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Mysterious Polio-Like Illness Paralyzes 20+ Kids in California

Feb 25, 2014

Mysterious Polio-Like Illness Paralyzes 20+ Kids in California

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 A rare “polio-like syndrome” has caused paralysis in about 20 children from across California, according to a report released Sunday by physicians in the San Francisco Bay Area.

The children, who are between the ages of 3 and 12, developed what is called acute, or sudden, flaccid paralysis — weakness or loss of muscle tone resulting from injury or disease of the nerves that stimulate muscles to move.

Although polio has been wiped out across most of the globe, other viruses can injure the spine, causing paralysis, said Dr. Keith Van Haren, author of the case report and a pediatric neurologist at Lucile Packard Children’s Hospital, at Stanford University. The children who have been affected seem to have been permanently paralyzed, he said.

Van Haren said these cases suggest there is a possibility of a new infectious polio-like syndrome in California.

The illness is not polio. All the victims had been immunized against polio and tested negative for the presence of the disease, Van Haren explained. And the disease is rare. “It’s not an epidemic,” he said. “But it is something that is concerning.”

The culprit could be a virus strain called enterovirus-68 that has been linked to polio-like outbreaks in children in Asia and Australia, Van Haren said. But not all of the victims tested positive for that virus, so the cause of the disease is still unclear.

Some of the children had respiratory or other illnesses before developing muscle paralysis, but for others muscle weakness was the first symptom.

Van Haren said some victims suddenly developed weakness of one or more limbs within about 48 hours of becoming sick. MRI scans showed worrisome changes in the gray matter of the spinal cord.

To help them more effectively fight the disease, the children were given steroids, intravenous immunoglobulin and/or blood plasma exchange — without improvement, according to the authors of the case report.

How was the mysterious illness discovered? Van Haren said that after he cared for four of five of the first cases that appeared in 2012, he realized the children’s illnesses and resulting paralysis were highly unusual. He notified the California Department of Public Health, which has helped monitor the outbreak since.

Van Haren and his team reviewed all five polio-like cases among children whose lab samples had been referred to California’s Neurologic and Surveillance Testing Program from August 2012 to July 2013. He has now included the data from about 15 additional cases reported since then, which he’ll be presenting at the American Academy of Neurology annual meeting, held April 26 to May 3 in Philadelphia.

Flaccid paralysis — unlike measles or pediatric flu deaths, for example — is not considered a disease or condition that must be reported to county or state health departments or national agencies like the U.S. Centers for Disease Control and Prevention.

Because there is no reporting requirement, the scope of the problem is still hard to assess, explained Dr. Carol Glaser, chief of encephalitis and the special investigations section in the California Department of Public Health. “We do not know whether these cases represent an increase in cases over what usually occurs or even if cases are an ongoing or isolated occurrence,” she said.

Glaser also pointed out that the California Department of Public Health has not yet identified a common cause for the cases. “At this stage, CDPH has asked health care providers to report any polio-like cases they might identify and send specimens so that we can better assess the situation,” she said.

On a national level, the CDC also cannot know for sure whether there are more cases of this polio-like syndrome than they have heard about, or to what event the illness may be appearing in other states. “It’s hard to know if five or 20 cases in the course of a year or two are significant,” said Jason McDonald, CDC spokesperson. “Acute flaccid paralysis can be the result of a variety of viral and non-viral causes.”

Parents who notice a sudden onset of weakness in their children should see their pediatrician right away, Van Haren advised. Physicians in the state should notify the California Department of Public Health any time they see a child with acute flaccid paralysis that is not due to diseases that affect the nervous system, such as botulism or Guillain-Barre syndrome, he added.

For her part, Glaser emphasized that only a very small number of cases have been identified, with no clear common cause. “Health care providers have been asked to send information about similar cases so that we can determine whether or not there is anything unusual about these cases,” she said.

Because this case review has not yet been published in a peer-reviewed journal, the data and conclusions should be viewed as preliminary, CDC’s McDonald cautioned.

More information

Learn more about non-polio enteroviruses from the U.S. Centers for Disease Control and Prevention.

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Comment by DR.MOHAN SHARMA on February 27, 2014 at 10:10pm

This is very alarming and great set back to all the global efforts to get rid of polio from the world.If symptoms and complications are same,then world will need extended efforts to erradicate it.I hope and wish it is just endemic and can be brought under control.
Thank you for posting this to spread awareness.

Comment by Dr. Mercedes R. Entienza on February 27, 2014 at 6:42pm

Doc, the cause of the disease is still unclear up to this date.

But they associate this to  a virus called enterovirus-68 which produces a polio-like syndrome.

More data and samples were being gathered to determine what really causes these syndrome.

Will just keep you posted if final diagnosis is establish.

Comment by DR.MOHAN SHARMA on February 27, 2014 at 5:45pm

What is the final diagnosis? Please let us know.

Comment by Dr. Mercedes R. Entienza on February 25, 2014 at 2:24pm

Yes, Ma'am I have visited and liked Helpmedico Australia.

God bless you!

Comment by Noela on February 25, 2014 at 1:56pm

I was very interested in your post because I had just written a short statement on my FB page about immunisation and polio:

I really shudder when I see anti vaccination lobbyists advocate for discontinuing vaccines for children.. Obviously they were not around when polio was an epidemic in Australia.

Polio

Stopping vaccination against polio will leave people susceptible to infection with poliovirus. Polio causes acute paralysis that can lead to permanent physical disability and even death. Before polio vaccine was available, 13,000 to 20,000 cases of paralytic polio were reported each year in the United States. Annual epidemics of polio often left victims—mostly children—in braces, crutches, wheelchairs, and, in serious cases, iron lungs. Many of the children that survived experienced life-long consequences from the disease.

In 1988, the World Health Assembly unanimously agreed to eradicate polio worldwide. As a result of global polio eradication efforts, the number of cases reported globally has decreased from more than 350,000 cases in 1988 to 187 cases in 2012 (as of November 14, 2012). Only three countries remain endemic for polio in 2012: Afghanistan, Nigeria, and Pakistan. Stopping vaccination before eradication is achieved would result in a resurgence of this preventable disease and threaten future generations of children.

I would like to add you as a friend on my site Helpmedico Australia..Please visit and "like". You are welcome to write comments and articles etc..The page is for the general populace rather than just Med students and we are still in our infancy.

Comment by Dr. Mercedes R. Entienza on February 25, 2014 at 1:28pm

You're welcome Ma'am Noela!

Comment by Noela on February 25, 2014 at 1:20pm

Thank you for posting this information Dr Mercedes.

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