Polio is one of the most well known causes of acute flaccid paralysis.
Although most people with polio infections have no symptoms at all, or just have a very mild illness, with a sore throat and a low grade fever, a small percentage can develop:
- a loss of superficial reflexes
- severe muscle aches and spasms in their limbs or back
- an asymmetrical flaccid paralysis with diminished deep tendon reflexes
This acute flaccid paralysis only affects the child’s strength in the affected muscle groups – there is no loss of sensation. The severity of the symptoms and the disease depends on which muscles are affected the most. If it is just your legs, then you will have trouble walking. On the other hand, if it affects your chest, then you might not be able to breath, unless you are put on a ventilator (iron lung).
Acute Flaccid Paralysis
Thinking about it in the context of polio, it becomes easy to understand acute flaccid paralysis or AFP.
It is the sudden onset (acute) of a flaccid (floppy or poor muscle tone) paralysis (weakness or inability to move) of one or more muscles.
But what many people don’t understand, is that in addition to polio, there are many more non-polio causes of AFP.
Many of us got a crash course in non-polio acute flaccid paralysis (NP-AFP) a few years ago when we started hearing reports of kids developing polio-like paralysis in 2014. Now thought to be caused by enterovirus D68 infections (EV-D68), the paralysis followed respiratory tract infections in many of the affected children. All together, at least 120 children in 34 states developed acute flaccid paralysis that year.
Interestingly, EV-D68 is one of more than 100 non-polio enteroviruses. The virus that causes hand, foot, and mouth disease, coxsackievirus A16, is another. Others cause pinkeye, meningitis, or encephalitis.
Keep in mind that many other viruses and conditions can cause non-polio AFP too, including:
- Guillian-Barré syndrome
- toxins (botulism)
- transverse myelitis
- traumatic neuritis
- other infections, including novel enterovirus C105, a non-polio enterovirus, and even tick-borne (Lyme disease) and mosquito-borne (Japanese encephalitis) infections
How do you determine the cause and how do you know it isn’t polio?
These kids with AFP typically have extensive testing to determine what is causing their AFP, including an MRI, antibody tests, and testing of their cerebrospinal fluid, etc. Although it isn’t always possible to identify a cause, you can at least rule out many potential suspects, like trauma, polio, and other infections.
Myths About Polio and Acute Flaccid Paralysis
Some folks don’t believe in non-polio AFP.
They believe that polio never really disappeared because vaccines don’t really work and that polio was simply renamed to, you guessed it, acute flaccid paralysis.
“Unbeknownst to most doctors, the polio-vaccine history involves a massive public health service makeover during an era when a live, deadly strain of poliovirus infected the Salk polio vaccines, and paralyzed hundreds of children and their contacts. These were the vaccines that were supposedly responsible for the decline in polio from 1955 to 1961! But there is a more sinister reason for the “decline” in polio during those years; in 1955, a very creative re-definition of poliovirus infections was invented, to “cover” the fact that many cases of ”polio” paralysis had no poliovirus in their systems at all. While this protected the reputation of the Salk vaccine, it muddied the waters of history in a big way.”
Suzanne Humphries, MD on Smoke, Mirrors, and the “Disappearance” Of Polio
What’s their evidence?
A rise in cases of non-polio AFP in India since 1997.
How do we know that there has been a rise in non-polio AFP cases in India since 1997?
It’s very simple and explains why there isn’t any data on before that 1997.
As part of the strategy to eliminate polio in that country, starting in 1997, all cases of AFP started getting tested for polio. It was a way to track the effectiveness of the immunization program. If you were seeing too many cases of AFP caused by polio, then not enough people were getting vaccinated. On the other hand, if you weren’t seeing any cases of AFP in an area, then the testing and surveillance probably wasn’t getting none, since there will always be some cases of non-polio AFP.
Unfortunately, they found many cases to track. And the cases kept increasing, although more and more, they weren’t being caused by polio. At least not by live polio virus.
Were they caused by the polio vaccine?
By 2015, after India was declared free of polio (the last case was in 2011), none of those cases of AFP were found to be caused by wild polio though. And India hasn’t had a case of cVDPV since 2010.
Why the increase in cases of non-polio AFP? It certainly isn’t because of Suzanne Humphries’ polio virus renaming conspiracy or any other anti-vaccine conspiracy involving the polio vaccine itself.
If we simply renamed polio to non-polio AFP, why did the numbers drop for so long and then slowly start to increase? Shouldn’t it have been a rapid crossover?
More importantly, why are the case of paralysis from non-polio AFP so much lower than the pre-vaccine era cases of AFP from polio?
And how come we rarely see large outbreaks of AFP like we did in the pre-vaccine era?
Sure, 120 kids in the EV-D68 non-polio AFP outbreak of 2014 is way more than any of us would like to see, but it is tremendously less than what we used to see in the pre-vaccine era from polio.
“Poliomyelitis is one of the important emergent viral diseases of the twentieth century… At its height, from 1950–1954, poliomyelitis resulted in the paralysis of some 22,000 U.S. citizens each year… Many thousands were left permanently disabled by the disease, while many others suffocated as a consequence of respiratory paralysis.”
Barry Trevelyan on the The Spatial Dynamics of Poliomyelitis in the US
While anti-vaccine conspiracy theories about AFP are as easy to dismiss as all of the rest they bring up, what is behind the rise in AFP in some areas of the world?
Although one study that was published in Pediatrics, “Trends in Nonpolio Acute Flaccid Paralysis Incidence in India 2000 to 2013,” did find a correlation between the use of the OPV vaccine and the incidence of non-polio AFP, many experts think the rise is a result of better screening. Also, once polio gets under control, other more neglected diseases start getting more attention, like enteroviral infections. Not surprisingly, other parts of the world have had the same experience.
There is also the fact that in 2005, the Global Poliomyelitis Eradication Initiative began “to cast a wider net for poliovirus detection and to maximize sensitivity so that every poliomyelitis case is detected.” Why? If even a single case was missed, it could lead to continued outbreaks and would get in the way of polio elimination in the country.
“This large increase in NP-AFP cases, which represent AFP cases caused by agents other than poliovirus, probably reflects the excellent implementation of the expanded definition of AFP and highly sensitive surveillance and detection methods used by NPSP in India from 2005 onwards…”
C. Durga Rao on Nonpolio Acute Flaccid Paralysis in India
So did the polio vaccine recently cause 53,000 paralysis victims in India?
The polio vaccine has worked to get us on the brink of eradicating polio though.
What To Know About Acute Flaccid Paralysis
Acute flaccid paralysis can be caused by the polio virus, but non-polio acute flaccid paralysis becomes a more important cause once polio is eliminated in a region.
More About Acute Flaccid Paralysis
- WHO-recommended surveillance standard of poliomyelitis
- Polio-like paralysis in California
- Enterovirus D68 Infection in Children with Acute Flaccid Myelitis, Colorado, USA, 2014
- About Acute Flaccid Myelitis
- Acute Flaccid Paralysis (AFP) Surveillance
- India’s Victory Over Polio Has an Unexpected Consequence
- Study – Eradicating poliomyelitis: India’s journey from hyperendemic to polio-free status
- Report – The Spatial Dynamics of Poliomyelitis in the United States: From Epidemic Emergence to Vaccine-Induced Retreat, 1910–1971
- Study – Antigenic Diversity of Enteroviruses Associated with Nonpolio Acute Flaccid Paralysis, India, 2007–2009