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The state health department confirmed this week at least two patients in South Carolina have been diagnosed with a mysterious paralyzing illness.
Unlike some other states, physicians in South Carolina are not required to report individual cases of acute flaccid myelitis to the S.C. Department of Health and Environmental Control, opening the possibility that there could be more. A cluster of such cases would be subject to mandatory reporting requirements. Across the country, the illness has largely afflicted children.
Symptoms associated with acute flaccid myelitis tend to occur about a week after children develop a fever and respiratory illness, causing some to lose the ability to move their face, neck, back, arms or legs. No one in the U.S. has died from it this year, but officials at the Centers for Disease Control and Prevention say at least half the patients do not recover from the paralysis and some have serious complications.
In October, a DHEC spokeswoman said the agency was aware of only one patient in South Carolina who had been diagnosed with acute flaccid myelitis in 2018. This week, the department confirmed a second patient in the Upstate has been identified.
Meanwhile, U.S. health officials said Tuesday that they still aren’t sure what’s causing it.
Polio and West Nile virus have been ruled out. Doctors have suspected the cause might be some kind of enterovirus, which in most people causes cold symptoms. But CDC officials say that’s not clear.
This year’s count could surpass the tallies seen in similar outbreaks in 2014 and 2016, officials said. Fortunately, the disease remains rare: This year, there have been 90 cases spread among 27 states, the Centers for Disease Control and Prevention said.
The first mysterious wave of paralysis cases in 2014 coincided with a wider spike in illnesses connected to an enterovirus called EV-D68, CDC officials said. But there was no such spike during the waves in 2016 or this year.
There’s also a lack of clinical evidence: CDC officials have checked the spinal fluid of about three-quarters of the 90 patients, and found EV-68 in only one. Another type of enterovirus called EV-A71 was found in only one other patient.
But there are questions about that, too. If a virus is the cause, it’s possible the test is not good enough, or the germ left the spinal fluid by the time the tests were taken, said the CDC’s Dr. Nancy Messonnier. It’s also possible the culprit is hiding elsewhere in the body.
Or perhaps the paralyzing illnesses are caused by some new germ for which no lab test has been developed. Or maybe there’s some predisposing factor in some patients that cause their immune systems to react so severely to a germ or other trigger that the immune response causes paralysis, CDC officials said.
Parents and even some scientists have criticized the agency for not solving the riddle.
“I understand why parents are frustrated. I’m frustrated. I want answers too,” said Messonnier, who is overseeing the agency’s outbreak investigation. CDC officials have pledged to do more to notify doctors to look for possible cases and to more thoroughly review cases from years past for further clues.
About 120 cases were confirmed in 2014, the first time such a wave occurred. Another 149 were reported in 2016. In 2015 and 2017, the counts were far lower, and it’s not clear why.
The illnesses have spiked in September each year there’s been a wave and tailed off significantly by November. But it can take weeks to determine which cases should be counted in the outbreak. More than 160 cases are still being investigated, and some of those may join the count, CDC officials said.
The Associated Press contributed to this report. Reach Lauren Sausser at 843-937-5598.
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