
  • Species Diptera: Chironomus anthracinus. This is a fly native to the Eastern Hemisphere. Some flies carry diseases.

  • Species Hymenoptera: Neodiprion sertifer, the pine sawfly found in North America since 1925.
  • Species Coleopter: Saperda populnea, a beetle found in North America and elsewhere.

Insect related spread of infections is an ongoing research concern at the Ohio State University and we may see some work there in the area of AFM in the future.

Possible Causes of Acute Flaccid Myelitis

A lot of static from speculation has surrounded AFM since medical concern arose in 2012. Proposed causes for the disease have included:

  • Poliovirus (quickly eliminated as a possibility)
  • Various childhood vaccines (eliminated quickly as a cause)
  • Avian flu
  • Bed bugs as carriers. This suggestion came from some in the non-medical population of Central Ohio and no resulting research has involved bed bugs.
  • Coxsackievirus A16: Found by CDC in only four out of 430 cases. This is not enough to prove a correlation.
  • Non-Polio Enterovirus Type EV-A71: Found in only four out of 430 cases.
  • Non-Polio Enterovirus Type EV-D68: Found in only four out of 430 cases. However a large outbreak of enteroviral respiratory infections in America occurred during the time that AFM hit hard in 2014. We may or may not have a cause in EV-D68, although some researchers at OSU believe so, pending further investigation.
  • West Nile Virus: Believed to be a cause by the California Department of Public Health.
  • An as-yet unknown virus or bacteria carried by mosquitoes or other vectors (insects, mammals, birds, fish, etc).

Note: From 2014 though 2018, at least 90% of patients suffered cold-like symptoms before acquiring AFM—either a respiratory infection, a fever, or both.

CDC will conduct routine testing and typing of CSF (cerebrospinal fluid), respiratory specimens and stool for enterovirus/rhinovirus, and poliovirus testing of stool specimens to rule out the presence of poliovirus. Additional testing protocols are being developed...

— CDC, as of November 20, 2018

Few Markers Found for Causes

Whatever the cause(s) of the disease, a consensus among researchers at CDC, OSU, and other sites seems to be that AMF can be passed through feces and/or blood, and can be detected in sputum and spinal fluid.Tears, nasal mucus, saliva, and blister fluids may also contain a related infectious element. However the infectious elements for which these tissues are tested has turned up little evidence for a cause.

Additional tissue specimens for testing included flash-frozen sections of brain/spinal cord tissues (including gray and white matter), heart, lung, liver, kidney, and other organ tissues. New testing may be developed.

Most cases of this disease occur during three months from August - October and spike during even-numbered years.

Infection Statistics for AFM

Year
Number of U.S. Cases
Number of Deaths
2012
10 cases in California
?
2013
Unknown, but a total of 59 from 2012 through 2015 in California
?
2014: August 1 - December 31
120
2 adults, ages 55 and 73
2015
22
?
2016
149
?
2017
33
At least one child, acknowledged by CDC.
2018 to November 20
106
At least two children, reported by parents on social media.
Data comes from the Centers for Disease Control and Prevention.
Notice the spikes in infection numbers in alternate years: 2014, 2016, and 2018 as of August of that year. By the end of October, 2018 the numbers were much higher.
Notice the spikes in infection numbers in alternate years: 2014, 2016, and 2018 as of August of that year. By the end of October, 2018 the numbers were much higher. | Source

Facebook group for parents of children with AFM: "A.F.M.-Acute Flaccid Myelitis Awareness, Our Generation's Polio" https://www.facebook.com/groups/afmawareness/

These are the most common symptoms of AFM.
These are the most common symptoms of AFM. | Source

"The incidence of EV-D68 infections is increasing world-wide...Application of the Bradford Hill criteria supported a causal relationship between EV-D68 and AFM."

-- A. Dyda, et.al.; 2018

.

While this is true, not many cases support this evidence yet. We look for corroboration in the next few years.

Hope for a Cause and Cure From Government Health Agencies

The U.S. Epidemic Intelligence Service (EIS) has been called onto the AFM case by the CDC in 2018.

Concerned parents of children who have died from AFM or are suffering the debilitating symptoms of the disease may feel led to contact new personnel assigned to work on infections transmitted from animals to humans.

The EIS Class of 2018 includes new two-year fellowship personnel who may find themselves investigating the condition or stumbling across pertinent information in the course of other investigations. These people are:

National Center for Emerging and Zoonotic Infectious Diseases

  • Emily McDonald, MD, MPH:
  • Ana Bardossy, MD
  • Danica Gomes, MD, MSc
  • Alexandra Medley, DVM, MPH

Division of Foodborne, Waterborne, and Environmental Diseases

  • Erin Conners, PhD, MPH
  • Radhika Gharpure, DVM, MPH
  • Mary Pomeroy, MSN
  • Pryanka Relan, MD, MPH
  • John Rossow, DVM, MPH

Division of Vector-Borne Diseases

  • Christopher Prestel, MD: Division of Healthcare Quality Promotion
  • Maya Ramaswamy, PhD, MS: Division of Preparedness and Emerging Infections
  • Sukarma Tanwar, MBBS, MScPH, MMED: Division of Healthcare Quality Promotion
  • Erin Whitehouse, PhD, MPH: Division of High-Consequence Pathogens and Pathology

National Center for Immunization and Respiratory Diseases

  • Nicole Brown, PhD:, Division of Bacterial Diseases
  • Eric Chow, MD, MPH, MS: Influenza Division
  • Benjamin Hallowell, PhD, MPH Division of Viral Diseases
  • Osato Idubor, MD, MHS: Division of Bacterial Diseases
  • Chandresh Ladva, PhD, MPH: Influenza Division
  • Olivia McGovern, PhD, MS: Division of Bacterial Diseases
  • Heather Reese, PhD, MPH: Division of Bacterial Diseases

Center for Global Health, Division of Vector-Borne Diseases

  • Velma Lopez, PhD, MPH

Sources

© 2018 Patty Inglish MS

Comments

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    • Patty Inglish, MS profile imageAUTHOR

      Patty Inglish MS 

      47 hours ago from USA. Member of Asgardia, the first space nation, since October 2016

      The latest report from the CDC shows 134 cases of AFM as of November 30, 2018.

    • Patty Inglish, MS profile imageAUTHOR

      Patty Inglish MS 

      6 days ago from USA. Member of Asgardia, the first space nation, since October 2016

      @Pamela -- I too hope for solid answers quickly, despite lack of funding.

    • Pamela99 profile image

      Pamela Oglesby 

      12 days ago from Sunny Florida

      This is an excellent article about this disease. I certainly hope researchers will further their understanding about the cause of this disease, and treatments. Prevention does seem to be a key tactic.

    • Patty Inglish, MS profile imageAUTHOR

      Patty Inglish MS 

      13 days ago from USA. Member of Asgardia, the first space nation, since October 2016

      @Linda - Thank your for reading and commenting on this topic. I think first, a researcher with time (but no supporting money for AFM research, unhappily) needs to look at spike increases of other infections and conditions in 2014, 2016, and 2018; then look for spike increases in single-celled entities and wildlife populations of mammals, birds, insects, fish, etc. during those years. We may some connections.

      Some masters and PhD candidates at OSU may be looking into these elements right now, so I too hope we arrives at some answers sooner rather than later.

      Thanks for writing your science-related articles that bring good knowledge to readers. It's an important contribution.

    • AliciaC profile image

      Linda Crampton 

      13 days ago from British Columbia, Canada

      Thank you very much for creating this informative and useful article, Patty. I have read a little about this horrible disease but am glad that I've learned a lot more by reading your article. I hope researchers discover the cause or causes of the disease soon.

    • Patty Inglish, MS profile imageAUTHOR

      Patty Inglish MS 

      2 weeks ago from USA. Member of Asgardia, the first space nation, since October 2016

      @Mary Horton - The more I hear about viral and bacterial diseases, the more I think about taking precautions. It is very sad how young children are sickened by whatever the cause of AFM is. Thanks for posting a response!

    • aesta1 profile image

      Mary Norton 

      2 weeks ago from Ontario, Canada

      Thank you for posting this here. I have to admit my ignorance about this. Although I do most of your recommended precaution, it is good to be reminded of how important these are.

    • Patty Inglish, MS profile imageAUTHOR

      Patty Inglish MS 

      2 weeks ago from USA. Member of Asgardia, the first space nation, since October 2016

      That makes me smile.

    • mckbirdbks profile image

      mckbirdbks 

      2 weeks ago from Emerald Wells, Just off the crossroads,Texas

      Hi Patty - Yes, we already know enough about concrete and blockheads for that matter.

    • Patty Inglish, MS profile imageAUTHOR

      Patty Inglish MS 

      2 weeks ago from USA. Member of Asgardia, the first space nation, since October 2016

      Hi Mike, and Happy Thanksgiving!

      I recently read two news articles by grieving mothers who had just lost their young sons to AFM. It is heartbreaking and these two families feel that the federal government is hiding the fact that some patients have died from this disease.

      Finding a cure for these types of disorders is much more important than building a border wall, many of us believe.

    • mckbirdbks profile image

      mckbirdbks 

      2 weeks ago from Emerald Wells, Just off the crossroads,Texas

      Hello Patty - What a serious subject. The precautions list seems like good solid advice. I hope this presentation was brought on by curiosity and not first (or second) hand experience.

      Enjoy your holiday.

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