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Acute Flaccid Myelitis (AFM) - These Polio-Like Illnesses Are Spreading Quickly
Acute Flaccid Myelitis (AFM) - These Polio-Like Illnesses Are Spreading Quickly
A rare condition known as acute flaccid myelitis (AFM) has been spreading across the U.S. Although it's still very rare,
affecting less than 1 in 1 million Americans each year, the U.S. Centers for Disease Control and Prevention (CDC) is
monitoring what appears to be an increasing trend in this polio-like disease.1
AFM targets the nervous system, including the spinal cord, leading to weakness in the arms and/or legs and loss of
muscle tone and reflexes. In some cases, the condition may also cause difficulty swallowing, slurred speech and an
inability to urinate. In the most severe cases, respiratory failure can occur if the muscles involved in breathing become
weakened, requiring a ventilator for the person to breathe.
"In very rare cases, it is possible that the process in the body that triggers AFM may also trigger other serious
neurologic complications that could lead to death," the CDC noted. Currently, there is no cure for AFM so treatment
involves supportive care. Most cases involve children and while some have recovered completely, others are faced
with long-term disabilities including ongoing paralysis that requires continued care.
62 confirmed cases so far in 2018 (as of October 16), spread across 22 states
33 confirmed cases in 2017, across 16 states
149 confirmed cases in 2016, across 39 states
22 confirmed cases in 2015, across 17 states
120 confirmed cases from August to December 2014, across 34 states
It should be noted that the CDC is currently investigating nearly 130 possible AFM cases with onset of symptoms in
August and September 2018. The 62 confirmed cases for 2018 are among these reports, but it's possible the number
may rise considerably in the coming months. At this point, there are more questions than answers surrounding AFM
and its causes.
The CDC admits they don't know what's causing the increase, who may be at a higher risk or what the long-term
effects may be. What they have found so far is that most cases seem to mimic symptoms found in various viral
illnesses, including polio virus, nonpolio enteroviruses, adenoviruses and West Nile virus.
That being said, specimens (stool, blood and cerebrospinal fluid) tested from AFM patients have so far been negative
for polio virus and no pathogens have been consistently detected in spinal fluid.
When the illness first spiked in 2014, it was around the time of an outbreak of respiratory illness caused by enterovirus
(EV) D68, another "polio-like virus" that was associated with paralysis. However, according to the CDC, "Among the
people confirmed with AFM, CDC did not consistently detect EV-D68 in every patient." 3
He brings up an important phenomenon, however, known as provocation poliomyelitis, which describes the increased
risk of neurological complications known to occur if a person with a polio virus infection receives an injury to a skeletal
muscle, which could include an injection from a vaccine. As noted in the Journal of Virology:5
"Skeletal muscle injury is known to predispose its sufferers to neurological complications of concurrent
poliovirus infections. This phenomenon, labeled 'provocation poliomyelitis,' continues to cause numerous
cases of childhood paralysis due to the administration of unnecessary injections to children in areas
where poliovirus is endemic.
Recently, it has been reported that intramuscular injections may also increase the likelihood of vaccine-
associated paralytic poliomyelitis in recipients of live attenuated poliovirus vaccines."
What's more, in most cases polio is a mild illness, causing sore throat, low-grade fever, fatigue, nausea and other flu-
like symptoms that disappear in two to 10 days. Often, polio can occur and show no symptoms at all.
6
It's only in 1 to 2 percent of cases that polio virus invades the central nervous system, resulting in paralysis. This
means some people receiving vaccinations could have an underlying polio infection and not even know it.
"Enteroviruses are the most prevalent viruses in the world," according to the European Centre for Disease Prevention
and Control,7 which means it's likely that some children receiving vaccinations are probably infected with an
enterovirus at the time of the injection, perhaps displaying no symptoms or only mild fever or flu-like symptoms (and
many physicians see no problem with vaccinating a child who is mildly ill).
Is it possible that provocation poliomyelitis could occur in children vaccinated while infected with a nonpolio
enterovirus? It's a question that deserves a closer look. As Cunningham explained:8
"It is taboo to suggest a role for vaccines, but some old-timers remember 'provocation poliomyelitis' or
'provocation paralysis.' This is paralytic polio following intramuscular injections, typically with vaccines.
PP was most convincingly documented by Austin Bradford Hill and J. Knowelden during the 1949 British
polio epidemic when the risk of paralytic polio was increased twentyfold among children who had
received the DPT injection … Similar observations were made by Greenberg and colleagues in New
York City; their literature review cited suspected cases as far back as 1921."
As it stands, the CDC only states, "AFM or neurologic conditions like it have a variety of causes such as viruses,
environmental toxins and genetic disorders."9 However, according to Cunningham, "AFM may result from a direct virus
attack on the spinal cord, or by an immune attack triggered by a virus, or by something else. If a polio-like virus is
circulating in the U.S., the possibility of its provocation by one or more vaccines has to be considered."10
As of October 9, 2018, there have been 61 reported cases of circulating vaccine-derived polio, compared to 19 cases
of wild polio worldwide.12 Last year, 2017 marked the first year more cases of polio have been caused by vaccine-
derived strains than wild or naturally occurring strains.
In Syria alone, 15 children were paralyzed by vaccine-derived polio, according to the World Health Organization
(WHO).13 Research published in the journal Cell also revealed that the live virus used in the oral polio vaccine can
easily mutate and spread through a community. 14 NPR reported: 15
"After a child is vaccinated with live polio virus, the virus replicates inside the child's intestine and
eventually is excreted. In places with poor sanitation, fecal matter can enter the drinking water supply and
the virus is able to start spreading from person to person.
'We discovered there's only a few [mutations] that have to happen and they happen rather quickly in the
first month or two post-vaccination," [lead study author Raul] Andino says. 'As the virus starts circulating
in the community, it acquires further mutations that make it basically indistinguishable from the wild-type
virus. It's polio in terms of virulence and in terms of how the virus spreads.'"
While news that the oral polio vaccine may be causing polio cases may be surprising to you, it was not at all so to
WHO, whose director of polio eradication Michel Zaffran called the vaccine-derived virus outbreaks an expected
"hiccup." He told NPR:16
"We knew that we were going to have such outbreaks. We've had them in the past. We continue to have
them now. We know how to find them, and we know how to interrupt them … So it's a hiccup ... a very
regrettable hiccup for the poor children that have been paralyzed, of course. But with regards to the
whole initiative, you know it's not something that is unexpected."
One British man received three doses of attenuated (weakened) live virus polio vaccine at 5, 7 and 12 months of age.
He also received a booster at age 7, as was recommended. The man has a health condition that suppresses his
immune system, making it more difficult for him to clear vaccine-strain poliovirus from the body.
Although he had no symptoms of the disease, when researchers tested his stool (more than 100 samples were taken
over a period of 28 years), they confirmed high levels of the poliovirus even decades later.
According to researchers, "The study has implications for the ecology of poliovirus in the human gut and highlights the
risks that such vaccine-derived isolates pose for polio reemergence in the post-eradication era."18 Indeed, at the very
least it once again highlights the many complexities surrounding vaccination, infectious disease and the little-
understood consequences that can occur as a result.
For now, however, it's important to be aware of the potential symptoms and seek medical care immediately if you spot
any of them in your child:
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