Infectious diseases continue to surprise physicians, scientists and the general public. In South Dakota, the first case of acute flaccid myelitis, or AFM, has been confirmed by state health officials. This illness resembles polio in its symptoms and progression.
State health officials in South Dakota are working with investigators at the Centers for Disease Control and Prevention to identify risk factors, possible contacts and to trace anyone who might have been exposed.
New South Dakota AFM Case
The confirmed case of AFM in South Dakota occurred in an adult. The patient experienced a course of disease that included a mild respiratory illness and fever. These symptoms were followed by muscle weakness, which lead to the patient's hospitalization and testing of biological specimens.
Epidemiology of National Cases
So far in 2018, there have been 165 confirmed cases of AFM in 36 states. Most of the cases have occurred in children ages 18 or younger. The cases appear to have a cyclical or seasonal distribution, which is also similar to polio. The CDC has been tracking cases of AFM since 2014. More than 90 percent of those cases started with symptoms of a mild respiratory illness before progressing to muscle weakness that required hospitalization. Most cases are diagnosed between the months of August and October.
Symptoms
Most AFM symptoms focus on the central nervous system. The symptoms include weakness of the facial muscles, droopiness of one side of the face and difficulty with moving the eyes in a coordinated way. Patients may also develop droopy eyelids, difficulty with swallowing and slurred speech. The CDC recommends that parents who notice any of these symptoms in their child seek medical care as quickly as possible.
Possible Cause
The CDC has been able to rule out a variety of known viruses, including enteroviruses and poliovirus in stool specimens taken from the patients. It is possible that an as-yet undiscovered enterovirus is responsible for AFM. These viruses are known for causing infectious illnesses that are typically mild.
Treatment Options
Currently, there is no specific treatment for AFM. However, clinicians can offer supportive care for patients affected by the disease. Clinicians might recommend interventions such as speech therapy for swallowing disorders. Neurologists might recommend physical therapy for patients who experience muscle weakness or a decrease in the ability to ambulate. Occupational therapy may be recommended for patients who develop arm weakness and difficulty with movements of their hands.
Ongoing Research
CDC and other researchers continue to look into the cause of AFM. The researchers are also investigating whether certain environmental triggers may increase a person's risk of developing AFM. Clinicians and researchers together are working to learn more about the disease process and what causes the neurological symptoms to develop. Although there are no specific ways to prevent AFM, the CDC and South Dakota health officials remind people that hand washing and avoiding sick people are key methods of preventing the spread of infectious illnesses.
Prevention
Since we don't know the cause of most of these AFM cases or what triggers this condition, there is no specific action to take to prevent AFM.
Certain viruses are known to cause AFM including enteroviruses, such as poliovirus and enterovirus A71 (EV-A71), and West Nile virus.
You can protect yourself and your children from poliovirus by getting vaccinated. Polio vaccine contains inactivated (not live) virus, and protects against poliovirus. This vaccine does not protect against other viruses that may cause AFM.
You can protect against bites from mosquitoes, which can carry West Nile virus, by using mosquito repellent, staying indoors at dusk and dawn (when bites are more common), and removing standing or stagnant water near your home (where mosquitoes can breed).
You can protect yourself and others from enteroviruses by washing your hands often(https://www.cdc.gov/handwashing/when-how-handwashing.html) with soap and water, avoiding close contact with people who are sick, and cleaning and disinfecting frequently touched surfaces, including toys.
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