Following a reported spike of cases in the U.S. this year, it has been revealed that more than two dozen Canadian children are also believed to have developed a rare and mysterious paralyzing illness known as acute flaccid myelitis (AFM). Health officials, however, still do not know what causes the polio-like condition.
鈥淭o date in 2018, 25 probable cases and 5 confirmed cases of sudden onset muscle weakness in children have been reported,鈥� Public Health Agency of Canada (PHAC) spokesperson Anna Maddison told 麻豆影视 in a written statement. All of those children are under the age of 15.
鈥淐urrently, the surveillance data do not indicate an increase in the number of potential cases in Canada,鈥� Maddison said.
Dr. Jeremy Friedman, pediatrician-in-chief at Toronto鈥檚 Hospital for Sick Children, however, says he has seen about a dozen confirmed cases since the beginning of September. That鈥檚 up from an average of one or two cases per year at the hospital.
鈥淚t certainly is a spike or a cluster of cases,鈥� he told 麻豆影视. 鈥淲e鈥檙e not entirely sure what seems to be setting this off.鈥�
This year, other AFM cases have been reported in Montreal, Ottawa, London, Ont. and the western provinces.
鈥淯nanswered questions are always unsettling,鈥� Dr. Friedman said.
鈥淒RAMATIC DISEASE鈥�
According to the (CDC) in the U.S., while AFM 鈥渋s rare鈥� it can also 鈥渓ead to serious neurologic problems.鈥�
AFM, the CDC explains, affects the spinal cord and nervous system and leads to polio-like symptoms -- such as muscle weakness or paralysis in the face, neck, back, arms or legs -- approximately one week after a fever and respiratory illness.
鈥淲hen we talk about acute flaccid myelitis, or AFM, what we鈥檙e basically talking about are children that present with a sudden onset of weakness or paralysis of one limb,鈥� Dr. Friedman added. 鈥淲hat we find is it鈥檚 often in conjunction with a viral illness, and when you do investigations and you do an MRI of the spinal cord, there鈥檚 a very distinctive abnormality in what we call the grey matter or the anterior horn cell of the spinal cord.鈥�
According to the CDC, approximately 90 per cent of those affected in the U.S. are children under the age of 18. Their average age is four. Most, the CDC says, fully recover.
The CDC has documented a significant spike in cases this year. So far in 2018, there have been 62 confirmed cases in 22 U.S. states while 93 more potential cases are currently under investigation. There has also been one death.
The illness, CDC data also shows, appears to occur in biennial waves. In 2017, for example, there were only 33 confirmed AFM cases in the U.S. while in 2016 there were 149. Reported cases tend to spike in August and September.
Similar historic data is not available in Canada.
Speaking to reporters on Oct. 16, Dr. Nancy Messonnier, who directs the CDC鈥檚 National Center for Immunization and Respiratory Diseases, described AFM as a 鈥減retty dramatic disease.鈥�
"This is a mystery so far," she said, according to The Associated Press.
The CDC believes that AFM is linked to a virus. So far, the poliovirus and the West Nile virus have both been ruled out. Enteroviruses -- which are a genus of predominantly respiratory germs -- are a potential culprit, though they have not been present in all documented AFM cases.
Graphic by Nick Kirmse (CTVNews.ca)
鈥淚T STARTED WITH A HEADACHE鈥�
In Montreal, there have been six recent confirmed AFM cases. One of those involves four-year-old Genevieve Blais of Gatineau, Que., who is currently receiving treatment at the Montreal Children's Hospital.
鈥淚t started with a headache,鈥� her father, Nicolas Blais, told 麻豆影视 from the hospital as Genevieve sat harnessed to a chair beside him.
When Genevieve developed a fever soon after, she was taken to hospital where she received antibiotics.
鈥淭he next day, Genevieve tried to get up and she was falling all over the house,鈥� Blais recalled. 鈥淪he could no longer walk.鈥�
The once-active girl is now in hospital, 鈥減aralyzed from head to toe,鈥� according to her father. She spends much of the day on a ventilator and improvements have been slight.
鈥淣ow she moves her hands a little, but cannot raise them or move her legs,鈥� Blais said. 鈥淗er neck falls from side to side and sometimes it falls forward.鈥�
The experience, he added, has been incredibly frightening.
鈥淚t is so hard to describe how we feel,鈥� Blais said. 鈥淚f she is going to walk again, it will be after some time. There is nothing else we can do but hope that she gets better with time.鈥�
Dr. Christos Karatzios from the hospital鈥檚 division of infectious diseases is part of the team overseeing Genevieve鈥檚 care.
鈥淯nfortunately, right now there is no established treatment,鈥� he told 麻豆影视. 鈥淭he treatment is supportive. Patients, if they can鈥檛 breathe, they are supported with ventilator鈥� If they cannot feed themselves, then they may be fed either through the nose or through the mouth with a tube down directly into the stomach鈥� (And) there are patients being treated with high dose steroids or intravenous antibodies.鈥�
According to Dr. Friedman in Toronto, Canada experienced a similar 鈥渃luster鈥� of AFM cases in 2014.
鈥淲hile there was improvement in most of those cases, there were a few cases where children were left with permanent neurological disabilities,鈥� he said.
Dr. Friedman adds that there continues to be a 鈥渟pectrum鈥� of treatment outcomes.
鈥淲e are treating all the children with various types of immune medications that try and decrease the swelling in the spinal cord,鈥� he explained. 鈥淪ome children are getting better quite quickly, some children are getting better more slowly and there have been a few children who actually still have not shown signs of improvement at this point.鈥�
鈥淭HE RISK IS STILL EXTREMELY LOW鈥�
As scientists work to learn the cause of AFM, the PHAC is urging Canadians to take the same precautions they do during cold and flu season, such as regularly washing their hands and sterilizing common surfaces and objects.
The PHAC, Maddison added, 鈥渋s enhancing real-time surveillance of sudden onset muscle weakness among Canadian children鈥� and 鈥渃losely monitoring this issue in collaboration with the provinces and territories.鈥�
And while Dr. Friedman is urging Canadian parents to be vigilant, he also insists that there is still no cause for alarm as AFM remains 鈥渁n incredibly rare condition.鈥�
鈥淭he health authorities estimate that the risk for children is about one in a million,鈥� he said. 鈥淎nd even if we do have a little bit of a cluster of cases at the moment, the risk is still extremely low in the general population.鈥�
With files from 麻豆影视 Medical Correspondent Avis Favro and Producer Elizabeth St. Philip, 麻豆影视 Montreal Bureau Chief Genevieve Beauchemin, The Canadian Press and The Associated Press.
