By Dr. Jesse Mackey, Senior Scientist, Molecular Biology
I’ve spent the last few days glued to my computer screen, searching for stories to bring to light for this blog, and stumbled across something that could potentially become the biggest medical story in the country.
Bad news travels fast these days — especially across the imperceptible domain of today’s internet: stories of virus outbreaks in the Middle East, food shortages, wildfires, countries primed for war, overpopulation, Global Warming, starvation, and so forth and so on. How does one remain optimistic in an era of relentless doom and gloom?
According to multiple stories I found in the midst of my online spelunking, within the last few weeks, there have been numerous reports in the media of a polio-like illness affecting children in California. Although the first case was reported in the fall of 2012, media attention has risen dramatically after the announcement that a report on five specific cases would be presented at the American Academy of Neurology Annual Meeting in late April. As of now, all cases of the illness have been localized in California from San Diego to the Bay area.
Since the first report of the illness roughly two years ago, a total of approximately 25 cases have been found in the same geographical area with patients ranging in age from two to sixteen. All patients suffer from acute paralysis of one or more limbs and sometimes respiratory difficulty. There is no known connection between any of the children and no clustering of these cases. The disease appears to be resistant to antiviral medications and thus far none of the children have regained use of their affected limbs.
What is meant by polio-like illness? Poliomyelitis, or polio, is an acute, viral, infectious disease that in its most severe form has neurological involvement and can cause paralysis, difficulty breathing, and sometimes death. In 1952-53, at the height of the polio epidemic in the U.S., there were more than 90,000 cases of polio reported nationally. After an intense vaccination campaign, by 1979 polio had been eradicated in the U.S. Polio is caused by poliovirus, a member of the Enterovirus genus which contains more than 60 viruses that can cause disease in humans. A large proportion of those infected develop mild flu-like symptoms typical of other viral illnesses. Only about 1% of those infected develop paralytic polio. As with polio, most enterovirus infections are asymptomatic and often go unrecognized, but rare cases with neurological involvement can result in breathing difficulty and paralysis.
Dr. Keith Van Haren, a pediatric neurologist at Lucille Packard Children’s Hospital at Stanford University, and Dr. Emmanuelle Waubant, a neurologist at The University of California San Francisco, have been studying five of the patients who developed the illness between August 2012 and July 2013. All five had been vaccinated against polio and experienced sudden or acute flaccid paralysis, and MRIs confirmed injuries to the central portion of the spinal column. Three of the children had a respiratory illness before the symptoms started. Investigators suspect that a virus — possibly another enterovirus — may play a role in the illness, but have no definitive answers. Dr. Van Haren will present a full report at the American Academy of Neurology Annual Meeting in late April. However, it is not clear if the results of the five cases studied by Dr. Van Haren and colleagues are typical of all 25 reported cases.
Two of the five tested positive for enterovirus 68, a very rare virus that has been linked to severe respiratory illness. This finding could be questionable since the patient samples were from nasal swabs and could have nothing to do with the paralysis; samples from the other three were either not collected or tested too late to provide conclusive results. Enterovirus 68 was first isolated in a California lab and since 2000 only 47 cases have been reported to the CDC.
In the meantime, all that we can hope for is that scientists like Dr. Van Haren and Dr. Waubant will eventually make progress toward understanding this strange outbreak paralyzing California’s children. Though a diagnosis or a cure may not be imminent, I choose to remain optimistic that answers will be uncovered, with time and research. After all, we managed, not so long ago, to eradicate polio. With all of today’s advancements in science and technology, the task of finding a cure should be anything but impossible. As I shut down my computer for the day, I’ve decided to impose a new rule for myself: no internet after working hours. Everyone should treat themselves to a break from the screen. It helps keep a clear head. It helps keep hope alive.