Intense effort is underway to understand and prevent acute flaccid myelitis (AFM) by the Centers for Disease Control and Prevention (CDC), as the agency pushes doctors to report symptoms early, per its new Vital Signs report.

Why it matters: Doctors continue to seek the cause of the serious neurologic syndrome after the largest recorded outbreak in 2018 — 233 patients in 41 states reported symptoms that often included limb weakness or paralysis. The CDC has expressed frustration in determining the source of the illness, as some but not all patients show evidence of enteroviruses, which are spread through the nervous system, in their bodies.

The latest: A recent preliminary report in the journal Biorxiv tested 100 children, 42 with AFM and 58 with other neurological conditions, using an experimental CRIPSR-Cas9-enhanced genomic test of cerebro-spinal fluid to look for viral evidence of infection by enteroviruses. Biorxiv is not peer-reviewed.

  • While still not definitive, the study found higher levels of antibodies from EV-A71 and EV-D68 in children with AFM than those with other neurological disorders.
  • CDC has ruled out polio as the enterovirus causing AFM.

Details:The CDC estimates that fewer than 1 to 2 per million children in the U.S. will get AFM every year. Based on the 2018 study:

  • The average age of AFM patients was 5 years old.
  • 98% were hospitalized.
  • 27% required machines to help them breath.
  • 11 cases in 8 different states have been confirmed so far in 2019.

The bottom line: The illness tends to spike in late summer through fall. If it follows its past history of spiking every other year, this year should show a smaller number of cases. The devastating illness currently affects a small number of people every year, but researchers are concerned it eventually could evolve into something more widespread.

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