Paralyzing Illness in Kids Seems to Strike in Weird Cycle

One morning last fall, 4-year-old Joey Wilcox woke up with the left side of his face drooping. It was the first sign of an unfolding nightmare. Three days later, the Herndon, Virginia, boy was in a hospital intensive care unit, unable to move his arms or legs or sit up. Doctors worried he was about to lose the ability to breathe. Joey, who survived but still suffers some of the effects, was one of 228 confirmed victims in the US last year of acute flaccid myelitis, or AFM, a rare, mysterious and sometimes deadly paralyzing illness that seems to ebb and flow on an every-other-year cycle and is beginning to alarm public health officials because it is striking more and more children. Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, published a report about the disease Tuesday in the journal mBio. Highlights from the AP:

• Fauci said AFM may bear similarities to polio, which smoldered among humans for centuries before it exploded into fearsome epidemics in the 19th and 20th centuries. He said it is unlikely AFM will become as bad as polio, but he warned not to "assume that it's going to stay at a couple of hundred cases every other year."
• While countries including Canada, France, and Norway have reported cases, the size and pattern of the US outbreaks have been more pronounced. More than 550 Americans have been struck this decade. The oldest was 32. More than 90% were children, most around 4, 5, or 6 years old.

• The first real burst of AFM cases hit in 2014, when 120 were confirmed, with the largest concentrations in California and Colorado. What ensued was an even-year, odd-year pattern: Cases dropped to 22 in 2015, jumped to 149 in 2016, and fell again, to 35 in 2017. Last year they reached 228, a number that may grow because scores of illnesses are still being investigated. In keeping with the cyclical pattern, just four cases have been confirmed this year so far.
• Most children had a cold-like illness and fever, seemed to get over it, then descended into paralysis. In some cases it started in small ways—for example, a thumb that suddenly wouldn't move. Some went on to lose the ability to eat or draw breath.
• Many families say their children have regained at least some movement in affected limbs, but stories of complete recovery are unusual. Health officials cannot say how many recovered completely, partly or not at all, or how many have died, though the Centers for Disease Control and Prevention says deaths are rare.
• More and more experts feel certain the main culprit is an enterovirus called EV-D68, based on the way waves of AFM have coincided with spikes of respiratory illnesses caused by EV-D68. Enteroviruses are a large family of viruses, some of which, such as polio, can damage the central nervous system, while many others cause mild symptoms or none at all. Scientists are using more sensitive spinal-fluid tests in hopes of establishing the connection between AFM and EV-D68 more firmly. That, in turn, could spur more focused work on treatments and maybe even a vaccine.
• While doctors have deployed a number of treatments singly or in combination—steroids, antiviral medications, antibiotics, a blood-cleansing process—the CDC says there is no clear evidence they work on AFM.
• The AP shares one tragic case: Katie Bustamante's son Alex developed AFM in 2016. The suburban Sacramento, California, mother realized something was wrong when she asked the boy, then 5, why he wasn't eating his yogurt. Alex replied that his thumb had stopped working and he couldn't hold his spoon. That morning was the start of 17 months of hospital stays, surgeries, therapy, and struggles with doctors and insurers to find a way to restore his ability to breathe. It ended one morning last May, when Alex died of complications.

(More paralysis stories.)