Cases of Acute Flaccid Myelitis in Minnesota and other states

For an insight into the CDC’s thinking, consider this 2014 article from the Lancet:

https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(14)70132-2/fulltext

Lancet Neurology said:
Polio-like disease in the news: much ado about nothing?
Reports of polio-like acute flaccid paralysis have received much attention in both the USA and India. Uncertainty about causes and the fear of polio lie behind the media coverage. But why does uncertainty persist? Dara Mohammadi investigates.
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Lancet Neurology said:
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But, Mark Pallansch, Director of the Division of Viral Diseases at the US Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA), explains that a causative relation between the presence of this common virus and paralysis cannot be assumed.

“Detection of common agents in non-sterile sites is never diagnostic”, he tells The Lancet Neurology. Children often carry such viruses asymptomatically or with respiratory symptoms, but to be diagnostic for causation it would have to be found in the CSF of one or both of the two infected children—which it was not. The other three children had no diagnosis. “Our interpretation is that there is no specific aetiology linked to those five cases.”
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Lancet Neurology said:
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More pressing for Pallansch and colleagues at the state level is figuring out whether the CDC has the resources to pursue a dogged, full-scale investigation to elucidate the reasons behind these and other unexplained cases of AFP.

“There's no argument that it's absolutely a serious clinical condition, and yes, maybe we should know more about it”, he says. “But these are extremely rare cases which might not be linked, and there are other competing priorities and limited resources.”
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“Maybe we should know more about it”

Does Mark Pallansch know that poliovirus does not show up in the CSF, except in the most severe 1% of cases? This is why, in the 1950’s, polio was diagnosed purely based on visible signs and symptoms. It was well appreciated at the time that poliovirus simply does not show up in either the blood or CSF after the first symptoms have become apparent.
 
Update from the CDC:
https://www.cdc.gov/mmwr/volumes/68/wr/mm6812a1.htm?s_cid=mm6812a1_w

CDC’s MMWR 29 March 2019 said:
CDC recently established active, prospective EV-D68 surveillance among pediatric patients at seven U.S. medical centers through the New Vaccine Surveillance Network (NVSN)
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Approximately half (169; 47.2%) of the 2018 EV-D68 detections occurred in September (Figure).
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Although AFM is rare in the United States, these AFM surveillance data, along with the EV-D68 activity documented through NVSN, provide additional supporting evidence for a temporal association between EV-D68 respiratory illness and AFM. CDC, in collaboration with clinical and public health partners, continues to investigate the relationship between AFM and enteroviruses, including EV-D68.
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Good to hear the CDC is trying active, prospective, surveillance.
Active, prospective, surveillance is the only real surveillance.

CDC’s passive surveillance approach is extremely limited in its capacity to identify infectious outbreaks.
I wonder how many outbreaks have been missed over the years due to the CDC’s “sit back and wait for someone to say something” approach.

...And when did they switch from calling it “Acute Flaccid Paralysis (AFP)” to calling it “Acute Flaccid Myelitis (AFM)”?
 
And now NIAID has weighed in, with a somewhat more urgent outlook than the CDC’s:
https://mbio.asm.org/content/10/2/e00521-19

Ten years ago people warned that Enterovirus 71 would be the “poliovirus of the 21st century”:
https://www.tandfonline.com/doi/pdf/10.1080/10158782.2009.11441350
https://dabamirror.sci-hub.tw/4635/2ca3893261125263cb72e32d848d0c11/modlin2007.pdf

Now they’re saying Enterovirus D68 might claim that title:
https://twin.sci-hub.tw/6383/99012e8beec3c1fc6b4125ac3aa4f916/wiznitzer2017.pdf
(co-authored by Avi Nath, of the NIH Post-infectious ME study)
 
According to this story, Enterovirus-D68 has been confirmed in one patient, but...
The confirmation of EV-D68 does not rule out other viruses as potential causes. Nor does it rule out the possibility of environmental factors, which could explain why just one in 1 million children contract AFM due to the exposure, while most children simply suffer common colds.
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http://www.startribune.com/virus-identified-as-a-cause-of-paralyzing-condition-in-minnesota-children-acute-flaccid-myelitis/508757812/
 
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