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In 2014, the medical world witnessed a curious uptick in cases of very young people, many of them babies or toddlers, suddenly becoming ill with neurological symptoms including muscle and limb weakness, breathing problems, difficulty swallowing, and, at worst, even paralysis.
What’s most scary is that the illness closely mimics polio, a scourge believed to be eliminated long ago in the wake of a life-saving vaccine. The illness certainly looks like polio, and lab techs soon found themselves receiving surprising requests to test saliva, feces, or spinal fluid for the polio virus. As it turned out, it is not polio.
Eventually, the Centers for Disease Control and Prevention (CDC) gave it a name — acute flaccid myelitis (AFM) — caused by enterovirus D68, or EV-D68. Within a five-month period in 2014, more than 1,100 cases of severe AFM were diagnosed in 49 states, 14 of them fatal. Frightening as it is, the incidence of EV-D68 infection remains extremely small (only 26 people tested positive for EV-D68 in 36 years), and the number of extreme cases involving paralysis are even more rare.
Other enteroviruses, West Nile virus, and adenoviruses all can cause AFM, so the CDC is not certain that all new AFM cases are associated specifically with EV-D68.
Dr. Benjamin Greenberg, a neurologist based in Dallas, Texas, has treated dozens of young children suffering the worst AFM symptoms of paralysis and the inability to breathe without ventilator assistance. “It’s worth noting that … the same virus can infect thousands, hundreds of thousands, or even millions of people with only a few individuals having catastrophic events from the virus, is true for almost every virus in human biology,” he said.
In Dr. Greenberg’s experience, patients can improve slowly, and some recover but not without some lasting muscular weakness or partial paralysis. Scientists theorize that these AFM-causing viruses travel to the spinal cord and irreversibly damage motor function.
To date, there is no vaccine for EV-D68, which is believed to be a mutation likely to mutate again. In addition, medical authorities maintain that EV-D68 does not pose a serious enough threat to invest in vaccine development at this time. EV-D68 usually causes mild symptoms, if any, and requires only supportive care. Most people are able to fight it off on their own with rest, hydration, and time — about 1-3 weeks.
The CDC is concerned enough about AFM to continue investigating the increased incidences in 2014 as well as additional increases in 2016, during which 138 people in 37 states were confirmed to have AFM. Though rare, AFM is a serious illness, and physicians who suspect a patient may have AFM are encouraged to contact their state and local health departments and collect appropriate samples for CDC testing. So far this year, there have been five (5) confirmed cases of AFM in the United States. The CDC is closely monitoring all occurrences of the disease.
If you are pregnant and worried about EV-D68 infection, there is good news. So far, no definitive evidence has linked non-polio enterovirus infection in pregnancy to an increased risk for birth defects, miscarriage, or other pregnancy complications. Pregnant women who become infected in the latter part of their pregnancies may pass the virus to their babies. However, these babies usually do fine. Furthermore, most pregnant women already have developed immunity by virtue of previous exposure to any number of non-polio enteroviruses. There are at least 64 non-polio enteroviruses capable of causing disease in humans.
The best way to prevent the acquisition or spread of EV-D68 is to practice good basic hygiene and take common precautions around people who may be sick. This includes: frequent handwashing; not sharing utensils, cups, or dishes; periodically disinfecting keys, door knobs, toys, and other items we touch often during the day; avoiding kissing or hugging someone who may be sick; and avoiding touching eyes, nose, and mouth with unwashed hands.
If you have any symptoms of an EV-D68 infection, or if you are just concerned about enteroviruses during your pregnancy, direct questions to your physician.
This blog provides general information and discussion about healthcare-related subjects. The content and linked materials provided are not intended and should not be construed as medical advice. If the reader is an expectant mother with a medical concern, she should consult with an appropriately licensed physician or healthcare provider.
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