Three children are receiving treatment in Pittsburgh for a rare neurological disease that can lead to lifelong paralysis, UPMC officials confirmed Tuesday.
Dubbed the “modern polio” disease, acute flaccid myelitis, or AFM, affects less than one in 1 million people a year in the United States, with just 362 confirmed cases since August 2014, the Centers for Disease Control and Prevention reports. Most of the cases nationwide have been in children.
“The patients are currently undergoing diagnostic procedures and treatment,” said Andrea Kunicky, a spokeswoman for UPMC Children’s Hospital of Pittsburgh, where three children are being treated. Officials would not say where the children are from.
“Isolation protocols and infection control procedures are in place, and we are working with the CDC and the Allegheny County Health Department to further monitor and evaluate the patient conditions,” Kunicky said.
The suspected cases reported in Western Pennsylvania follow a federal public health warning last week for physicians to be vigilant about the condition following reports of six patients diagnosed with AFM in Minnesota.
The rare condition, which attacks the nervous system, is not contagious from person to person but may be spread by a virus or the likes of mosquito bites . It can impair muscle reflexes and cause weakness in arms and legs.
“Much like survivors of polio, they may have a limp, they may not be as coordinated as they were,” said Dr. Amesh A. Adalja, a Pittsburgh-based infectious disease specialist and senior scholar at the Johns Hopkins Center for Health Security. “Some people don’t get back to their baseline. You may get some partial recovery, but most people are going to have deficits that may last for their lifetime.”
In the most severe cases, AFM “can also paralyze the diaphragm and lead to respiratory failure” and even death, said Adalja. He said it’s important to seek immediate medical attention if a respiratory illness is causing prolonged difficulty in breathing.
Early response typically involves efforts to figure out the cause, using IV fluids to keep patients hydrated and beginning physical therapy and rehabilitative care. Patients whose respiratory muscles are impacted may require help breathing.
“There are some experimental therapies, but none of them have been proven to work definitively,” Adalja said. “That’s something that’s going to be done on a case-by-case basis. There’s nothing that’s been proven to halt to progression,” often forcing patients to wait it out before knowing how bad their paralysis and other muscle deficits may be.
Though officials have observed a rise in cases since 2014, the origins of most remain unclear. Potential causes can be viruses, environmental toxins and genetic disorders, the CDC said. They recommend as prevention regular hand-washing, keeping up to date on vaccines and avoiding mosquito bites.
“There’s not one single cause,” Adalja said. “We’re in the middle of respiratory virus season, and in rare cases, these viruses can lead to AFM.”
There are likely multiple genes involved in why ubiquitous cold and flu-like viruses lead to the rare complication in a tiny number of instances, whereas most people will fight off the same initial virus without ever contracting AFM, Adalja said. It’s more common in children in part because “children tend to have more respiratory viruses in general.”
“It may reflect that this is caused by a viral infection, and it may be one that a specific virus that has proclivity to cause AFM is circulating in Minnesota,” he said. “It’ll take some time to try and untangle the cause.”
The last major AFM outbreak — 120 cases across 34 states in 2014 — coincided with a sharp rise in severe respiratory illnesses caused by enterovirus D68.
This year, the CDC has observed 38 confirmed cases in 16 states, the federal agency said in an update last week.
The CDC must review case information to confirm the cases under observation in Pittsburgh, a process which could take a few weeks, said Allegheny County Health Department spokesman Ryan Scarpino.
There were no immediate reports of cases elsewhere in Pennsylvania. Allegheny Health Network has seen no recent AFM cases, spokesman Doug Braunsdorf said.