AFM Resurgence: Rise of Enterovirus D68 Sparks Concerns in US

A resurgence of Acute Flaccid Myelitis (AFM), a viral illness that can cause paralysis in children, is causing concern in the United States. This renewed emergence follows an increase in enterovirus (EV) D68 cases in recent years, though official counts remain relatively low in 2024. While EV-D68 commonly leads to mild respiratory infections, scientists uncovered a link between the virus and AFM over a decade ago.

Understanding the Connection: EV-D68 and AFM

The primary symptom of AFM is the abrupt onset of weakness in the limbs. Patients may also experience facial weakness, difficulty speaking, and pain throughout their body and back. In more severe cases, AFM can result in permanent paralysis or even respiratory failure. This debilitating condition is linked to EV-D68, a virus related to polio, which can also cause paralysis in a small percentage of individuals.

Researchers have determined that certain strains of EV-D68 have evolved to resemble the polio virus more closely, increasing the likelihood of developing AFM. This evolutionary shift explains the potential for severe complications associated with EV-D68 infection.

The Rise of EV-D68 and AFM

While AFM cases remain relatively low, both EV-D68 and AFM appear to be on the rise. Data from WastewaterSCAN, a program that uses wastewater analysis to monitor disease outbreaks, reveals a substantial increase in the presence of EV-D68 in the US since early August. This method has proven effective in providing early warnings of infectious disease outbreaks, as seen during the COVID-19 pandemic.

Historically, EV-D68 outbreaks typically peak in the US during the summer and fall months. “We are detecting EV-D68 nucleic acid in wastewater across the country now, and the levels are increasing,” said Alexandria Boehm, director of the WastewaterSCAN program. This data underscores the importance of monitoring and preparedness as the virus's resurgence unfolds.

Key Considerations for AFM Outbreak

Symptoms of AFM

• Sudden weakness in the limbs
• Facial weakness
• Slurred speech
• Pain throughout the body and back

Causes of AFM

AFM is caused by infection with enterovirus (EV) D68, specifically mutated strains that resemble polio.

Polio Connection

EV-D68 is related to the polio virus, and some strains have undergone genetic changes to resemble polio more closely. This resemblance explains the potential for paralysis associated with AFM.

Severity of AFM

In the most severe cases, AFM can lead to permanent paralysis or respiratory failure. The severity of the condition can vary depending on the individual and the strain of EV-D68 involved.

Monitoring AFM

Wastewater data is being used to track the spread of EV-D68 and provide early warnings of AFM outbreaks. This surveillance system allows public health officials to identify potential hot spots and respond swiftly to potential outbreaks.

Prevention of AFM

While there is no specific treatment for AFM, early diagnosis and supportive care can help manage symptoms and improve outcomes. Good hygiene practices, such as frequent handwashing and covering coughs and sneezes, are crucial in preventing the spread of EV-D68 and reducing the risk of AFM.

Although AFM is a serious condition, it remains relatively uncommon. If you or your child experience any symptoms of AFM, contact your doctor immediately. Early intervention is key to managing the condition and minimizing potential long-term effects.