Intended for healthcare professionals

Rapid response to:


US county bars unvaccinated children from public spaces amid measles emergency

BMJ 2019; 364 doi: (Published 28 March 2019) Cite this as: BMJ 2019;364:l1481

Linked opinion

Measles in America—what’s playing out in New York State is nightmarish

Rapid Response:

Measles emergency vs. AFM emergency?

There were 372 measles cases reported in the US in 2018, and 465 cases reported so far in 2019. No deaths, so far. As of March 29, 2019 there were 228 cases of acute flaccid myelitis/AFM confirmed in the US for 2018, with another 150 cases still under investigation. (CDC) This is a devastating disease: 8% to14% of children are left with severe disabilities and only 8% to 18% fully recover. (Gill et al, CMAJ 2018 Dec 3;190:E1418) The number of deaths is unknown. Experts believe that AFM is substantially underreported and that the size of future outbreaks is likely to increase.

There is credible evidence that 75% of cases of AFM might result from injections of vaccines or antibiotics as a result of provocation paralysis and might therefore be prevented, even without knowing the viruses involved. (Cunningham, BMJ rr 4 Dec 2018) So far our CDC and other public health officials have made no effort to investigate the possibility.

Measles is a bad disease and prevention is important, but prevention of polio-like AFM may be even more important. US officials have so far avoided making a complete effort on behalf of children at risk for AFM.

Competing interests: No competing interests

11 April 2019
Allan S. Cunningham
Retired pediatrician
Cooperstown NY 13326, USA <