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Expand chart
Adapted from a CDC chart; Chart: Axios Visuals

Top U.S. disease experts shared commentary in MBio on Tuesday that acute flaccid myelitis (AFM), the rare illness that strikes mostly young children and causes limb weakness or paralysis, may be caused by a "hit and run" virus and could become more prolific — but research acceleration is needed to know more.

Why it matters: Researchers have been seeking the elusive cause of the illness — which rarely leaves traces of any causative agent in the spinal fluid as expected — since AFM popped onto the national radar as a major outbreak in 2014 and reached a record number in 2018.

What's new: "Circumstantial evidence suggests a strong relationship between [enterovirus D68] and AFM," Anthony Fauci, National Institute of Allergy and Infectious Diseases director and co-author of the commentary, told Axios.

  • The Centers for Disease Control and Prevention published new figures last week on EV-D68 showing a strong increase — of 14%— in detected infections in hospitalized patients in 2018, compared with the prior year of 1%. Detections of EV-D68 peaked in September — the same month that AFM peaked last year.
  • There was a record number of illnesses in 2018 with 228 confirmed cases in 41 U.S. states, and 4 confirmed cases in 4 states this year so far. Most of the children diagnosed had cold-like illnesses with low fevers that got better, but experienced sudden-onset of muscle weakness or paralysis 3 to 10 days later.

But, but, but: Not every year with an uptick in AFM — which so far has been cyclical
with an increase every 2 years — has also correlated with EV-D68, although it's been a prime suspect. Among others, enterovirus A71 has also been a suspect.

  • The authors suggest there could be a "hit-and-run infection" by EV-D68 or another virus, which may have run its course but triggered an immune response or caused other effects. Then it's the paralyzing event that demands testing of blood, stool or spinal fluid, at a point when the virus is out of the patient's system.
  • Another possibility is we could be "entering some kind of new epidemic era" of viral mutations, they write.

What's next: Research is continuing into both the causes and treatments, for which the CDC has interim guidelines.

The bottom line: While there's "significant suggestion" that EV-D68 plays a role in AFM, it's "very frustrating when you don't know the etiology of the infection," Fauci says. In the commentary, the scientists wrote...

"Watching healthy children become permanently paralyzed virtually overnight by a seemingly random, lightning-strike disease is as heartbreaking today as it was in the polio era."
"The trajectory of AFM over the past 5 years suggests that the problem is getting worse, and so it is critical that we galvanize our efforts to learn more about, and respond adequately to, this ubiquitous, often crippling, continually reemerging group of viruses."

Go deeper:

Go deeper

Updated 2 hours ago - World

Biden reviews U.S. arms deals with Saudi Arabia and UAE

Trump struck several large arms deals with Mohammed bin Salman (L) and Saudi Arabia. Photo: Kevin Dietsch-Pool/Getty Images

The Biden administration has put on hold two big arms deals with Saudi Arabia and the United Arab Emirates which were approved in the final weeks of the Trump administration, a State Department official told Axios.

Why it matters: The sales of F-35 jets and attack drones to the UAE and a large supply of munitions to Saudi Arabia will be paused pending a review. That signals a major policy shift from the Trump era, and may herald sharp tensions with both Gulf countries.

Trump supporter found with pipe bombs accused of plot to attack Democrats

Five improvised explosive devices that the FBI says "were fully operational and could cause great bodily harm or injury if handled improperly." Photo: FBI/Justice Department

The FBI believes California Gov. Gavin Newsom (D) and the Bay Area headquarters of Twitter and Facebook were targets of a man facing federal explosives charges, according to a criminal complaint.

Driving the news: Prosecutors charged Ian Benjamin Rogers after finding weapons including five pipe bombs, 49 guns and thousands of rounds of ammunition following a Jan. 15 search of his Napa County home and auto repair business. His alleged goal was to ensure former President Trump remained in office.

6 hours ago - Health

Fauci: COVID vaccine rollout needs to prioritize people of color

Anthony Fauci. Photo: Alex Wong via Getty Images

Infectious disease expert Anthony Fauci highlighted the need to address racial disparities in the COVID-19 vaccination process, per an interview with The New England Journal of Medicine on Wednesday.

What he’s saying: "I think that's the one thing we really got to be careful of. We don't want in the beginning ... most of the people who are getting it are otherwise, well, middle-class white people."