AFM – PART I
COMPILATION AND COMMENTARY
BY LUCY WARNER
NOVEMBER 13, 2018

"AFM -- PART II" IS ALSO POSTED TODAY, WHEN A TRUE SWARM OF STORIES EMERGED IN THE NEWS. THIS MAY TURN OUT TO BE THE NEWS SUBJECT OF THE YEAR. I AM SEPARATING TODAY’S STORIES FROM THOSE OF OCTOBER DUE TO THE LENGTH OF ALL OF IT TOGETHER. IT MAY BE IN THE RANGE OF 50 OR MORE PAGES. THE ORIGINAL, TITLED "WELCOME TO OUR BRAND-NEW PARALYTIC VIRUS," BY WHICH I CERTAINLY DO NOT MEAN TO DIMINISH ITS' DANGEROUS POTENTIAL OR THE PAIN OF THE PARENTS OF THESE CHILDREN, BUT TO DISTANCE MYSELF FROM THE MARCH OF TIME. LOOKING BACK OVER MY OWN LIFETIME SOMETIMES MAKES ME FEEL DEPRESSED, AND ESPECIALLY WHEN I LOOK AT THE NEWS; AND YET I AM NOT ONE OF THOSE PEOPLE WHO CAN JUST LOOK AWAY AS LONG AS MY OWN FAMILY AND FRIENDS ARE NOT INVOLVED. DOING THESE NEWS STORIES HELPS ME WORK THROUGH THINGS AND TRY TO REMAIN ON THE SIDE OF POSITIVE ACTIVITY.

TODAY'S STORIES INCLUDE SOME UNDERSTANDABLE PANIC AND SUSPICION IN THE PUBLIC OVER THE CDC'S PROGRESS, HOWEVER SCIENTIFIC WORK USUALLY CANNOT BE DONE IN THE WINK OF AN EYE, SO I AM NOT GOING TO PREDICT A NEW PLAGUE. THE STORIES ABOUT POSSIBLE UNDERCOUNTS BY THE CDC IS, I FEEL SURE, IF THEY ARE TRUE AT ALL, NOT A POLITICAL PLOY TO KEEP THEIR FEET OUT OF THE HOT WATER. I DO HOPE THAT PRESIDENT TRUMP'S RECENT INVOLVEMENT WITH THE CDC HAS NOT WEAKENED THEIR ABILITY TO RESPOND TO THIS FRIGHTENING SITUATION. I BELIEVE THAT THEIR PART OF "THE DEEP STATE" WILL HOLD FIRM TO THE GOOD SCIENTIFIC PRACTICE FOR WHICH THEY ARE SO WELL-KNOWN.


OCTOBER

WELCOME TO OUR BRAND-NEW PARALYTIC VIRUS
COMPILATION AND COMMENTARY
BY LUCY WARNER
OCTOBER 17, 2018

THIS NEW PARALYTIC DISEASE AFM HAS BEEN DUBBED – “ENTEROVIRUS 68.” ITS’ FULL MEDICAL NAME IS “ACUTE FLACCID MYELITIS.” THE SECOND ARTICLE FROM WIKIPEDIA GIVES MORE INFORMATION. THE DISEASE WAS FIRST DETECTED IN 2014, AND IS EXTREMELY RARE. AN AVERAGE OF ONE CASE IN A MILLION ARE PREDICTED FOR THE USA IN ONE YEAR. THAT’S THE ONLY GOOD NEWS ABOUT IT, THOUGH.

62 CASES HAVE BEEN FOUND IN 22 STATES IN JUST THE LAST FEW WEEKS, MAINLY IN CHILDREN. IT MUST HAVE BEEN INCREASING IN NUMBERS OVER TIME, BECAUSE WHEN THE FIRST CASES WERE DIAGNOSED IN 2014, THERE WERE 120 COUNTED. SINCE 2014, A TOTAL OF 386 HAVE BEEN CONFIRMED.

IT USUALLY STARTS WITH FLU-LIKE SYMPTOMS AND GOES INTO “SUDDEN” MUSCLE WEAKNESS. PHYSICAL THERAPY IS BEING USED, WITH SOME GOOD RESULTS, BUT THE DISEASE CAN CAUSE PARALYSIS OF THE DIAPHRAGM LIKE POLIO, AND REQUIRE A VENTILATOR. THAT, OF COURSE, CAN BE FATAL, AND THERE IS NO VACCINE, YET. I HOPE THE CDC IS WORKING ON THAT PROJECT RIGHT NOW, AND THAT WE WILL BE ABLE TO TREAT IT SOON. AT THIS POINT DOCTORS ARE JUST TREATING THE SYMPTOMS.

IF I WERE TO GIVE A PIECE OF ADVICE, I WOULD SAY THAT WE SHOULD AVOID CROWDED ENVIRONMENTS, TRAINS, AIRPLANES, BUSES, HOSPITALS, MOVIE THEATERS, ETC; BECAUSE IN ORDER FOR IT TO HAVE TRAVELED AS FAR AND AS FAST AS IT HAS, IT MAY BE SPREAD BY AIR LIKE FLU IS. NEITHER OF THESE TWO ARTICLES TELLS WHAT IS KNOWN ABOUT THE FIRST KNOWN CASE. I PREDICT WE’LL BE SEEING PEOPLE GOING ABOUT WITH FACE MASKS ON AFTER THIS NEWS GETS OUT.

IT SEEMS TO ME THAT, TO BE SO UNCOMMON IN THE POPULATION, IT SPREADS RAPIDLY AND OVER A WIDE RANGE. 62 CASES IN 22 STATES IN JUST A FEW WEEKS IS PRETTY FRIGHTENING TO ME. DID ANY OF YOU EVER READ THE HORROR/SCIENCE THRILLER BY STEPHEN KING CALLED “THE STAND?” THERE IS ALSO A DEMONLIKE FIGURE IN THE BOOK WHO IS BRINGING ABOUT VARIOUS TERRIBLE THINGS, INCLUDING THIS HORRIFIC SUPERFLU. THE STORYLINE IS ABOUT THE APOCALYPSE. IT’S A VERY GOOD STORY, BUT I WOULDN’T ADVISE IT FOR AN EMOTIONALLY FRAGILE PERSON.

https://www.cbsnews.com/news/symptoms-of-mysterious-polio-like-illness-accute-flaccid-myelitis-parents-should-watch-out-for/
By ASHLEY WELCH CBS NEWS October 17, 2018, 12:40 PM
Symptoms of mysterious polio-like illness parents should watch out for

NEWS VIDEO -- CBS THIS MORNING

Federal health officials have issued an unusual warning about a growing number of cases of a polio-like illness called acute flaccid myelitis, also known as AFM. The Centers for Disease Control and Prevention announced Tuesday that 62 cases have been confirmed in 22 states in recent weeks. Ninety percent of those affected are children.

"It's rare, but certainly when you hear about it it's very scary for parents," CBS News medical contributor Dr. Tara Narula told "CBS This Morning."

AFM affects the nervous system, specifically the area of spinal cord called gray matter, and causes the muscles and reflexes in the body to become weak or even paralyzed.

The disease is extremely rare, with the CDC estimating that less than one in a million people in the United States will get AFM every year.

Officials began tracking the disease in 2014 when they received reports of 120 cases nationwide. Outbreaks appear to follow an every-other-year pattern with another sharp rise in 2016, primarily in late summer and early fall. That pattern appears to be repeating this year. There have now been a total of 386 confirmed cases since 2014.

Symptoms of AFM

It's important for parents to know the symptoms so they can get their child immediate medical care and help doctors get a handle on the disease.

"Many times it can start with what looks like a respiratory illness, a little bit of a fever," Narula said. "The hallmark is sudden onset of weakness in the arms or the legs. Children can also have trouble swallowing, trouble with their speech, facial droop, trouble with their eye muscles."

The scariest and most severe symptom is when the disease affects the diaphragm, the muscle that helps us breathe.

"That's when children can really deteriorate and end up on a ventilator," Narula explains.

At a press briefing Tuesday, Dr. Nancy Messonnier, director of CDC's National Center for Immunization and Respiratory Diseases, said, "We want to encourage parents to seek medical care right away if you or your child develops symptoms of AFM, such as sudden weakness and loss of muscle tone in your arms or legs."

Doctors diagnose AFM based on a combination of the patient's symptoms and an MRI scan.

What's behind the rise?

Health officials do not know what's causing the increasing number of cases of AFM. It's also unclear why the illness seems to peak in the late summer and fall.

"This is truly a mystery disease," Messonnier told CBS News. "We actually don't know what is causing this increase. For some of the previous cases we've identified one pathogen or another, but we have no unifying diagnosis."

While the cause of AFM is not clear, experts say it can occur as a result of a variety of viral illnesses including the polio virus, enteroviruses, West Nile virus, and adenoviruses. None of the U.S. patients tested positive for polio, a crippling and often deadly disease which was eliminated in this country thanks to the polio vaccine.

Messonnier also said none of this year's cases have been linked to West Nile virus. Several cases have been linked to enteroviruses or other germs, but officials have not been able to find a cause for the majority of the cases.

Treatment for AFM

Unfortunately, there is no specific treatment for AFM, though the CDC says neurologists may suggest options on a case-by-case basis. Doctors may also recommend physical or occupational therapy to help with arm or leg weakness.

"Early intervention is definitely always helpful. Unfortunately, there are no real treatments that have been proven to work, but early rehabilitation has been shown to help," Narula said.

Some patients recover completely, while others continue to struggle with muscle weakness.

All the uncertainties are frustrating for parents like Jenna Shumpert, whose son Hunter came down with AFM when he was just 15 months old. He suffered paralysis and had to be put on a ventilator.

"Nobody really knows treatment protocols, they don't know prognosis, and they can't really give parents an answer as to where this is coming from," she said.

1017-ctm-mysteryillness-narula-1686932-640x360.jpg
Hunter was hospitalized with AFM when he was 15 months old.
Now 3 years old, Hunter has slowly recovered. He continues to get therapy to strengthen his muscles and uses electric stimulation pads to help rejuvenate his damaged nerves.

What parents can do to prevent AFM

The CDC says there are preventive measures people can take to reduce the risk of infections that could lead to AFM.

"Getting vaccinated, taking precaution against mosquitoes, washing hands — all of these things are recommended by the CDC," Narula said.

Vaccines and hand-washing help protect against the spread of viral illnesses, while insect repellent helps ward off the mosquitoes that transmit West Nile virus.

© 2018 CBS Interactive Inc. All Rights Reserved.


https://en.wikipedia.org/wiki/Enterovirus_68
Enterovirus 68
From Wikipedia, the free encyclopedia

Enterovirus 68 (EV68, EV-D68, HEV68) is a member of the Picornaviridae family, an enterovirus. First isolated in California in 1962 and once considered rare, it has been on a worldwide upswing in the 21st century.[2][3][4] With some uncertainty, it has been implicated in cases of a polio-like disorder called acute flaccid myelitis.

Virology

EV68 is one of the more than one hundred types of enteroviruses, a group of ssRNA viruses containing the polioviruses, coxsackieviruses, and echoviruses. It is unenveloped. Unlike all other enteroviruses, EV68 displays acid lability and a lower optimum growth temperature, both characteristic features of the human rhinoviruses. It was previously called human rhinovirus 87 by some researchers.[5]

Since the year 2000, the original virus strains diversified and evolved a genetically distinct outbreak strain, clade B1. It is Clade B1, but not older strains, which has been associated with AFM and is neuropathic in animal models.[6]

Epidemiology

Since its discovery in 1962, EV68 had been described mostly sporadically in isolated cases. Six clusters (equal to or more than 10 cases) or outbreaks between 2005 and 2011 have been reported from the Philippines, Japan, the Netherlands, and the states of Georgia, Pennsylvania and Arizona in the United States.[7] EV68 was found in 2 of 5 children during a 2012/13 cluster of polio-like disease in California.[8]

Cases have been described to occur late in the enterovirus season (roughly the period of time between the spring equinox and autumn equinox),[7] which is typically during August and September in the Northern Hemisphere.

Predisposing factors

Children less than 5 years old and children with asthma appear to be most at risk for the illness,[9] although illness in adults with asthma and immunosuppression have also been reported.[7]

2014 North American outbreak

Main article: 2014 enterovirus D68 outbreak

In August 2014, the virus caused clusters of respiratory disease in the United States.[10] By mid-October 691 people in 46 states and the District of Columbia had come down with a respiratory illness caused by EV-D68. Five children died.[citation needed]

Signs and symptoms

EV68 almost exclusively causes respiratory illness, which varies from mild to severe, but can cause a range of symptoms, from none at all, to subtle flu-like symptoms, to debilitating respiratory illness and a suspected rare involvement in a syndrome with polio-like symptoms. Like all enteroviruses, it can cause variable skin rashes, abdominal pain and soft stools. Initial symptoms are similar to those for the common cold, including a runny nose, sore throat, cough, and fever.[11] As the disease progresses, more serious symptoms may occur, including difficulty breathing as in pneumonia, reduced alertness, a reduction in urine production, and dehydration, and may lead to respiratory failure.[7][11]

The degree of severity of symptoms experienced seems to depend on the demographic population in question. Experts estimate that the majority of the population has, in fact, been exposed to the enterovirus, but that no symptoms are exhibited in healthy adults. In contrast, EV-D68 is disproportionately debilitating in very young children, as well as the very weak. While several hundred people (472), mostly youth, have been exposed to the disease, less than a hundred of those patients have been diagnosed with severe symptoms (such as paralysis), and during the recent outbreak in the US just a single death was recorded over the last weekend of September 2014. The death was of a 10-year-old girl in New Hampshire.[12]

Acute flaccid myelitis

The virus has been suspected as one cause of acute flaccid myelitis a rare muscle weakness, usually due to polio- since two California children who tested positive for the virus had paralysis of one or more limbs reaching peak severity within 48 hours of onset. "Recovery of motor function was poor at 6-month follow-up."[13] As of October 2014, the CDC was investigating 10 cases of paralysis and/or cranial dysfunction in Colorado and other reports around the country, coinciding with the increase in enterovirus D68 activity.[14] As of October 2014 it was believed that the actual number of cases might be 100 or more.[15][16] As of 2018 the link of EV-D68 and the paralysis is strong, meeting six Bradford Hill criteria fully and two partially.[6] [17]

Diagnosis

A real-time PCR test to speed up detection was developed by CDC.[18]

Treatment

There is no specific treatment and no vaccine, so the illness has to run its course; treatment is directed against symptoms (symptomatic treatment). Most people recover completely; however, some need to be hospitalized, and some have died as a result of the virus.[7] Five EV68 paralysis cases were unsuccessfully treated with steroids, intravenous immunoglobulin and/or plasma exchange. The treatment had no apparent benefit as no recovery of motor function was seen.[13] A 2015 study suggested the antiviral drug pleconaril may be useful for the treatment of EV-D68.[19]

Treatment

There is no specific treatment and no vaccine, so the illness has to run its course; treatment is directed against symptoms (symptomatic treatment). Most people recover completely; however, some need to be hospitalized, and some have died as a result of the virus.[7] Five EV68 paralysis cases were unsuccessfully treated with steroids, intravenous immunoglobulin and/or plasma exchange. The treatment had no apparent benefit as no recovery of motor function was seen.[13] A 2015 study suggested the antiviral drug pleconaril may be useful for the treatment of EV-D68.[19]

Prevention

The US Centers for Disease Control and Prevention (CDC) recommend "avoiding those who are sick". Since the virus is spread through saliva and phlegm as well as stool, washing hands is important.[11] Sick people can attempt to decrease spreading the virus by basic sanitary measures, such as covering the nose and mouth when sneezing or coughing.[9] Other measures including cleaning surfaces and toys.[11]

For hospitalized patients with EV-D68 infection, the CDC recommends transmission-based precautions, i.e. standard precautions, contact precautions, as is recommended for all enteroviruses,[20] and to consider droplet precautions.[21]

Environmental cleaning

According to the CDC in 2003, surfaces in healthcare settings should be cleaned with a hospital-grade disinfectant with an EPA label claim for any of several non-enveloped viruses (e.g. norovirus, poliovirus, rhinovirus).[22]