This article was taken from The Province newspaper, Canada.
This year, six children in Quebec are suspected of having developed acute flaccid myelitis, although that number is not considered official because of a lag time in verifying and reporting cases.
Currently, doctors at the Montreal Children’s Hospital are taking care of two children with the debilitating disease, while two others who partially recovered have returned home. At Ste-Justine Hospital, two children are receiving supportive care and are being infused with intravenous immunoglobins to try to accelerate improvement.
Preliminary data in the Montreal area suggest that preschool and elementary schoolchildren are most at risk of developing the illness. At the Montreal Children’s, the average age of the patients is four.
“I’ve been working (in this field) for 14 years and I have not seen this before,” Dr. Christos Karatzios, an infectious-diseases specialist at the Montreal Children’s, said in an interview.
“We do see neurological illnesses, you know. There’s viral meningitis, they can come in with neurological illnesses following a viral infection. But I have not seen this kind of disease, and not only this kind of disease, but three cases in three weeks?”
“I remember texting my wife,” he added. “I was here late every night because I had some weird cases, and I was saying, ‘Another paralyzed kid?’ Something’s going on. So we have this impression that something’s peaking. The surveillance is still ongoing.”
Dr. Christian Renaud, a microbiologist and infectious-diseases specialist at Ste-Justine, emphasized that it’s premature at this point to declare an outbreak in Montreal, along the lines of what has occurred in the state of Colorado. On Oct. 9, the Colorado department of public health confirmed that “as part of an outbreak,” there have been 14 cases of acute flaccid myelitis (AFM).
“If the four actual cases from McGill and our two are confirmed, then it would be a little bit higher,” Renaud said. “It’s kind of difficult to say it’s really an outbreak, but we seem to have more cases this year.”
AFM is not polio, because it’s not caused by the poliovirus. But the disease does affect the grey matter of the spinal cord, as polio does, and it can cause paralysis, too.
At the height of the polio epidemic, the U.S. reported nearly 58,000 cases in 1952, one year before the development of a vaccine. By comparison this year, the U.S. Centers for Disease Control has confirmed 62 cases of AFM out of 155 patient reports.
“CDC continues to receive reports of children with acute flaccid myelitis,” the agency says on its website. “CDC is working hard to find the causes of these AFM cases.”
In general, the CDC notes that less than one person in a million in the U.S. develops AFM each year.
Scientists have not developed a vaccine for AFM, largely because they haven’t nailed down the viruses that cause the disease. In Colorado, 11 patients tested positive for enterovirus A71, one tested positive for enterovirus D68 and two tested negative for enteroviruses.
“While all the patients were hospitalized, nearly all have fully recovered,” Colorado’s public-health department stated. “There have been no deaths.”
Both Karatzios and Renaud warned, however, that some patients who do recover from AFM can suffer from permanent paralysis.
“We know that for D68, A71 polio-like illnesses, after a couple of years, patients still are significantly affected,” Karatzios explained. “We know that poliomyelitis left lifelong neurological sequelae back in the day.”
At the Montreal Children’s, doctors have hooked up the patients to CPAP machines to help them breathe.
One patient at the Montreal Children’s has tested positive for D68 and at Ste-Justine one patient has tested positive for A71. A child who fell ill with AFM in August and who was hospitalized at the Montreal Children’s did not test positive for either virus.
All but one of the affected children live in the Montreal area. The exception is a girl who lives near Gatineau and who was transferred to the Montreal Children’s.
Despite the unusual number of cases, Montreal officials are urging parents to stay calm.
“I think the first thing is, don’t panic,” Karatzios advised. “It’s still quite rare. Even if you do get infected with enterovirus or even the enterovirus D68 or A71, it does not mean that your kid will go on to develop flaccid myelitis or a polio-like illness.”
Enterovirus infections typically arise in late summer and fall. Enteroviruses can be spread through contact with a person’s feces; eye, nose and mouth secretions; and fluid from blisters.
“You have make sure to teach children and yourselves, wash your hands before you put them in your mouth, wash your hands before you eat, wash your hands after you go to the bathroom,” Karatzios said. “Use soap and water or these portable sanitizers with alcohol in them.”