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Researchers say they have strong new evidence that a virus is involved in a rare and puzzling polio-like condition that began affecting children in the U.S. about five years ago. The researchers hope their work will lead to a better test for the paralyzing condition, called acute flaccid myelitis (AFM), which has been diagnosed in more than 500 kids since 2014.

The scientists used an experimental method to pull evidence of viral infections from the spinal fluid of 42 AFM patients. This technique turned up antibodies specific to enteroviruses, a group of viruses that includes the poliovirus. They also include the leading suspect for causing AFM, an enterovirus called EV-D68. The test also found evidence of other viral infections.

It’s not definitive evidence that EV-D68 has caused most or all of the recent cases of AFM, said Dr. Michael Wilson, an assistant professor of neurology at the University of California, San Francisco, who helped lead the research team. But it’s a big step toward proving enteroviruses are the culprits.


“These results offer a roadmap for rapid development of enteroviral cerebrospinal fluid antibody assays to enable efficient clinical diagnosis of enterovirus-associated AFM in the future,” Wilson and colleagues wrote in a preliminary report published in the preprint journal Biorxiv. Wilson stresses that the report, which includes work from 17 different labs across the country and Canada, has not yet been subjected to peer review.

“This paper looked for and found immune responses to enterovirus in spinal fluid. Finding evidence of antibodies in spinal fluid in response to the virus is an important first step toward a diagnostic test for AFM and a path toward treatment,” the federal Centers for Disease Control and Prevention, which took part in the research, said in a statement to STAT. If one virus is found to be responsible, that could fuel arguments for developing a vaccine to prevent infection.


Doctors who have treated patients with AFM have long suspected that EV-D68 and perhaps other, similar viruses are causing the illness. But it’s been almost impossible to find the evidence they need to say so conclusively, because the condition appears after an infection has cleared up.

“By then the virus is long gone,” Wilson said in a telephone interview. “A lot of these kids have been sick for a week or two before they develop their neurological symptoms.”

Acute flaccid myelitis first started causing concern in 2014, when it was diagnosed in 120 patients in 34 states. Since then, the number of cases has risen in an every-other-year pattern. The CDC confirmed 22 cases in 2015, 149 cases in 2016, 35 cases in 2017 and 232 last year. So far this year, nine cases have been confirmed.

The pattern seemed to line up with outbreaks of enterovirus, especially EV-D68, which causes respiratory symptoms. Neurological complications are known to sometimes follow viral infections, but AFM specifically affects gray matter in the spinal cord. Patients, virtually all of them young children, suffer symptoms ranging from muscle weakness to widespread paralysis.

Because the spinal cord is affected, the CDC wanted to find evidence that the virus was invading tissue there. But tests only occasionally found this evidence.

“People were afraid that something was going on that we didn’t understand,” Wilson said.

Wilson, who investigates rare neuroinvasive conditions, is part of a network of physicians trying to get to the bottom of AFM. The CDC has also since set up a task force to find its cause.

What they needed was a test for past infections – one that would show the most recent infection, and perhaps show whether one single virus was responsible for the damage, or whether a co-infection was to blame.

Wilson’s team adapted a method developed by Harvard Medical School geneticist Stephen Elledge and colleagues, which uses bacteriophages — a type of virus that infects bacteria — to fish out antibodies from blood.

Bacteriophages are good for this work because they can be engineered to display various peptides on their surface, like lures on a fishing line. Wilson’s team created phages that carried pieces of all the viruses known to infect vertebrates, as well as viruses carried by mosquitoes. This created a test for multiple viral infections, using only a small amount of spinal fluid.

“You incubate it with a patient’s spinal fluid, and let the antibodies in the spinal fluid bind to the partner peptide,” Wilson said.

The researchers found evidence of many viral infections, but mostly enteroviruses. Comparison tests in spinal fluid taken from 58 children with other neurologic diseases did not turn up the same antibodies.

“These results provide further evidence for a causal role of non-polio enteroviruses in AFM,” they wrote.

Elledge praised the study. “It is a very good paper and demonstrates clearly and convincingly what others had some data for that were not conclusive, that AFM is likely to be caused by enteroviruses,” he said.

There’s a lot of work left to do, Wilson said. The team will have to establish thresholds for how much enterovirus antibody is needed to link it with the AFM symptoms. “You really only develop a robust antiviral response in the spinal fluid when you have an invasive viral infection,” Wilson said.

But now they have a new test to work with. “It was a pain to build,” Wilson said. “But now that it’s built, it’s very high throughput. We can run 200 to 300 samples at a time.”

That means they can use it to test for other neuroinvasive viruses, such as West Nile Virus and the varicella virus that causes chickenpox and shingles.

  • Just read a fascinating book call The Moth in the Iron Lung. The book that goes into a lot of reasons why illnesses we thought were polio weren’t and why it became an epidemic in first world countries that it did in the mid century I lost an uncle and had an aunt who had polio and dated a man who had crossbody polio as a child so polio has always been something I studied. This book was some interesting info

  • This happened to my daughter in 2004. Her Doctor at Children’s Hospital in New Orleans said it was cased by a virus. It mimics polio. she had severe asthma symptoms for a week then was fine for about a week then AFM symptoms started. It’s been happening much longer then 2014.

  • This is all cause and effect! Obama took many thousands of 3rd world children and families that sent them to cities and town all over the U.S. All of a sudden, diseases that had been eradicated in America started showing up all over again. People will say “well, maybe so, but not this virus.” The question is, why couldn’t this be part of it?

    • Immigrant children are not to blame. We have people in this country who pass on viruses and bacteria without even knowing. Let’s not blame, but rather congratulate the researchers and scientists for their fine work. As a teacher, I know children who have this condition, I am also old enough to have known people who have had polio. It is just as frightening to a parent now as it was before. Thanks to the medical community for working on this.

  • This disease has been going on a lot longer than 5years ago! My daughter was infected w it around 2005. It progressively got worse over 11 years. It ultimately took her life a year and a half ago. I can only hope they find a cure soon!

  • This is highly commendable research pared with solid logistics, very worthy of in-depth and swift further investigation. Certainly if this potentially is a new, evolved virus that could explode into polio-style effects. Rotary and the Bill & Melinda Gates are tackling polio which was global and is now only present in Afghanistan and Pakistan (Nigeria hopefully to be declared free in August). We need to do / allow all possible to prevent another virus with similar crippling effects from becoming a potent disabler.

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