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