The People's Perspective on Medicine

What Causes Polio-Like Illness AFM?

Investigators have identified enteroviruses, especially EV-D68, as the most likely cause of AFM, acute flaccid myelitis that can cause paralysis.
Asian child girl is sick and has a thermometer in her mouth while lying on the bed. Mother checking temperature of her sick daughter with thermometer.  Sick child with fever and illness in bed.

Scientists now believe they may have identified the cause of acute flaccid myelitis, abbreviated AFM. This polio-like illness has affected around 600 children since it was first detected almost a decade ago. The disease starts with flu-like symptoms but rapidly turns into muscle paralysis. After the respiratory symptoms subside, some kids are left with long-term nerve damage that makes it hard to move arms or legs. In the worst cases, breathing is also affected.

That progression of symptoms was also true of polio, though a strong vaccination campaign has essentially eliminated polio in the U.S. A large number of AFM cases appeared in 2014, 2016 and 2018. As soon as these cases began appearing, scientists tried to figure out the cause.

What Is the Cause of AFM?

The researchers were able to rule out polio virus very quickly. At least three years ago, they were focusing on an enterovirus as a possible cause. Investigators have now confirmed that enteroviruses are probably responsible (Nature Medicine, Oct.21, 2019).

Usually these common viruses cause mild illness with cold-like symptoms. Once the infection has passed, the viruses aren’t easily identified. Consequently, the researchers used a tool called VirScan to identify antibodies. According to the article, this tool identifies “481,966 overlapping peptides derived from all known vertebrate and arboviruses (VirScan).” 

Enteroviruses in Nervous System Fluid:

Around 70 percent of the AFM patients have antibodies to enteroviruses in their cerebrospinal fluid, compared to just 7 percent of kids with other neurological diseases. At this point, the most likely culprit is EV-D68. Besides the antibodies, epidemiology supports closer examination of this non-polio enterovirus. It caused many more infections than usual in 2014, 2016 and 2018, corresponding to the appearance of multiple cases of AFM.

Scientists will need to do more research to determine how this virus causes such harm in a small proportion of children. Ideally, they will come to understand how best to help them. Hopefully, a vaccine will be developed against the enterovirus in the near future to prevent this devastating condition.

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    About the Author
    Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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    • Schubert RD et al, "Pan-viral serology implicates enteroviruses in acute flaccid myelitis." Nature Medicine, Oct. 21, 2019. DOI: 10.1038/s41591-019-0613-1
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    I have a friend my age (78) who developed this type of malady after returning from a trip to Dubai. The onset of symptoms sounds the same. The result has been devastating to both himself and his family. He is basically quadriplegic and has speaking ability that is barely audible. He has had this for about 14 years. I have asked those that take care of him if he has ever been given a “name” for this horrid sickness, and there has been none. I sent this to him, as he can read emails and perhaps will investigate further. Possibly this could lead to a name and identifying markers that would possibly lead to a great improvement in his condition. [WE] can only hope. Until then, I was happy to see this article and was glad I could pass it on, as it may give just a glimmer of hope to a rather hopeless situation.

    This is a vaccine side effect. It is listed on the package insert.

    So far, that is not what the research has shown.

    At the beginning of August I had the stomach flu. A couple weeks later, I had numbness of my feet that progressed to my abdomen. As a nurse, I immediately thought Guillain Barre syndrome! I went to the ER and was diagnosed with transverse myelitis. My neurologist said it was idiopathic but I think it was related to the stomach flu a few weeks prior.

    Can’t this virus affect adults? I have a 45 year-old friend who went from being active to non-walking in 10 days time, and no one can find out why. He has even spent 12 days in Johns Hopkins to no avail. They have ruled out many things but can’t find a solution or cure. He has been unable to walk since May.

    Most adults have already encountered some version of this virus and can mount an immune response. But we don’t know if that applies to your friend.

    * Be nice, and don't over share. View comment policy^