TORONTO — Health officials in Canada and the U.S. are warning parents to be on the lookout for a rare, polio-like condition that can lead to long-term paralysis in young children, and they’re concerned that a surge in cases could be complicated by the coronavirus pandemic.
The condition, known as acute flaccid myelitis (AFM), has been around for years at low levels but tends to peak every other year, with the last surge of cases reported in the U.S. in 2018.
The life-threatening condition has already emerged in the U.S., with 16 confirmed cases and 38 under investigation, prompting the U.S. Centers for Disease Control and Prevention (CDC) to warn of a possible outbreak this fall.
Officials are concerned that the ongoing COVID-19 pandemic may complicate an outbreak of the condition because parents may hesitate to take their children to the doctor due to fear of the novel coronavirus.
AFM is a paralytic condition often described as a “polio-like” illness that results in the sudden onset of weakness in one or more limbs due to swelling in the spinal cord. It can be caused by a number of different infections, including enteroviruses or West Nile virus, and auto immune diseases.
Severe cases can result in respiratory failure, requiring the use of a ventilator.
Though some children recover quickly, others suffer long-term paralysis and muscle weakness and require ongoing care, including six-year-old Xavier who was diagnosed with the condition in 2018.
“Seeing him when he was completely paralyzed, where his eyes were moving but he couldn’t turn his head, that was hard,” Xavier’s mother, Rachelle Downton, told CTV News.
“It’s very scary because it’s not like there’s a cure right now. And while you’re in the acute phase, there are some treatments that they’ll use at the hospital but it’s not 100 per cent.”
Two years after his diagnosis, Xavier is slowly recovering. He requires ongoing physiotherapy — which was put on hold during the height of the COVID-19 outbreak — due to muscle weaknesses in his right arm and shoulder. He also walks with a limp due to an imbalance in his hips.
“They didn’t think he was ever going to walk again. Just short of a year, he took his first step,” Downton said, describing her son as a healthy boy with lots of energy.
“Physically he still has his limits and some parts of him that don’t work really well. But health wise he’s been amazing.”
The Public Health Agency of Canada (PHAC) says it has increased ongoing surveillance of the condition in light of rising case numbers in the U.S.
In a statement to CTV News, a PHAC spokesperson said there have been less than five cases of AFM in Canada this year. A more detailed report on the condition’s prevalence in Canada is expected to be released in the fall.
Pediatric infectious diseases specialist Dr. Christos Karatzios, who treated three or four AFM patients in 2018, stresses that although the condition is rare, parents should seek immediate medical attention if their child suffers sudden arm or leg weakness, loss of reflexes, or facial drooping.
“What parents and children can do to help prevent the transmission of the viruses that cause acute flaccid myelitis is exactly the same thing that they’ve been doing during the COVID-19 pandemic,” Karatzios told CTV News.
“Washing hands, being careful not to touch faces, washing hands after going to the bathroom and being socially distant… all of this is going to help.”
CDC REPORT SHEDS LIGHT ON RARE CONDITION
In early August, the CDC released the results of a study done after the last AFM outbreak in 2018 when 238 cases were confirmed across the U.S.
Most of the cases were found in young children, with an average age of five-years-old. Most patients diagnosed with AFM had fever or respiratory illness approximately six days before suffering limb weakness.
During the outbreak, 98 per cent of patients were hospitalized, 54 per cent were admitted to intensive care units, and 23 per cent required ventilation. Most children were hospitalized within one day of limb weakness.
One type of enterovirus, EV-D68, was the most common virus identified among AFM patients.
Those who tested positive for EV-D68 typically experienced more severe symptoms and were more likely to require ventilation.
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