Eric Hopton for redOrbit.com – Your Universe Online
In August 2014, the US Centers for Disease Control (CDC), along with its partner organizations, began investigating reports of children across the U.S. falling sick with a mysterious illness. These children had developed sudden onsets of weakness in one or more of their arms or legs. Subsequent MRI scans revealed inflammation of the “gray matter” nerve cells in the spinal cord. The CDC is now referring to this as “acute flaccid myelitis”.
In its latest update on the situation, the CDC reported that, between August 2, 2014 and January 5, 2015, it had verified reports of 103 children in 34 states who developed acute flaccid myelitis (AFM).
The CDC is collaborating with its partners across the nation build up a picture of the outbreak and to identify the risk factors and possible causes of this condition. Testing of several types of specimens for various pathogens that can result in this syndrome is ongoing. So far, we know that:
• The median age of the children was about 7 years.
• Almost all of them were hospitalized; some were put on breathing machines.
• Most patients had fever and/or respiratory illness before onset of neurologic symptoms.
• About two thirds of the children who have been observed (median 19 days) after their illness reported some improvement in symptoms, while about one third showed no improvement. Only one of the children has fully recovered.
On January 9, the CDC issued Morbidity and Mortality Weekly Report (MMWR) containing a detailed analysis of cases confirmed through November 13, 2014.
At this time, we still don’t know the specific causes of this illness and investigations continue. However, we do know that the cases identified so far are most similar to illnesses caused by viruses, including:
• Enteroviruses (polio and non-polio)
• Edenovirus
• West Nile virus and similar viruses
• Herpes viruses
One line of enquiry that the CDC is pursuing is a potential link to a 2014 US outbreak of severe respiratory illness caused by the enterovirus D68 (EV-D68). There is at this time no firm connection between the two outbreaks and the CDC said “We are aware of only two published reports of children with neurologic illnesses confirmed as EV-D68 infection from cerebrospinal fluid testing”. Enteroviruses rarely cause encephalitis and myelitis. In general, they cause mild illness, and sometimes aseptic meningitis.
It is not uncommon for children to develop neurologic illness with limb weakness where the cause remains unidentified, though we do know that these illnesses can result from, among other causes, viral infections, environmental toxins, and genetic disorders, and Guillain-Barre syndrome, a neurologic disorder caused by an abnormal immune response that attacks the body’s nerves.
The CDC is actively investigating the outbreak and taking a number of measures including:
• requesting that healthcare professionals be vigilant for and report cases of acute flaccid myelitis to CDC through their state or local health department
• verifying reports of cases of acute flaccid myelitis using our case definition
• working with healthcare professionals and state and local health departments to investigate and better understand the cases of acute flaccid myelitis, including potential causes and how often the illness occurs
• testing specimens, including stool, respiratory and cerebrospinal fluid, from the children with acute flaccid myelitis
• providing information to healthcare professionals, policymakers, general public, and partners in various formats, such as the Morbidity and Mortality Weekly Report, health alerts, websites, social media, and presentations
CDC is also exploring the potential association of acute flaccid myelitis (AFM) with enterovirus D68 (EV-D68) and other risk factors for AFM. This investigation includes planning a potential case control study as well as testing specimens from AFM cases for a wide range of viruses that may be associated with this clinical presentation, and testing to possibly detect previously unrecognized pathogens.
The following information has been provided for parents:
“If your child appears to have a sudden onset of weakness in arms or legs, parents should contact a healthcare provider to have their child assessed for possible neurologic illness.
Being up to date on all recommended vaccinations is the best way to protect yourself and your family from a number of diseases that can cause severe illness and death, including polio, measles, whooping cough, and acute respiratory illnesses such as influenza.
You can help protect yourselves from infections in general by
• Washing your hands often with soap and water
• Avoiding close contact with sick people
• Disinfecting frequently touched surfaces
You can protect yourself from mosquito-borne viruses, such as West Nile virus, by using mosquito repellent, and staying indoors at dusk and dawn, which is the prime period that mosquitoes bite.”
The CDC has also provided Guidance for Clinicians and Health Departments.
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