201 people, mostly young kids, developed a polio-like
condition known as acute flaccid myelitis (AFM) in 2018, as per US Centers for
Disease Control (CDC) who still does not have a prime suspect. This number may
well increase, as it can take long to confirm a suspected case.
AFM resembles polio, is likely caused by a virus.
Coxsackievirus A16, EV-A71, and EV-D68 viruses have been
isolated in the spinal fluid of four of 527 confirmed cases of AFM since 2014.
No pathogen has been detected in the spinal fluid in other cases.
Also, it is not easy to isolate a virus in patients who
are not acutely infected. AFM often appears as an infection wanes, and it can take
days for doctors to suspect the condition and start testing.
More than 80% of patients have had fevers and respiratory
illnesses of some sort. EV-A71 and EV-D68 both cause respiratory infections.
Coxsackievirus A16 causes hand, foot and mouth disease. Several patients have
also had rhinovirus, which causes the common cold.
It is also unclear whether a virus is directly attacking
nerves, as poliovirus does, or is causing an autoimmune reaction, as seen in
Guillain-Barré syndrome.
No deaths have been reported but some of the patients are
severely disabled.
The last case of polio from India was reported in the
year 2011; the non-polio acute flaccid paralysis (NPAFP) rate in India was
13.35/100,000 in this year, which was much higher than the expected rate of
1-2/100,000. Some states had a higher rate of NPAFP than others. In 2011, the
NPAFP rate in UP was 25/100,000; in Bihar, the rate was 35/100,000 (Int J
Environ Res Public Health. 2018;15(8):pii:E1755).
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical
Associations in Asia and Oceania
(CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA
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