A new virus seen in some 25 Californian youths is causing alarm for its polio-like symptoms. Though poliomyelitis, to refer to it by its proper name, has been eradicated in the U.S. due to systematic vaccinations over several generations, the more debilitating form of the disease has left its mark on the collective psyche of the nation. This new syndrome, though related to the polio virus which caused so much havoc in the last century, is thus far nowhere near as devastating. Thought to be caused by an enterovirus from the same family as polio, the new Californian entrant can be compared to the feared virus in that it mimics polio symptoms in its more virulent cases.
This is cause for concern for Dr. Keith Van Haren, the neurologist treating the affected children, because the new virus shows a low likelihood of complete recovery for its victims. Van Haren, who teaches at the Stanford School of Medicine and is a practicing pediatric neurologist, says that the virus is extremely rare, though it has a very sudden onset. So far, no cases of the syndrome have been reported by the CDC in any location outside of California, though for those affected that is little comfort, as the children struggling to recover from the virus have yet to regain the full use of affected limbs and full respiratory function. Indeed, there is as yet no prognosis indicating that they may ever fully recover.
The affected youths have tested negative for polio, a virus in which one in every 200 victims were paralyzed, some to the point where they had to spend the remainder of their lives in a machine called an “iron lung” in order to continue breathing. The virus that is causing this new syndrome is from the same family as polio, however, being an enterovirus with much more severe symptoms than the related but milder hand, foot and mouth virus seen often in young children. Many researchers have likened the new syndrome to enterovirus-68, which has before now been seen mostly in children in Australia and Asia, though not all the California cases have tested positive for this virus.
The concern comes from the fact that the virus has resulted in five cases of paralysis in 25 victims, a very high percentage, and the fact that the culprit has yet to be identified without any doubt. In this way the new California virus again mimics polio, comparing positively in that polio was also originally a disease known to affect mostly children. The disease became an epidemic when it began to affect adults, due to a curious twist in cultural evolution. In the last century new hygiene and sanitation practices allowed many children to escape poliovirus infection. The downside was that without contracting the disease as children, many adults fighting poliomyelitus developed the more severe paralytic form of the disease, which for one in 500 sufferers, ended in death.
With epidemics springing up more often, and with worse symptoms, polio was once a heavy-hitter worldwide. The virus has affected populations from the dawn of time in every corner of the globe. There is evidence of polio outbreaks in Ancient Egypt and in Ancient Rome; famous Scottish author Sir Walter Scott may have been a polio survivor. Polio was medically described in 1789, and starred in its first full medical report in 1840. At this point all its symptoms began to be recorded as belonging to the same illness, allowing medical professionals to correctly label outbreaks and epidemics as the result of the same disease, despite the differences in presentation between children and adults.
It took over 100 years for a working vaccine to be developed, beginning with the work of Maurice Brody and John Enders and ending with a working vaccine begun by Hilary Koprowski and perfected by Jonas Salk, just in time to be used in the midst of a vast polio epidemic in the U.S. in the 1950s. In the intervening decades 20,000 people a year were struck down, and those who survived were often forced to spend their remaining lives inside a rocking bed or a giant metal coffin called an iron lung, a machine which alternated a vacuum and forced air pressure around the sufferer’s body in order to keep their lungs working.
Luckily such days are behind us. With the development of working vaccines, the treatment of symptoms after the fact can be seen as barbaric in retrospect. In the present day poliomyelitis has been eradicated in all but four countries worldwide, though other enteroviruses are still to be found in affected areas, notably in Asia. These days polio is endemic only in India, Pakistan, Afghanistan, and Nigeria, and other enteroviruses enjoy limited success in these and other areas to confuse the issue.
Further muddying the waters is the fact that many other illnesses, both viral and non-viral, can produce similar flaccid muscle paralysis, making it difficult to be sure that the cases in California are all the result of a single culprit. There is as yet no clear-cut evidence of a common cause, no certainty that enterovirus-68 is the virus causing all the symptoms in these children. The children did not test positive for other enteroviruses, such as aseptic meningitis or HFMD (hand, foot and mouth disease).
This family of viruses, though existing in multiple subcategories, are deemed ‘ubiquitous’ by doctors in that they affect everyone at some point in their lives, are transmitted by direct contact, and live in the gastrointestinal tract or in the upper respiratory tract, a reason why breathing is so often affected in enterovirus syndromes. Poliovirus and syndromes like meningitis can be tested for with a spinal cord MRI. This test confirms the likelihood that some enterovirus is to blame for the California symptoms, which like polio, do not respond to steroids or immunotherapy.
Though only two of the affected children tested positive for HEV-68, it is not a known syndrome in the United States. Between 10 and 15 million people are found to carry HEV-68 in the U.S. annually, though unlike with the California cases most of these infections cause few symptoms and only a fraction are serious enough to cause paralysis.
Van Haren has stated concerns that the reason no cases of the new virus have been reported outside of California may be because the syndrome can be mistaken for other illnesses, and may be missed as part of a larger pattern. As well, the results of Van Haren’s work is still being peer-reviewed, and so the CDC and other similar bodies have yet to come up with a cohesive reporting criteria. With today’s global travel, however, it is indeed unlikely that such a virus could exist only in one single point on earth. Until further cases are reported, though, we can hope that this new polio-mimic will remain sequestered in California, and that it will not result in any outbreaks or epidemics like the virus to which it has been compared.
By Kat Turner