- A young child shows
up to the medical office with a basic upper respiratory illness, stuffy nose, sore throat, mild fever. Five days later, they're paralyzed. This is happening across
the United States, and I want to talk about it on this week's Wednesday Checkup. (dramatic music) A five-year old girl and her parents come to a family medicine doctor's office for a typical, run-of-the-mill
upper respiratory infection. In fact, the only reason the parents are bringing the child in
is because they wonder, should she get antibiotics or not? In taking the child's history, we find out that the young girl has had a sore throat, a dry, non-productive cough, and some runny nose
for about a day or two. There's been no fever
that's been recorded, but the child has felt warm
and sweaty at certain times, maybe slightly decreased appetite,
decreased activity level. But, overall, the child is
still playful, feeling well, maybe a little bit fatigue. On physical exam, the child
has a high temperature but not a fever because we classify fever as 100.3 or higher, and
the child has a temperature of about 99.9, which isn't
normal but not yet a fever. The ears look totally normal,
not red, not infected. The throat, mildly red, no white spots, no signs of outward bacterial infection. The sinuses are non-tender. There is some runny nose, but it's clear, it's not green or overly mucousy. The child's lungs are
clear, there's no pneumonia. The stomach is soft, it's not tender. The reflexes are all totally normal. And what the doctor figures
out from the situation is that the child is suffering from an upper respiratory
infection because of a virus. Knowing that this condition
is caused by a virus and not a bacteria, the doctor
recommended a few things. First and foremost, no antibiotics because they don't work on viruses. He recommended rest,
hydration, nasal saline to rinse out the sinuses,
over-the-counter medications to keep the child comfortable,
and the magic bullet, green tea and honey to
control that nighttime cough. The parents were very
happy with this plan. They rated the doctor
five out of five stars, and they went home, and the child started
to get better each day. However, on day six, the
child suddenly developed arm and leg weakness, very
significant arm and leg weakness, so much so that they called
the doctor's answering service. The on call doctor calls
back, hears the whole history, the child had a mild respiratory
virus, five days later it developed this arm and leg weakness, and immediately told the mother, "Ma'am, you need to bring your child "to the emergency room
right now because I'm afraid "your child may have
acute flaccid myelitis." The condition the doctor's
referring to, AFM, has received a lot of
publicity over the last year because it's a frightening proposition for anyone that has
young children at home, and I totally understand that. Look, this is a rare illness,
it's a mysterious illness, but there are things that we do know, and I'd like to discuss them here today. What is AFM? This is a neurological,
polio-like disorder affecting the nerves of the spine that causes muscle weakness,
decreased muscle tone and at times even paralysis. It most commonly affects
children around the age of five. What's scary about this is, if the paralysis affects
the respiratory muscles, the child can stop breathing. Because of this, the CDC
states that 98% of patients who have this condition
end up hospitalized, with more than half ending
up in intensive care units. The scariest part of all of
this is that both the CDC and doctors don't yet
know what causes AFM. We do have a strong
suspicion that it's related to these mild respiratory viruses that come a week prior to
the child developing AFM. We've also noticed that,
in areas of the country where these respiratory virus are spiking, we also see higher rates of AFM. The prime suspect at this
moment is enterovirus D68. Normally, when children are
infected with enterovirus D68, they have some mild
respiratory viral symptoms, or they can be asymptomatic altogether, and most don't develop AFM. But some do, and we don't
know the reason as to why. You might be wondering, what's the prognosis of
this type of condition? To be honest, they're not that great. About 70 to 80% of children
who are diagnosed with AFM months later will still have
some level of residual weakness despite our best efforts at treatment. But why now? Is this like a newly discovered
condition or something? No, AFM has been around sporadically, but in 2014 the CDC had
noted a global epidemic of it with the spiking cases here in the U.S. We have noticed a
pattern to this disorder, where it spikes between
August and October, which is really interesting 'cause August is starting right now. And it spikes every other year, so in 2014 there was a spike in cases, then in 2015 it kind of leveled off. 2016, spike, 2017, it kind of leveled off. In 2018 last year, it was
the biggest ever spike and the most cases ever
recorded with about 230 cases, bringing up the total
today to just around 600. So what do we do if a child is brought into the hospital
and diagnosed with AFM? This is where things get tricky. Because we don't quite yet know the cause, it's difficult for us to
recommend a foolproof treatment. If you visit the CDC website
as a medical professional to get advice on what you should do with a child who has AFM,
there's no good evidence. There's things that we
do do for these children because they work in other
neurological conditions, like steroids, immunotherapy, plasmapheresis, all
these medical treatments. But none of them have great evidence. The only thing that
seems to work very well is early intervention for
occupational and physical therapy. What we're actually
doing is having the child retrain their nerves and muscles so that they can function
effectively once again. I mentioned earlier that, even though this is supposed
to be an off year for AFM, and we're not supposed to see a peak, we still should be on the
lookout for certain symptoms. And that's because the
earlier we can get a child to the hospital with AFM,
not only does the child fare better, but we can get better samples that we can then send to
the CDC for future research. Symptoms you should be on the lookout for when it comes to AFM is
difficulty moving the eyes or drooping eyelids,
facial droop or weakness, difficulty with swallowing
or slurred speech, or sudden arm or leg weakness. When doctors obtain samples
from their patients, they automatically request
consent from these patients to send them to the CDC
for future research. Actually, the NIH just gave the University of Alabama
Birmingham a $10 million grant to study the natural history
and progression of AFM. So, how do we protect ourselves
and children from AFM? Well, first, you have to understand that, while we suspect that
there's a viral component, this isn't a contagious
illness in a sense that, if a child has AFM and your
child interacts with them, that means they're gonna get it. That's not how this works. This is a sequela or a
complication of the virus. So just by following some simple steps, you can protect yourself from viruses, which then will protect you from the complications of
these viruses, such as AFM. Those steps being practicing
good hand hygiene, always washing your hands. Avoiding touching your face. Washing and disinfecting
commonly used surfaces. Practicing good cough and
sneeze hygiene, dap, dap. If you're sick or your child
is sick, please stay home. And, most importantly,
vaccinate yourselves and your children because,
when you get vaccinations, you protect yourselves from the viruses that can cause complications and kill. In fact, the reason why we
give the measles vaccine, for example, is not necessarily
to protect you from measles. It's to protect you from the
complications of measles. Actually, there's an
interesting fact to be had here. Polio had complications that
were very similar to this, where children were becoming paralyzed, not being able to move their
arms and legs, and guess what? Polio was eradicated
because of vaccinations. If you have any outstanding
questions about AFM, I'm gonna drop some reading links down below in the description, and please feel free to jump
into the comment section. You know I'm quite active there. And don't forget, tomorrow
night, Chasing the Cure Live is premiering on TNT and TBS,
or you could stream it online, 9:00 p.m. Eastern Standard Time, 6:00 p.m. Pacific, August 8. See you there 'cause I'm
gonna be watching it also. As always, stay happy and healthy.
