There is an AFM outbreak in America. People have a lot of questions. Is AFM a new polio? Is my polio vaccine still active? What explains the sudden spike in AFM cases? Where are we facing an outbreak, and if so what can you do to protect yourself? Let’s take a close look at AFM.
What is AFM?
AFM: What we know
AFM (acute flaccid myelitis) is a mystery. We know it’s a rare disease but not much else. Prior to 2014, the CDC reported that about two of every million kids in the United States would get AFM. The disease attacks our central nervous system through the grey matter in our spinal cords. We do not know the cause of AFM. But we do know that certain viruses have been known to cause AFM. These viruses include the West Nile virus, enterovirus A71 and poliovirus. We know poliovirus as polio. The symptoms and affects of AFM and polio are similar.
Where is AFM Outbreak Active?
The mysterious AFM disease is spreading across the United States, with CNN reporting cases in thirty states. Colorado has the most cases with fourteen. Texas has eight cases and Minnesota has six.
Symptoms of AFM
AFM is very complex. We don’t know much about it so it’s hard to say why some people go from having a fever to full-blown AFM. But there are symptoms. But we do know that since 2014 the vast majority of AFM cases started with a respiratory illness or fever. Generally, people will suffer lack of facial control or facial droopiness. This progresses into lack of strength in the muscles, lack of control of the limbs and slower reflexes. Slurred speech and difficulty swallowing are also symptoms of AFM.
Prevention Measures for AFM
There are three main things to do:
- Make sure your kids have a polio vaccine shot. Also look into polio titers to see if you vaccine is still effective.
- Wash your hands frequently. Avoid touching surfaces that others who are sick may have touched.
- If you are in warm climates, avoid mosquitoes and wear mosquito repellent.
Treatment of AFM
Again, AFM is a moving target. To date, there is no specified protocol for treatment of AFM. But once doctors diagnose AFM, the next move is to find a neurologist to work with. Physical and Occupational therapy are among the most popular treatment methods to date. The CDC continues to look into best practices for treatment.
AFM and Polio Outbreak
There has been a lot of concern surrounding the recent AFM outbreak. While it is related to polio by virtue or virus transmission, it is a different kind of outbreak. Let’s compare both.
Polio Outbreaks
1894: Vermont. Over 130 cases of polio were reported throughout Vermont. Most were children, but a handful of adults were affected.
1916: New York City. The outbreak that rocked America. The New York outbreak saw over 27,000 cases and over 6,000 deaths.
1934: Los Angeles. From May though October, Los Angeles General Hospital reports over 2,500 cases. And that’s just one hospital.
By the 1940’s the United States is in a full-blown polio plague. We average over 20,000 cases a year until 1949. The polio vaccine is introduced in 1955 and crushes the virus.
AFM Outbreaks
2012: California Department of Health reports a small outbreak in the Bay Area. Cases continue to rise every year.
2014: In an October release, The CDC reports over 100 likely cases have been reported in California, Texas and Colorado.
2016: The number of confirmed AFM cases rises to almost 150 nationwide.
2018: Outbreaks in Colorado Minnesota and Maryland bring confirmed and suspected totals to 127 cases.
Spreading Disease and Fear of Disease
Similarities Between Polio and AMF
Polio had a seasonality to it’s spreading. It was a summertime concern. Communities would close public pools and parks out of concern of the disease spreading. AMF also seems to follow a summer/early fall pattern. The numbers for AFM aren’t as high as polio, but many parents are starting to worry for their kid’s health. Kids play together and spread germs. Both diseases strike the central nervous system and cause a weakness of muscle and loss of control of the limbs. Unlike an invisible illness, these symptoms are noticeable. So far no cases of AFM have tested positive for polio, but the effects are similar.
Sanitation
David Oshinsky, author of Polio: An American Story notes the correlation between sanitation and the rise of the polio epidemic. “The major polio epidemics don’t come until the early 20th century, which is exactly the same time when we’re doing things like separating waste from water, we’re cholorinating our water and having waste treatment plants, we using germ killers to wipe off tables, we’re washing our hands more and and all of a sudden this disease (polio) pops up.”
That last part from Oshinsky’s quote sounds more like today’s society than the early 20th century. Does using “germ killers to wipe off tables, washing our hands more” make us more susceptible to disease? The answer is yes.
Oshinksy: “Before the 20th century, children were more likely to contract mild polio infection at early ages, achieving immunity without even knowing it. When new sewer systems arrived, children were protected against dysentery and other infectious diseases, but also left vulnerable to contracting polio.”
Could the modern trend of anti-bacterial everything and hyper-vigilant parents ensuring everything their child touches is wiped down, disinfected and steamed be working against us? Yes, it could.
Vaccination
There is no vaccination for AFM. A polio vaccine exists, but the number of parents opting to not vaccinate their children is increasing. This is a major concern. Many states require vaccinations for polio, but more and more parents are opting to file for exemptions. This was the case in Minnesota where an outbreak of measles occurred in the city’s vibrant Somali community. A larger outbreak struck a Jewish community in Brooklyn. And an Amish community in Ohio also suffered a measles outbreak.
AFM Disease: Going Forward
The AFM outbreak has received a lot of press coverage; and rightfully so. The numbers of cases and suspected cases seem to be climbing every day. The CDC has committed to weekly updates. The disease can be crippling and has already proven fatal in one case. People are rightfully concerned. But keep in mind, we are talking about something that has under 200 confirmed cases in a country of over 325 million people. Remember to wash your hands, avoid mosquitoes, and check up on your polio titer. Please reference the CDC Fact Sheet for more helpful information.