4 polio-like paralysis cases under investigation

Four suspected cases of polio-like paralysis are under investigation in New York, the state health department confirmed, as doctors are advising parents to take seriously any signs of lethargy or weakness in children, especially when they have symptoms similar to the common cold.

Citing patient confidentiality laws, state health officials on Friday could not reveal details regarding the whereabouts in New York, ages, gender or other identifying details.

None of the cases have been confirmed and are not at this point part of a surge in pediatric paralytic illnesses being diagnosed across the country. 

In recent weeks, diagnoses of paralysis have been made among children nationwide and linked to a virus known as EV-D68. The pathogen more frequently underlies mild to moderate respiratory symptoms, indistinguishable from the common cold.

State health officials emphasized Friday that while EV-D68 has been implicated in the paralytic condition — formally called acute flaccid myelitis — other causes of that serious manifestation are known to exist. Regardless of the cause, seasonal viral paralysis is extraordinarily rare and is not polio, doctors said.

Among children who have developed paralysis, doctors have described weakness in the arms and legs. The disorder also is capable of morphing into a form that affects the muscles that govern breathing. In such instances, the child must be placed on a ventilator, according to the Centers for Disease Control and Prevention.

The CDC is investigating 127 possible cases of paralysis nationwide diagnosed recently in 22 states and tentatively linked to EV-D68.

The New York State Department of Health confirmed 40 cases of respiratory illnesses in children statewide caused by the virus, an increase of one new diagnosis since last week. State health officials recommend frequent hand-washing and advise parents to teach children to keep their hands away from their faces.

Dr. Morris Rabinowicz, chairman of pediatrics at Plainview Hospital, said EV-D68 circulates episodically and is seen, for unexplained reasons, in even-numbered years. The virus also circulated in 2012, 2014 and 2016, he said.

Rabinowicz said he has seen no cases of the paralytic disorder in children. But he is reminding parents to remain vigilant when their children are ill and to take note if they seem to lose strength in their arms or legs.

“My advice to parents is to be aware that the most likely [causative agent] when their child has an infection is that it's something simple and nothing to worry about,” Rabinowicz said.

“But since this is a period where there is an upswing in this virus, parents should not just home-treat their child, especially if there is a change in the child’s mobility or strength. Parents should contact their physician. It is best to have a professional assess the child,” he said.

The CDC has found that EV-D68 tends to circulate during late summer and fall. During those seasons in 2014, and into the winter of 2015, 1,153 cases of the respiratory infection were diagnosed in 49 states.

The virus primarily affects children because they have not had the lifelong exposure to enteroviruses that adults have had, said Dr. Aaron Glatt, chairman of medicine at South Nassau Communities Hospital in Oceanside.

He emphasized that there is still much to be learned about EV-D68 and viruses related to it, which as a family, are known as enteroviruses.

The biggest black box, Glatt said, is the fact that the viruses circulate episodically.

 “I would daresay there is no scientific explanation for that even though I am aware that there is a cyclical nature to this virus and many other viruses as well,” added Glatt, a spokesman for the Infectious Diseases Society of America.

Glatt said there is no specific treatment for the infection, although antiviral medications have been administered to some patients.

Infectious disease experts at the CDC note that while most children quickly recover from paralysis, some have lingering weakness in an affected limb and require ongoing care.