A rare condition known as acute flaccid myelitis (AFM) has been spreading across the U.S. Although it’s still very rare, affecting less than 1 in 1 million Americans each year, the U.S. Centers for Disease Control and Prevention (CDC) is monitoring what appears to be an increasing trend in this polio-like disease.¹

AFM targets the nervous system, including the spinal cord, leading to weakness in the arms and/or legs and loss of muscle tone and reflexes. In some cases, the condition may also cause difficulty swallowing, slurred speech and an inability to urinate. In the most severe cases, respiratory failure can occur if the muscles involved in breathing become weakened, requiring a ventilator for the person to breathe.

“In very rare cases, it is possible that the process in the body that triggers AFM may also trigger other serious neurologic complications that could lead to death,” the CDC noted. Currently, there is no cure for AFM so treatment involves supportive care. Most cases involve children and while some have recovered completely, others are faced with long-term disabilities including ongoing paralysis that requires continued care.

Cases of AFM Polio-Like Illness on the Rise

AFM has been making media headlines in recent weeks, but the condition has actually been quietly rising for years. From August 2014 to September 2018, the CDC received reports of 386 confirmed cases of AFM in the U.S. Broken down, this amounts to:²

• 62 confirmed cases so far in 2018 (as of October 16), spread across 22 states
• 33 confirmed cases in 2017, across 16 states
• 149 confirmed cases in 2016, across 39 states
• 22 confirmed cases in 2015, across 17 states
• 120 confirmed cases from August to December 2014, across 34 states

It should be noted that the CDC is currently investigating nearly 130 possible AFM cases with onset of symptoms in August and September 2018. The 62 confirmed cases for 2018 are among these reports, but it’s possible the number may rise considerably in the coming months. At this point, there are more questions than answers surrounding AFM and its causes.

The CDC admits they don’t know what’s causing the increase, who may be at a higher risk or what the long-term effects may be. What they have found so far is that most cases seem to mimic symptoms found in various viral illnesses, including polio virus, nonpolio enteroviruses, adenoviruses and West Nile virus.

That being said, specimens (stool, blood and cerebrospinal fluid) tested from AFM patients have so far been negative for polio virus and no pathogens have been consistently detected in spinal fluid.

When the illness first spiked in 2014, it was around the time of an outbreak of respiratory illness caused by enterovirus (EV) D68, another “polio-like virus” that was associated with paralysis. However, according to the CDC, “Among the people confirmed with AFM, CDC did not consistently detect EV-D68 in every patient.”³

Could Vaccines Be Involved in ‘Provoking’ AFM?

In 2015, Dr. Allan Cunningham, a retired pediatrician from New York, wrote an intriguing analysis to the BMJ, asking “Do we need a new approach to making vaccine recommendations?”⁴ He was specifically referring to the “U.S. mystery of acute flaccid myelitis,” which at the time was just over 100 cases in 34 states, alongside a spate of more than 1,100 cases of EV D68, the latter of which did not seem to be the overriding cause.

He brings up an important phenomenon, however, known as provocation poliomyelitis, which describes the increased risk of neurological complications known to occur if a person with a polio virus infection receives an injury to a skeletal muscle, which could include an injection from a vaccine. As noted in the Journal of Virology:⁵

“Skeletal muscle injury is known to predispose its sufferers to neurological complications of concurrent poliovirus infections. This phenomenon, labeled ‘provocation poliomyelitis,’ continues to cause numerous cases of childhood paralysis due to the administration of unnecessary injections to children in areas where poliovirus is endemic.

Recently, it has been reported that intramuscular injections may also increase the likelihood of vaccine-associated paralytic poliomyelitis in recipients of live attenuated poliovirus vaccines.”

What’s more, in most cases polio is a mild illness, causing sore throat, low-grade fever, fatigue, nausea and other flu-like symptoms that disappear in two to 10 days. Often, polio can occur and show no symptoms at all.

It’s only in 1 to 2 percent of cases that polio virus invades the central nervous system, resulting in paralysis.⁶ This means some people receiving vaccinations could have an underlying polio infection and not even know it.

Risk of Paralytic Polio Increased Twentyfold Among Children Who Received DPT Vaccine

Of note, polio is only one type of enterovirus. There are more than 100 nonpolio enteroviruses, most of which are mild but some of which can infect the central nervous system and cause serious illness, including paralysis.

“Enteroviruses are the most prevalent viruses in the world,” according to the European Centre for Disease Prevention and Control,⁷ which means it’s likely that some children receiving vaccinations are probably infected with an enterovirus at the time of the injection, perhaps displaying no symptoms or only mild fever or flu-like symptoms (and many physicians see no problem with vaccinating a child who is mildly ill).

Is it possible that provocation poliomyelitis could occur in children vaccinated while infected with a nonpolio enterovirus? It’s a question that deserves a closer look. As Cunningham explained:⁸

“It is taboo to suggest a role for vaccines, but some old-timers remember ‘provocation poliomyelitis’ or ‘provocation paralysis.’ This is paralytic polio following intramuscular injections, typically with vaccines.

PP was most convincingly documented by Austin Bradford Hill and J. Knowelden during the 1949 British polio epidemic when the risk of paralytic polio was increased twentyfold among children who had received the DPT injection … Similar observations were made by Greenberg and colleagues in New York City; their literature review cited suspected cases as far back as 1921.”

As it stands, the CDC only states, “AFM or neurologic conditions like it have a variety of causes such as viruses, environmental toxins and genetic disorders.”⁹ However, according to Cunningham, “AFM may result from a direct virus attack on the spinal cord, or by an immune attack triggered by a virus, or by something else. If a polio-like virus is circulating in the U.S., the possibility of its provocation by one or more vaccines has to be considered.”¹⁰

Vaccine-Strain Polio Is Circulating the Globe

The spread of vaccine-derived disease, including polio, is often absent in talks about vaccine safety, but it’s another topic worthy of discussion — and research. Wild type polio was declared eradicated in the U.S. in 1979 and in the Western Hemisphere in 1994.¹¹ But despite widespread annual polio vaccine campaigns targeting Asia, Africa and the Middle East, the wild type poliovirus is still circulating.

The Global Polio Eradication Initiative slated 2018 as the year polio would be eradicated from the Earth, but the virus is proving to be harder to outwit than officials would have you believe. Not only are strains of wild poliovirus still circulating in the world, but mutated vaccine-strain polio viruses also circulate. A large part of the problem is the polio vaccine itself, specifically the live oral polio vaccine (OPV).

As of October 9, 2018, there have been 61 reported cases of circulating vaccine-derived polio, compared to 19 cases of wild polio worldwide.¹² Last year, 2017 marked the first year more cases of polio have been caused by vaccine-derived strains than wild or naturally occurring strains.

In Syria alone, 15 children were paralyzed by vaccine-derived polio, according to the World Health Organization (WHO).¹³ Research published in the journal Cell also revealed that the live virus used in the oral polio vaccine can easily mutate and spread through a community.¹⁴ NPR reported:¹⁵

“After a child is vaccinated with live polio virus, the virus replicates inside the child’s intestine and eventually is excreted. In places with poor sanitation, fecal matter can enter the drinking water supply and the virus is able to start spreading from person to person.

‘We discovered there’s only a few [mutations] that have to happen and they happen rather quickly in the first month or two post-vaccination,” [lead study author Raul] Andino says. ‘As the virus starts circulating in the community, it acquires further mutations that make it basically indistinguishable from the wild-type virus. It’s polio in terms of virulence and in terms of how the virus spreads.'”

While news that the oral polio vaccine may be causing polio cases may be surprising to you, it was not at all so to WHO, whose director of polio eradication Michel Zaffran called the vaccine-derived virus outbreaks an expected “hiccup.” He told NPR:¹⁶

“We knew that we were going to have such outbreaks. We’ve had them in the past. We continue to have them now. We know how to find them, and we know how to interrupt them … So it’s a hiccup … a very regrettable hiccup for the poor children that have been paralyzed, of course. But with regards to the whole initiative, you know it’s not something that is unexpected.”

It’s Possible to Shed Polio Virus for Decades

WHO also noted, “When a child is immunized with OPV, the weakened vaccine-virus replicates in the intestine for a limited period … During this time, the vaccine-virus is also excreted.”¹⁷ In some people, however, the period of replication may not be so “limited.”

One British man received three doses of attenuated (weakened) live virus polio vaccine at 5, 7 and 12 months of age. He also received a booster at age 7, as was recommended. The man has a health condition that suppresses his immune system, making it more difficult for him to clear vaccine-strain poliovirus from the body.

Although he had no symptoms of the disease, when researchers tested his stool (more than 100 samples were taken over a period of 28 years), they confirmed high levels of the poliovirus even decades later.

According to researchers, “The study has implications for the ecology of poliovirus in the human gut and highlights the risks that such vaccine-derived isolates pose for polio reemergence in the post-eradication era.”¹⁸ Indeed, at the very least it once again highlights the many complexities surrounding vaccination, infectious disease and the little-understood consequences that can occur as a result.

How to Spot Symptoms of Acute Flaccid Myelitis

It’s unknown whether the increase in cases of AFM is in any way related to provocation poliomyelitis, vaccine-associated polio or another cause entirely, but the CDC, rather than exploring all potential possibilities, is still recommending practicing ” … disease prevention steps, such as staying up-to-date on vaccines, washing your hands and protecting yourself from mosquito bites,” as the current solution.

For now, however, it’s important to be aware of the potential symptoms and seek medical care immediately if you spot any of them in your child: