Dr. Anthony Fauci is head of the National Institute of Allergy and Infectious Diseases. He is one of the world’s foremost authorities on HIV/AIDS. He has won some of the most prestigious awards in medicine including the Lasker Award. Dr. Fauci is the go-to expert when it comes to infectious diseases. That’s why his article about acute flaccid myelitis (AFM) in mBio (April 2, 2019) is so disturbing. Perhaps you have heard of the polio-like illness that has been cropping up across the country. Dr. Fauci and his colleagues suggest that AFM may be evolving. The trajectory of this epidemic is somewhat reminiscent of the early days of the polio epidemic that went on to terrorize the world during the 1940s and 1950s.
A Short History of Polio:
If people think about polio at all these days, it is from the perspective of the rear-view mirror. That’s because the disease has almost been eradicated. Epidemiologists report that there are only three countries left in the world where polio is still a problem—Afghanistan, Nigeria and Pakistan. The World Health Organization reports that there were 350,000 cases of polio in 1988. By 2017 that number had fallen to 22.
Although most people think of polio as a disease of the 20th century, it has actually plagued humans for centuries. Archeologists point to ancient Egyptian artwork depicting people with limb deformities as signs of early polio-like disease. There are reports in the medical literature of cases in the 18th century. But it wasn’t until the early 1900s that epidemics of polio were registered. At the peak of the polio epidemic, more than 500,000 people were infected each year.
The point is that polio kind of limped along for centuries without much notice. There would be periodic outbreaks in various communities, but it was not a disease that panicked people. That changed in 1916 when a polio epidemic led to over 6,000 deaths.
Fast Forward to 2010: Acute Flaccid Myelitis (AFM)
Acute flaccid myelitis causes symptoms that are suggestive of a polio-like illness. The CDC warns parents to be on the alert for:
“• weakness and loss of muscle tone and reflexes in the arms or legs
• facial droop or weakness
• difficulty moving the eyes
• drooping eyelids
• difficulty swallowing
• slurred speech”
Will acute flaccid myelitis evolve into a polio-like illness that becomes widespread? No one yet knows, but 2018 was not a good year.
According to Dr. Fauci and his colleagues (mBio, April 2, 2019):
“AFM was first recognized around 2010 as a seemingly novel condition and quickly grew into an alarming and important disease threat, with the first large outbreak occurring in 2014. Since then, seasonal waves have occurred every other year in the United States, the largest occurring in 2018.”
Dr. Fauci told Mike Stobbe of The Associated Press (USA Today, April 3, 2019) that AFM:
“…may may bear similarities to polio, which smoldered among humans for centuries before it exploded into fearsome epidemics in the 19th and 20th centuries.”
““Don’t assume that it’s going to stay at a couple of hundred cases every other year.”
What Lies Ahead for This Polio-like Disease?
In their scientific article, Dr. Fauci and his colleagues summarize the trajectory of acute flaccid myelitis (AFM):
“Although sporadic AFM is not rare, its sudden appearance in epidemic form is unprecedented. Beginning in the summer and fall of 2012, California and other locales began to detect small, unexpected upticks in AFM cases featuring influenza-like respiratory prodromes and associated with various NPEVs (nonpolio enteroviruses).
“By 2014 to 2015, large AFM epidemics began to appear across the United States and globally; again, such outbreaks typically occurred in temporal association with EV-D68 [enterovirus D68] epidemics. The EV-D68/AFM epidemiological association has since become unmistakable.”
Dr. Fauci points out that the viruses thought to be responsible for acute flaccid myelitis “have been neglected for decades.” He and his colleagues go on to conclude:
“Watching healthy children become permanently paralyzed virtually overnight by a seemingly random, lightning-strike disease is as heartbreaking today as it was in the polio era. The trajectory of AFM over the past 5 years suggests that the problem is getting worse, and so it is critical that we galvanize our efforts to learn more about, and respond adequately to, this ubiquitous, often crippling, continually reemerging group of viruses.”
You can read more about AFM and which states have been affected at this link:
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