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In the fall of 2014, Kevin Messacar was working at the University of Colorado Children's Hospital when he and his colleagues noticed a series of unusual cases similar to polio among youth.
Messacar did not know it at the time, but it was the first epidemic of acute flaccid myelitis or MAF, a neurological disorder that is fed by a virus that affects the gray matter of the spinal cord and can cause paralysis.
There was another peak in 2016, and now a new outbreak is underway. The Centers for Disease Control announced Tuesday it has confirmed 62 MFA patients out of 127 suspected cases in 22 states since the month of August.
The average age of patients is 4 years old and the symptoms are alarming: face drooping, sudden weakness of limbs, sudden inability to speak.
The current rise in the number of cases has turned the AFM into a frightening disease of the month, thanks to its "polio-like" ability to attack the nervous system of children leaving their parents terrified.
But Messacar, pediatrician and researcher specializing in infectious diseases, said the public could relax. Although AFM is a serious disease, panic "does not provide a true picture", with the potential to contract the virus about one in a million.
He said the focus on AFM is being fueled in part by advocacy groups of patients and families lobbying medical experts, often on social media, to help rehabilitate their children.
Nancy Messonnier, director of the CDC's National Center for Immunization and Respiratory Diseases, agrees.
"As a parent myself, I understand what it's like to be afraid for your child," she said. "Parents need to know that AFM is very rare, even with the increase in the number of cases we are currently seeing."
Messacar, who has published a series of articles on the AFM, said the most likely culprit was a couple of viruses, the enterovirus D68 and the A71, which belong to the same family as polio but with a slightly different structure.
Health officials believe that AFM is triggered when D68, A71 or other related viruses (Japanese encephalitis and Japanese encephalitis have also been associated) have attacked the child's nervous system, thus allowing the AFM to entrench themselves.
Children who have received the polio vaccine are not protected from AFM, and the best prevention advice that public health officials can give is to wash their hands and cough or sneeze until elbow.
The pace of this year's outbreaks is in line with the enterovirus cycle.
"Enterovirus D68 has appeared every two years in the United States since 2014," said Messacar. "The circulating pattern every two years or so is a well-described schema for this family of viruses. For example, enterovirus A71 has been causing widespread epidemics of hand, foot and mouth diseases and neurological diseases in South Asia for about a decade, with recurring patterns like this one.
"The best prevention advice that public health officials can offer is to wash your hands and cough or sneeze in the crook of your elbow."
The rate of AFM outbreaks means that environmental toxins or a genetic disease are probably not the cause, Messacar said. "Viruses are more likely to be responsible for what we see cyclically," he said.
The CDC suggested this week that rhinovirus – closely related to enterovirus and cold-related – could be another culprit.
Messacar said it was not a bad idea. "If you rub random people on the street, 40% of them will have a rhinovirus without any symptoms," he said. "It's a cold [virus] which we are constantly exposed to. There is much more epidemiological evidence and scientific support for enterovirus D68 and A71 in these cases, but rhinovirus has been detected in many children. "
Enteroviruses D68 and A71 did not appear suddenly in 2014; scientists have known about them since the 1960s, but the virus did not appear in these clusters two years before 2014.
"We did not know if this virus came and went, or it would come back and repeat itself repeatedly," he said. But now that the AFM is making a third return over a well-defined two-year period, Messacar said surveillance needs to be improved. "We do not know what will happen in 2020, but seeing the trend every two years in the last four years means we have to get ready."
Although rare, the disease is "potentially devastating," Messacar said. "We have not seen a case of permanent paralysis of this kind since the polio era. Even though these cases are rare, they can potentially change lives and lead to life-long illness. This should be taken seriously.
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