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Several children’s hospitals across Canada are reporting cases of acute flaccid myelitis, an illness that mostly affects children and can cause paralysis of the limbs.
Toronto’s Hospital for Sick Children has seen about a dozen confirmed cases since the beginning of September, said Dr. Jeremy Friedman, associate pediatrician-in-chief at SickKids. Normally, they see maybe one case a year.
The Montreal Children’s Hospital has had three cases in the last month and one during the summer. The Children’s Hospital of Eastern Ontario (CHEO) in Ottawa has also had two cases since midsummer. Both hospitals say this is unusual.
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The B.C. Children’s Hospital said that it has not had any cases of AFM or related illnesses.
“This is certainly a rare but pretty serious condition that affects the nervous system,” said Friedman.
Typically, patients begin with non-specific symptoms that might resemble the common cold, said Sunita Venkateswaran, a pediatric neurologist at CHEO.
“Then they can develop a bit of a headache or neck pain, fever. Things that are very non-specific, again. And then they get the rapid onset of limb weakness. That could mean weakness in one limb, more than one limb; there’s no rhyme or reason why one patient presents one way versus another.”
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The illness can be serious — one of the patients at the Montreal Children’s Hospital is currently on a ventilator, according to Dr. Christos Karatzios, an infectious disease specialist at the hospital.
“She’s awake, but she’s pretty much paralyzed,” he said.
Another child has since gone home and is doing relatively well.
Patients can also lose function in one or more of their limbs and sometimes lose control of muscles in the trunk or neck. AFM’s symptoms resemble those of polio.
Children with acute flaccid paralysis at CHEO are treated with steroids, intravenous immunoglobulin and plasma exchange, Venkateswaran said.
“The majority of cases have some recovery. But once again, you cannot predict who is going to recover completely versus who is going to recover partially.”
In Toronto, recovery has been variable, said Friedman.
“What we’ve seen so far is a sort of spectrum, with some kids getting better quite nicely and quite quickly and then others showing some nice signs of improvement but not getting entirely back to normal,” he said. “And then, in a smaller group, we’ve seen some kids that are actually very slow to show any signs of improvement.”
However, Friedman said, it’s still very early to say how well these children will recover, as it might simply take time.
First spike since 2014
Friedman noted that there was a similar spike in the summer and late fall of 2014, when the cases appeared to be connected to infections with enterovirus D68. This is the first spike that hospitals in Toronto, Ottawa and Montreal have noticed since then.
According to the Public Health Agency of Canada, 25 probable cases and five confirmed cases of sudden-onset muscle weakness in children have been reported in Canada so far this year, which can stem from a variety of conditions, not just AFM.
This is a bit at odds with what hospitals are reporting. In a statement, PHAC said: “Currently, the surveillance data do not indicate an increase in the number of potential cases in Canada.”
American hospitals are also seeing a higher-than-normal number of cases. In a press briefing last week, the U.S. Centers for Disease Control said that they have seen 62 confirmed cases of AFM this year. There has been one death so far.
Researchers don’t know exactly what causes the illness, though it is likely associated with a viral infection.
“We don’t know who may be at higher risk for developing AFM or the reasons why they may be at higher risk. We don’t fully understand the long-term consequences of AFM,” said Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases.
“We don’t have a consistent cause. There is no way to prevent this,” Venkateswaran said.
However, doctors say parents shouldn’t be worried.
“I don’t think there is any cause for alarm. This is still an incredibly rare condition,” said Friedman. “Across North America, the risk for a child to get AFM is quoted as about one in a million. It’s a really, really rare condition.”
Even though these cases are an unusual spike — making its incidence higher than one in a million — it’s still very rare, he said. Friedman, Karatzios and Venkateswaran all said that parents should not be alarmed.
“Not everybody who gets infected by one of these viruses goes on to develop paralysis,” said Karatzios.
However, if your child displays any limb weakness or paralysis, you should immediately seek medical attention — whether or not it ends up being related to AFM.
In case there is a link to a viral infection, PHAC recommends that Canadians take the same precautions recommended for every cold and flu season.
“This includes frequent hand washing, sneezing into the bend of your arm, as well as cleaning and sterilizing common surfaces and objects,” PHAC said.
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