Q&A: Will 2020 be another outbreak year for AFM?
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As of July 31, there have been 16 confirmed cases of acute flaccid myelitis this year in the United States, according to the CDC, which said last week that it is anticipating another outbreak of the serious neurological condition.
Since the CDC began tracking acute flaccid myelitis (AFM) in August 2014, there have been 633 confirmed cases, mostly among young children. Surges appear to occur in even-numbered years, with larger spikes during the months of August through October.
Healio spoke with Kevin Messacar, MD, a pediatric infectious disease physician and researcher at Children’s Hospital Colorado, about AFM and what clinicians and parents need to know.
Question: How does 2020 look so far, compared with recent even-numbered years?
Answer: Based on previous patterns of surges of AFM cases in even years since 2014, we would expect to start seeing an uptick in AFM cases from August through October of this year. However, the same public health measures of physical distancing, masking and handwashing being used to control the spread of SARS-CoV-2 may have similar effects on controlling the spread of the enteroviruses most closely associated with AFM. So far, we haven’t seen an uptick in EV-D68 circulation on our surveillance or in AFM cases. (Editor’s note: The enterovirus D68 is commonly suspected to cause AFM.) We are hopeful that we could avoid an enterovirus-associated AFM outbreak this year but want to be sure to quickly detect, diagnose and manage any cases should they arise. Despite all of the surveillance data and modeling, no one can perfectly predict the future in these uncertain times, so we are trying to be as prepared as possible for the potential of an AFM outbreak in 2020 or beyond.
Q: What is known about AFM?
A: Although we have learned so much about this disease, its causes, improved diagnosis and testing, we still lack proven effective ways to treat and prevent AFM. The AFM research community is working tirelessly to better understand the mechanisms by which common enterovirus infections lead to the rare complication of AFM so that we can design better treatment and prevention strategies.
Q: What should clinicians and parents being looking for?
A: Parents should seek care immediately at the first sign of weakness in the arms or legs or muscles of the face and throat, especially in the setting of fever or when following a coldlike illness. It is safe to bring your child to the hospital, even in the midst of the COVID-19 pandemic, and it is essential not to delay seeking the prompt care they may need. Clinicians should consider AFM in the differential diagnosis of any patient presenting with the acute onset of weakness, particularly when associated with fever and a prodromal illness and with a heightened suspicion during the summer-fall season of enterovirus circulation.
Q: What should clinicians do if they suspect a patient has AFM?
A: A careful neurologic exam can detect flaccid weakness suggestive of lower motor neuron disease, which should prompt a lumbar puncture and MRI of the brain and spine to confirm the diagnosis. Early biologic specimens should be collected, including cerebrospinal fluid, blood, respiratory and stool samples to identify an etiology. All suspected patients with AFM should be hospitalized during the acute phase, given the risk of airway compromise and rapid respiratory decompensation, and all suspected cases need to be reported to the health department.
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Healio Interview
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