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home : columns : ask the doctors December 10, 2019

11/6/2019 7:45:00 AM
research could advance understanding of afm

Dear Readers: This week we wanted to discuss some important updates on several topics you've asked about recently, including the poliolike illness called acute flaccid myelitis, the potentially deadly EEE mosquito virus and vaping lung disease.

-- When we wrote about acute flaccid myelitis (AFM) last summer, the cause of the poliolike disease was a mystery. What was known then was that some children who developed flulike symptoms -- including fever, aches and pains, and congestion -- also experienced loss of muscle control in their arms and legs. They also often developed trouble breathing and swallowing. And a number of children with the illness became paralyzed, and some died.

Although the symptoms and the pattern of onset of acute flaccid myelitis resemble those of polio, the stools of patients with AFM have tested negative for poliovirus, which is an enterovirus. However, a new analysis of available data, published in October in the journal Pediatrics, suggests that a different enterovirus plays a role. Specifically, lab tests point to enterovirus D68, one of more than 100 known non-polio enteroviruses. The connection needs further study, but this is the first real advance since AFM first appeared. With a clearer understanding of the disease, researchers are now able to narrow their focus, and, hopefully, develop medications or a vaccine for the condition.

-- Another topic from last summer is the Eastern equine encephalitis virus. Referred to simply as EEE virus, it's a potentially fatal mosquito-borne illness. First recognized in humans in 1938, it has been a rare occurrence for people to become infected with the virus. Recently, infection rates have quadrupled to about 30 cases a year, up from an earlier average of seven cases per year. In 2019, 11 people have died as a result of the virus.

Infection with EEE is still rare, but due to the increase in severe cases, health officials are urging everyone to use insect repellants and cover up while outdoors, particularly from dusk to dawn, which is prime time for mosquitoes.

-- The number of people with a serious lung illness associated with vaping continues to grow. The U.S. Centers for Disease Control and Prevention updates statistics weekly. At this time, there have been a total of 1,299 patients in 49 states, plus Washington, D.C., and the Virgin Islands. At least 23 people have died.

The specific cause of the disease is not known, but bootleg products that contain THC are a possible culprit. According to the CDC, close to 80% of patients in the cases it has analyzed so far have reported using products that contain THC. Another study found that 66% of patients had used a black market product. Vitamin E acetate, an additive used as a thickening agent, has emerged as a suspected agent. So have the noxious fumes that are created when the unregulated chemicals contained within a vape cartridge get superheated. Meanwhile, a small but growing number of patients are being hospitalized a second time.

(Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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