The number of confirmed cases of acute flaccid myelitis, a rare polio-like disease that can cause permanent disability, has increased to four in Massachusetts while cases under investigation in the commonwealth have increased to seven.
According to the Massachusetts Department of Public Health, which reported the state’s first two cases this year in October, there are now “4 confirmed, 1 probable and 6 suspect cases of AFM in Massachusetts.”
The DPH had reported Dec. 27 that there were “3 confirmed, 1 probable and 5 suspect cases of AFM in Massachusetts.”
Nationwide, the number of confirmed cases of the disease that can result in paralysis and for which there is no established clinical management continues to increase in more states. The Centers for Disease Control and Prevention say efforts are ongoing to both better diagnosed as well as confirmed the cause of AFM and thus better treat the disease that afflicts mainly children though the two cases confirmed in Montana are said to be in individuals over the age of 18.
In its Jan. 4 weekly update on AFM, the CDC reports, “So far in 2018, there are 193 confirmed cases of AFM in 39 states.”
This, according to the CDC, makes the cumulative total some 519 confirmed cases of AFM in 46 states and the District of Columbia since 2014, when the CDC began surveillance of the condition in the United States as a result of 120 AFM cases being reported to it from 34 states between August through December 2014.
The CDC describes AFM, which is currently diagnosed partly through MRI to detect lesions in grey matter in the spine, as a “rare but serious condition” that “affects the nervous system, specifically the area of the spinal cord called gray matter, which causes the muscles and reflexes in the body to become weak.”
Its weekly confirmed case counts have not included any reports of deaths from AFM this year, though at least one media outlet in September reported the death of a Virginia boy said to have contracted the disease in 2016.
There is at least one Facebook group where families affected by the disease discuss their experiences and recommended centers for treatment.
The 193 confirmed cases to date for 2018 are among the total of 349 reports that the CDC has received of patients under investigation.
The Jan. 4 CDC map shows Tennessee has now joined states with confirmed cases. A number of states like Tennessee have one confirmed case. Texas has the highest number of confirmed cases at 25, followed by Colorado with 16 and Ohio, 13.
States with no confirmed cases to date this year include Alaska, Connecticut, Delaware, Hawaii, Idaho, Maine, New Hampshire, Oregon, Utah, Vermont and West Virginia as well as the District of Columbia.
The number of confirmed cases to date for 2018 has tripled since October when the CDC said there were 62 confirmed cases of AFM in 22 states, and began issuing weekly updates.
The CDC has noted that many patients with AFM had onset of symptoms between August and October when many viruses begin to circulate and the number of confirmed cases seems to increase every other year.
The disease itself is not considered infectious to others, but the viruses in circulation that may be associated with it are contagious and proper hygiene is urged to avoid spreading them and parents are advised to have their children current with recommended vaccinations.
There were 22 confirmed cases of AFM in 17 states in 2015; 149 in 39 states and the District of Columbia in 2016 and 35 confirmed cases in 16 states in 2017, according to the CDC.
The case counts represent only those cases for which information has been sent to and confirmed by CDC with the CDC as well as state and local health departments continue to investigating suspected and probable cases.
The disease, which has not been linked to one identifying pathogen or inflammatory process initiated by infection, is characterized by a sudden weakness or paralysis in any part of the body, what is called an acute flaccid paralysis, and often starts as mild respiratory infection with fever. Some patients with AFM do recover fully, but many do not.
According to a CDC report of Nov. 16:
Among 106 patients with acute flaccid limb weakness classified during Jan.1-Nov. 2, 2018, 80 cases of AFM were classified as confirmed from 25 states, 6 as probable, and 20 as noncases. This represents a threefold increase in confirmed cases compared with the same period in 2017.
Among confirmed cases, the median patient age was 4 years, 47 or 59 percent were male, and, among 65 patients with information on race available, 56 or 86 percent were white.
During the 4 weeks preceding the onset of limb weakness, signs and symptoms consistent with a viral illness were reported for 79 or 99 percent of patients with confirmed AFM, including fever for 65 or 81 percent, respiratory symptoms (e.g., cough, rhinorrhea, and congestion) for 62 or 78 percent, and gastrointestinal symptoms (e.g., vomiting and diarrhea) for 30 or 38 percent patients.
Upper limb only involvement was reported by 38 or 47.5 percent of patients, lower limb only by 7 or 8.8 percent, two to three upper and lower limbs by 12 or 15.0 percent, and all four limbs by 23 or 28.8 percent.
All patients with confirmed AFM were hospitalized, and 47 or 59 percent were admitted to intensive care units; no deaths have been reported.