Are enteroviruses the predominant cause of AFM in the US?
There has been much speculation about what has been causing the recent outbreaks of acute flaccid myelitis, or AFM, in the United States since its emergence in 2014, with enteroviruses being the main suspect.
Infectious Diseases in Children asked Amesh A. Adalja, MD, a member of the Infectious Diseases Society of America and a senior scholar at the Johns Hopkins Center for Health Security, whether there is sufficient evidence now to demonstrate that enteroviruses are the predominant cause of AFM.
In my analysis, I do believe that there is enough evidence to implicate enteroviruses as the cause of AFM in the United States. Since the appearance of AFM in 2014, it has been completely coincident with the appearance of a specific type of enterovirus, EV-D68, and many cases had antecedent respiratory infections consistent with an enterovirus infection.
From the very beginning, it was a leading hypothesis that enteroviruses were a cause of AFM because it is well known that polio, which is also an enterovirus, can cause similar types of symptoms in the past. So, we knew enteroviruses were capable of causing it; there was just a problem with trying to make that definitive linkage.
I think that with the discovery that antibodies to enterovirus exist in the cerebrospinal fluid of AFM patients — a fact just demonstrated over the last year — the case is basically closed.
- CDC. Causes and prevention of AFM. Available at: https://www.cdc.gov/acute-flaccid-myelitis/causes-prevention.html. Accessed on January 3, 2020.
Disclosure: Adalja reports no relevant financial disclosures.