Don't panic parents, but be on guard for rare, paralyzing illness: Canadian Paediatric Society

The head of the Canadian Pediatric Society says pediatricians are 'walking the fine line' between reassuring parents about how rare AFM is, while still emphasizing the severity of the illness.

The CPS says a child's risk of being diagnosed with acute flaccid myelitis is approximately 1:1,000,000

The Children's Hospital in London, Ont. (Dave Chidley)

It's highly unlikely that your kid will catch the rare, polio-like illness known as acute flaccid myelitis (AFM), but you still need to be vigilant about potential symptoms.

That's the message that Dr. Catherine Farrell, president of the Canadian Paediatric Society, wants to convey to parents about the disease that's spiked in the U.S. this fall.

"If there's something that worries you about your child's state of health, their ability to perform the kind of functions that they normally perform, then you should consult [your healthcare provider] quickly," said Farrell.

Early symptoms include muscle weakness in the arms, legs or face, often coming on after a cold or other viral illness, she said. Some examples to watch for can include a child: 

  • Complaining of tired legs.

  • Dragging a leg, or having trouble getting up from a chair or going up stairs. 

  • Having droopy eyelids, an asymmetric smile or swallowing difficulties.

"If a child needs to cough but is only able to cough weakly, that is a sign of a medical emergency," noted Farrell.

How rare is rare?

Locally, three cases of AFM have presented at the London Health Sciences Centre (LHSC) Children's Hospital in 2018, all of which happened since early September. There were no cases at LHSC the previous year.

One of those three patients was a young child from the region of either St. Thomas, Elgin County or Oxford County, according to Dr. Joyce Lock, medical officer of health for Southwestern Public Health. The medical officer couldn't give any further details for patient privacy reasons. 

Until this year, Lock said her health unit hadn't seen any cases of AFM 'in recent memory.'

"We do know from historical keeping an eye on things that these cases do come by every few years so we're always on the alert for them," she said.

This graph from the Public Health Agency of Canada shows numbers of AFP from 2000, when it landed on the notifiable diseases list, until 2016. (Public Health Agency of Canada)

Canada-wide, there have been 18 confirmed cases and 15 potential cases of acute flaccid paralysis (AFP)—a category of illness that includes AFM—in 2018. The Public Health Agency of Canada says that number is still "within the anticipated range for the year," but noted that may still change.

The U.S. has seen a greater surge, with 62 cases confirmed and another 65 under investigation.

AFM tends to pop up starting in the late summer or fall, according to Farrell, whether because of a seasonal virus or another environmental condition specific to that time of year. 

Memo sent to Ontario pediatricians 

In recent days, many in the healthcare industry have taken steps to flag the illness to colleagues. 

Last week, Dr. Jeremy Friedman, of the Hospital for Sick Children in Toronto, sent an email to members of the pediatrics section of the Ontario Medical Association with the headline "URGENT- PLEASE READ: Children Presenting with Acute Weakness."

In it, Friedman and his colleague, Dr. Ronald D. Cohn, noted a recent increase in patients at SickKids with muscle weakness, accompanied by a previous viral illness—symptoms that are typical of AFP.

"Given the potential for irreversible injury and the possibility that earlier intervention may make a difference, we hope to increase situational awareness that these patients may be presenting to the ER, and that rapid coordination of imaging (MRI), viral studies and treatment will be needed," wrote Friedman.

Southwestern Public Health has also sent out an advisory to primary care providers about the health unit's local case of AFM and possible symptoms to watch out for, according to Lock.

Part of why doctors are being extra cautious is that there is no vaccine or "optimal" treatment for AFM, and doctors aren't yet sure what causes it, according to Farrell.

She hopes that in the years to come doctors will "put their heads together" in determining the most effective treatments for the illness.

In the meantime, Farrell's advice to parents is to use "universal measures" for staying healthy, including hand washing, keeping household surfaces clean and avoiding those with coughs and colds. 

And, "If your child has symptoms that worry you, consult a healthcare professional," she said.