Mysterious polio-like illness affects children 22 US states

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Mysterious polio-like illness affects children 22 US states

Postby seemslikeadream » Thu Oct 18, 2018 11:16 am

AFM: Mysterious polio-like illness affects children in 22 US states | The Independent

1 day ago
US health officials are worried about an increase in a mysterious and rare condition that mostly affects children and can paralyse arms and legs, with more than 120 confirmed or suspected cases reported.

Of those, 62 cases of acute flaccid myelitis, or AFM, have been confirmed in 22 states, according to Nancy Messonnier, a top official at the Centers for Disease Control and Prevention (CDC).

More than 90 per cent of the confirmed cases have been in children 18 and younger, with the average age being four-years-old.

The surge in cases has baffled health officials, who on Tuesday took the unusual step of announcing a change in the way the agency will count cases in the future.

They also wanted to raise awareness about the frightening condition so parents can seek medical care if their child develops symptoms and so reports of the illness can be quickly relayed back to the CDC.

“We understand that people, particularly parents, are concerned about AFM,” said Ms Messonnier, director of the National Center for Immunisation and Respiratory Diseases. Despite extensive laboratory and other testing, CDC has not been able to find the cause for the majority of the cases. “There is a lot we don’t know about AFM, and I am frustrated that despite all of our efforts, we haven’t been able to identify the cause of this mystery illness.”

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The increase in cases has been happening since 2014, usually in August and September, but only in 2014 and 2016, Ms Messonnier said in a news briefing with reporters. The CDC knows of one child who died with the disorder in 2017.

Since officials have been unable so far to determine how the disease spreads, they are starting to count suspected cases as well as confirmed to better anticipate increases in confirmed cases over the coming months, she said.

There is no specific treatment for the disorder and long-term outcomes are unknown. The rare but serious disorder affects a person’s nervous system, specifically the spinal cord. Neurological conditions like it have a variety of causes, such as viruses, environmental toxins and genetic disorders.

Among the cases under investigation are five reported to Maryland health officials in recent weeks, a health department spokeswoman said. Maryland’s first case was reported on 21 September. No known cases have been reported in Virginia or the District this year, but there were three confirmed cases in Virginia in 2016, health department officials said.

“We know this can be frightening for parents and I know many parents want to know what signs and symptoms they should be looking out for in their children,” Ms Messonnier said. Parents should seek medical care right away if their child develops sudden weakness or loss of muscle tone in the arms and legs.

Some patients diagnosed with this condition have recovered quickly, but some continue to have paralysis and require ongoing care, she said.

CDC began tracking the condition in 2014, when there were 120 confirmed cases. Then in 2016, there were 149 confirmed cases. Officials said it is too early to know whether the total for 2018 will surpass those previous years. But the data reported on Tuesday represents “a substantially larger number than in previous months this year,” Ms Messonnier said.

She said it was important for parents and clinicians to remember that this is a rare condition, affecting fewer than one in one million people under 18. “As a parent myself, I understand what it’s like to be scared for your child,” she said. “Parents need to know that AFM is rare even with the increase in cases we are seeing now.”

Still, because this is a “pretty dramatic disease”, Ms Messonnier said health officials want to raise awareness about the symptoms to make sure parents seek medical care immediately if their children show a sudden onset of weakness in their arms and legs.


The agency knows that poliovirus is not the cause of these cases, because CDC has tested every single stool specimen from patients, and none have tested positive for poliovirus. Ms Messonnier said West Nile virus, which had been listed as a possible cause on CDC’s website, is not causing the illnesses.

In some individuals, health officials have determined that the condition was from infection with a type of virus that causes severe respiratory illness.

So far, the CDC has found no relationship between vaccines and children diagnosed with AFM from the 2014 cases.

Officials will be conducting additional analysis on this year’s cases. “Our medical team has been reviewing vaccine records when available during this year’s investigation and do not see a correlation,” said CDC spokeswoman Kristen Nordlund. The disorder has been diagnosed in children who have received some of their recommended vaccinations and in unvaccinated children, she said.

The agency does not know who may be at higher risk of developing this condition or the reasons they may be at higher risk. CDC has tested many different specimens from patients with this condition for a wide variety of pathogens, or germs, which can cause AFM. But so far, no pathogen has been consistently detected in the patients’ spinal fluid.

Parents can best protect their children from serious diseases by taking prevention steps, such as washing their hands, staying up to date on recommended vaccines and using insect repellent to prevent mosquito bites, Ms Messonnier said.

There is no specific treatment for AFM, but neurologists who specialise in treating brain and spinal cord illnesses may recommend certain interventions, such as physical or occupational therapy, on a case-by-case basis.

Benjamin Greenberg, a neurologist who has treated children with AFM at the University of Texas Southwestern in Dallas, said AFM is “exquisitely rare”.

But, if their child is diagnosed, parents should prepare for extensive physical therapy – therapy that is not always covered by insurance, he said. Some children paralysed by AFM have eventually regained their ability to walk, but need time.

“Families really sticking with it are seeing slow but steady recovery,” he said.

CDC is not releasing a list of the 22 states with confirmed and suspected cases because of privacy issues. But some state health departments have been making public their reported cases. States are not required to provide this information to CDC, but they have been voluntarily reporting their data.

https://www.independent.co.uk/news/scie ... 87751.html


CDC: Rare mysterious illness ASM partially paralyzes children, and it's spreading

Herb Scribner, Deseret News - hscribner@deseretnews.com Oct 18, 2018 Updated 18 min ago
CDC: Rare mysterious illness ASM partially paralyzes children, and it's spreading

A new polio-like illness has spread across 22 states so far this year, impacting children nationwide.

What happened: So far, the Centers for Disease Control and Prevention has confirmed 62 cases of acute flaccid myelitis and plans to investigate 65 more.

Roughly 90 percent of the cases so far have involved children, who suffer from muscle weakness or paralysis that impacts face, neck, back or limbs.
The symptoms appear about one week after the children start experiencing a fever or respiratory problems.
So far, viruses, environmental toxins and genetic disorders are all possible causes for the spike.
The CDC said the West Nile virus, adenoviruses, poliovirus and non-polio enteroviruses are also possible reasons why the illness has begun spreading.
The CDC says this is still a rare condition that affects less than one in 1 million people per year.
On the ground: Serena Hill, a mother in Tennessee,

told WRCB
that her son, Spencer, experienced common cold problems before he struggled to move his arms and to walk.

“You see your child, who likes to run and play,” she said. “All of a sudden, ‘Mommy I can’t zip my pants. I can’t write.’ Then you see him fall and his legs give out. It is absolutely terrifying.”
A cure?: Spencer received steroid infusions that helped free up the paralysis. In the last three weeks, he has improved his motor skills. He still has little movement in his fingers.

History: The CDC has no idea why there has been a spike in cases, though there have been similar spikes in 2014 and 2016, according to Fox News.

Since 2014, there have been 386 total cases, including the ones so far this year.
2014: 120 cases nationwide across 34 states.
2015: 22 cases nationwide across 17 states.
2016: 149 cases across 39 states, including Washington, D.C.
2017: 33 cases across 16 states.
"This remains a rare syndrome, but the similarities to poliomyelitis, polio-like illness, are concerning and bear close monitoring," Dr. Todd Ellerin, director of infectious diseases at South Shore Hospital in Weymouth, told ABC News. "Now is it going to be as widespread as that? Hopefully not. And that's why we have to keep our eye on this."

https://www.heraldmailmedia.com/life/cd ... 889d4.html
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Re: Mysterious polio-like illness affects children 22 US sta

Postby Agent Orange Cooper » Thu Oct 18, 2018 3:08 pm

https://www.bmj.com/content/350/bmj.h308/rr

Vaccines and the U.S. Mystery of Acute Flaccid Myelitis

Since August 2, 2014 our Centers for Disease Control has received reports of 107 cases of 'acute flaccid myelitis' (AFM), a polio-like illness in children in 34 states. During the same interval there have been 1153 cases of respiratory illnesses associated with enterovirus D-68 (CIDRAP News 1/16/15. CDC update 1/15/15. Catherine Saint Louis, NY Times 1/13/15). AFM affects motor neurons in spinal cord gray matter, resulting in asymmetrical limb weakness; 34% of patients have cranial nerve motor dysfunction. Median age of patients is 7.6 years/range: 5 months-20 years (MMWR 63: 1243--January 9, 2015). So far only one child has fully recovered. EV-D68 is a suspected cause but, thus far, no viruses have been found in the spinal fluid of patients, and only a minority have had an antecedent illness associated with EV-D68. Case-control studies are planned to look for clues, but presently AFM is a mystery disease of unknown cause.

It is taboo to suggest a role for vaccines, but some old-timers remember "provocation poliomyelitis" or "provocation paralysis." This is paralytic polio following intramuscular injections, typically with vaccines. PP was most convincingly documented by Austin Bradford Hill and J. Knowelden during the 1949 British polio epidemic when the risk of paralytic polio was increased 20-fold among children who had received the DPT injection (BMJ 2:1--July 1, 1950). Similar observations were made by Greenberg and colleagues in New York City; their literature review cited suspected cases as far back as 1921 (Am J Public Health 42:142--Feb.1952). I first became aware of PP 10 years ago while browsing through "Krugman's Infectious Disease of Children" (page 128 of the 2004 edition).

AFM may result from a direct virus attack on the spinal cord, or by an immune attack triggered by a virus, or by something else. If a polio-like virus is circulating in the U.S., the possibility of its provocation by one or more vaccines has to be considered.
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Re: Mysterious polio-like illness affects children 22 US sta

Postby Blue » Thu Oct 18, 2018 3:56 pm

I noticed this:

The increase in cases has been happening since 2014, usually in August and September, but only in 2014 and 2016, Ms Messonnier said in a news briefing with reporters. The CDC knows of one child who died with the disorder in 2017.


Kids go back to school in August and September and that's when they vaccinate them.

Sounds a lot like this:

Confirmed: India’s Polio Eradication Campaign in 2011 Caused 47,500 Cases of Vaccine-Induced Polio Paralysis
(Sorry don't know why link doesn't work.)

A paper published earlier this year in the Indian Journal of Medical Ethics should have made headlines around the globe, as it estimated there were 47,500 cases of a polio-like condition linked to children in India receiving repeated doses of oral polio vaccine in 2011 alone. The incidence of non-polio Accute Flaccid Paralysis (AFP) in India is now 12 times higher than expected and coincides with huge increases in OPV doses being given to children in the quest to “eradicate” wild type polio infection and paralysis.

Researchers reported:

"…while India has been polio-free for a year, there has been a huge increase in non-polio acute flaccid paralysis (NPAFP). In 2011, there were an extra 47,500 new cases of NPAFP. Clinically indistinguishable from polio paralysis but twice as deadly, the incidence of NPAFP was directly proportional to doses of oral polio received. Though this data was collected within the polio surveillance system, it was not investigated. The principle of primum-non-nocere [First, do no harm] was violated."

Another way the public is being misled about India's claims to be polio-free is that live virus polio vaccine is causing vaccine strain polio in an unknown number of children and adults.. The problem is that, while the oral vaccine has reined in wild polio, persons recently vaccinated with the live attenuated oral polio vaccine can shed vaccine strain virus in their body fluids for weeks and, in some cases, both the recently vaccinated and close contacts of the recently vaccinated can come down with vaccine strain polio. Poor sanitation, including open sewage in underdeveloped countries, where drinking water is too often also used for bathing and disposal of human waste, can make it easy for vaccine strain polio virus to be transmitted.

Environmental surveillance for VDPV is now being conducted in a number of countries, including Australia, Egypt, Haiti, and Indonesia.
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Re: Mysterious polio-like illness affects children 22 US sta

Postby liminalOyster » Fri Oct 19, 2018 11:00 am

Blue » Thu Oct 18, 2018 3:56 pm wrote:Kids go back to school in August and September and that's when they vaccinate them.


Kids going back to school also means that they are likely suddenly in contact with all sorts of new viruses. Not to mention seasonal changes. Both of which support the accepted hypothesis that an enterovirus is responsible.

If you look at the current US vaccine schedule, the age of most kids exhibiting AFM is outside of the age when they are receiving new vaccines. Possibly flu which is seasonal and certainly increasingly common. But the other vaccines administered at that time are boosters of vaccinations usually received several years earlier (DTAP, MMR, VAR).

That said, I don't see any reason to rule out the possibility (in my admittedly only slightly more than cursory scan of material about AFM) of unrecognized vaccine injury. But it's worth remembering that this kind of epidemiology is largely driven by public health workers who have no direct influence placed on them by big pharma. Yes, they operate within the conventions (and/or dogma) of the medical establishment. But noone's likely getting paid in Public Health to cover up a scandal.

I actually really like what other material I found from the author of the piece which AOC posted. Especially given that he qualifies his skepticism and willingness to iconoclasm with enthusiastic support for vaccination in general. He strikes me as very intelligent and appropriately wary and mistrusting of the influence of business on the growing vaccine schedule including the CDC etc. Funny how even that relatively moderate position is so risky for people ostensibly bound by the Hippocratic oath.
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Re: Mysterious polio-like illness affects children 22 US sta

Postby liminalOyster » Fri Oct 19, 2018 1:31 pm

“Poliolike” Childhood Muscle-Weakening Disease Reappears
Researchers have traced some cases of acute flaccid myelitis to a known virus, but treatments remain elusive
By Karen Weintraub on October 18, 2018

"Poliolike" Childhood Muscle-Weakening Disease Reappears

A poliolike condition that left more than 100 children in the U.S. at least partially paralyzed in 2014 is back, and not much more is known this time around, officials with the U.S. Centers for Disease Control and Prevention say. The CDC is not ruling out any possible triggers—from infections to toxins, autoimmune reactions to bug bites.

“We have not been able to find a cause for the majority of these” cases, Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, said Wednesday at a news conference. “And I’m frustrated that despite all of our efforts, we have not been able to identify the cause of this mystery illness.”

But researchers who have studied the muscle-weakening disease—called acute flaccid myelitis (AFM)—most closely say they now have a good understanding of its primary cause, although they still do not know how to treat the condition or halt its progression.

Scientists at the University of Colorado School of Medicine infected mice with a virus that was circulating during the 2014 AFM outbreak as well as during similar spikes of the disease in 2016 and this year. The virus triggered a paralyzing illness in the mice that “looked an awful lot like what we saw in children,” says Kenneth Tyler, chairman of the school’s Department of Neurology. Tyler thinks the virus, called enterovirus D68, has changed since it was first identified in 1962, becoming more dangerous. He has bred mice that develop paralysis after an infection with the current version of enterovirus D68 but not from earlier strains. He has tested a number of possible treatments on his mice but has not yet found any that make a significant difference in the course of their AFM-like illness.

Enterovirus D68 has been linked to some of the human cases of the disease, and although it is not the only cause, it has likely been a driving force behind the three recent outbreaks, says Kevin Messacar, an infectious disease physician and researcher at Children’s Hospital Colorado. He and Tyler say the CDC has been cautious about acknowledging enterovirus D68’s role in the outbreaks.

The virus’s symptoms are similar to those of the common cold and can include coughing, shortness of breath and other asthmalike breathing problems. “Many people will get the infection and very few will get the neurologic disease” that leads to paralysis, Messacar says. In rare cases, about a week after the infection, the child will develop weakness in his or her arms, legs or muscles of the face or throat, he says. Although there is no definitive diagnosis, doctors can identify AFM from a combination of symptoms and an MRI scan, which can reveal spine inflammation.

The CDC’s Messonnier describes AFM as “pretty dramatic” and says the federal agency is escalating its response compared with that in previous years. She also emphasizes it is extremely rare, striking about one in a million children, so parents should not panic—but they should seek medical attention if their child shows signs of sudden weakness or loss of muscle tone in their arms or legs. Since July the CDC has confirmed 62 cases of AFM in 22 states, and is investigating 65 more possible cases. One child with AFM died last year. Ninety percent of the cases have been in children, she says.

Messonnier did not address enterovirus D68 directly during the news conference and said the CDC has not yet had time to fully analyze the cases from this summer and fall. She said the cases were definitely not caused by the polio virus, which has not been found in any of the stool samples from affected children. There is no evidence of infection with the mosquito-borne West Nile virus either, she says, although she still encourages parents to send their children out with bug repellent. Some children with AFM recover full motion and strength—usually within a few months—whereas in others the nerve damage seems permanent, she says.

Mitchel Seruya, a surgeon at Children’s Hospital Los Angeles, says when he has operated on children with AFM, he has been amazed by how unresponsive their affected nerves are. He can hit them with an electric shock akin to touching a car battery, he says, but they do not move. That suggests to him the disease can completely wipe out the nerves. Seruya has operated on 15 children whose AFM-induced paralysis lasted at least three months. He redirects redundant nerves from other parts of the arm or abdomen to replace those lost to the disease. He says he has had very good outcomes in 14 of the 15 patients; the one girl who did not regain full function had “a suboptimal result, but [her parents are] happy she got something back.” But treatments for the infection itself remain elusive.

Mark Hicar, a pediatric infectious disease specialist and assistant professor at the University at Buffalo, S.U.N.Y., has treated two children with AFM, one in 2014 and one this year. Both were boys—one age six, one three; each had a common cold–like illness and spiked a fever about a day before they stopped using one leg. Neither boy tested positive for enterovirus D68—or A71, a similar virus also linked to AFM—but the tests are not definitive, he says. The three-year-old improved significantly within the first two days but then plateaued and is now back in the hospital being treated with anti-inflammatory medications, says Hicar, who is hoping the drugs will prevent the boy’s immune response from exacerbating the damage. But data on the efficacy of treatments is so thin that he says he is not sure whether the therapy is helping the boy or not.

A vaccine against enterovirus D68 would be scientifically possible, although may not be currently economically feasible, Messacar says. Polio is a very similar virus—and there’s a vaccine to protect against it. The Chinese have developed a vaccine against enterovirus A71, but it is not available in the U.S., he adds. Because AFM is so rare and has several potential causes, it would be hard for a company to make money on a vaccine, Messacar says.

The illness pattern is very similar to the polio outbreak of the 1940s and 1950s, says Andrew Pavia, chief of the Division of Pediatric Infectious Diseases at The University of Utah, except for its scale. Whereas polio infected tens of thousands of children, AFM has struck just over 100 every other year. Many people who had polio as children and recovered suffered muscle weakness again decades later. It’s unclear from mouse studies whether AFM symptoms will return in afflicted individuals, Tyler says.

According to the CDC, there were 120 confirmed cases of AFM in the second half of 2014, 22 in 2015, 149 in 2016 and 33 in 2017. “There’s been an increase in AFM in even-numbered years since 2014 that doesn’t appear to be random,” Messacar says, noting that enterovirus infections are most common from July through October in northern states, although they are less seasonal in the South. Research suggests dew point temperature—a combination of humidity and temperature—seem to affect the seasonality and geographic distribution of enteroviruses, he says.

Pavia agrees enterovirus D68 is the most likely cause for the majority of AFM cases, but “we have to wait and see” whether this year’s outbreak will follow the same pattern as 2014 and 2016. The primary methods for preventing infection with the virus are the same as for any cold: wash hands frequently, sneeze into your arm or elbow and try to avoid close contact with people who are ill, Pavia says.

Enterovirus D68 is probably contagious for about as long as the common cold, Messacar says. Whereas the viruses associated with AFM are contagious, AFM does not spread from person to person because it is a rare neurologic complication.

That was certainly true in Sarah Pilarowski’s family. Her eight-year-old son Liam got a horrible cold in 2014 but then recovered, but her six-year-old daughter, Lydia, developed a cold and fever that seemed to linger forever, says Pilarowski, a Denver pediatrician. When Lydia was not strong enough to hold an ear of corn in her left hand, Pilarowski got worried. Lydia was diagnosed with AFM and endured months of occupational and physical therapy, followed by psychotherapy to resolve her nightmares and lingering anxieties. She did not test positive for enterovirus D68, but Pilarowski is convinced both her children had the virus, which was making the rounds in the Denver area the summer her kids got sick.

Although there is not currently a vaccine or specific treatments with proved efficacy, there are still things researchers can do to combat AFM, Messacar says, such as keeping better track of enterovirus D68 and A71 infections, learning more about the link between the viruses and AFM, and systematically studying the efficacy of treatment and rehabilitation therapies being used. “Let’s start doing something about it. Let’s get funding,” he says. “Let’s not act like this is a surprise if this comes back in 2020, but let’s be more prepared.”

Editor’s Note: (10/18/18): For purposes of clarification, this story was edited and updated after its original posting.

https://www.scientificamerican.com/arti ... reappears/
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Re: Mysterious polio-like illness affects children 22 US sta

Postby Agent Orange Cooper » Fri Oct 19, 2018 1:37 pm

https://www.ncbi.nlm.nih.gov/m/pubmed/19880568/

Transverse myelitis and vaccines: a multi-analysis.

Abstract
Transverse myelitis is a rare clinical syndrome in which an immune-mediated process causes neural injury to the spinal cord. The pathogenesis of transverse myelitis is mostly of an autoimmune nature, triggered by various environmental factors, including vaccination. Our aim here was to search for and analyze reported cases of transverse myelitis following vaccination. A systematic review of PubMed, EMBASE and DynaMed for all English-language journals published between 1970 and 2009 was preformed, utilizing the key words transverse myelitis, myelitis, vaccines, post-vaccination, vaccination and autoimmunity. We have disclosed 37 reported cases of transverse myelitis associated with different vaccines including those against hepatitis B virus, measles-mumps-rubella, diphtheria-tetanus-pertussis and others, given to infants, children and adults. In most of these reported cases the temporal association was between several days and 3 months, although a longer time frame of up to several years was also suggested. Although vaccines harbor a major contribution to public health in the modern era, in rare cases they may be associated with autoimmune phenomena such as transverse myelitis. The associations of different vaccines with a single autoimmune phenomenon allude to the idea that a common denominator of these vaccines, such as an adjuvant, might trigger this syndrome.
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Re: Mysterious polio-like illness affects children 22 US sta

Postby Elvis » Fri Oct 19, 2018 2:16 pm

Blue wrote:Confirmed: India’s Polio Eradication Campaign in 2011 Caused 47,500 Cases of Vaccine-Induced Polio Paralysis
(Sorry don't know why link doesn't work.)


I fixed the link; there were some extra characters at the end of the URL.
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Re: Mysterious polio-like illness affects children 22 US sta

Postby Grizzly » Fri Oct 19, 2018 2:17 pm

Interesting! Thanks, Slad... et, al
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Re: Mysterious polio-like illness affects children 22 US sta

Postby liminalOyster » Sat Oct 20, 2018 3:46 pm

After testing patients’ stool specimens, the CDC determined poliovirus is not the cause of the AFM cases. Messonnier said West Nile virus, which had been listed as a possible cause on CDC’s website, is also not causing the illnesses. In some individuals, health officials have determined that the condition was from infection with a type of virus that causes severe respiratory illness.

So far, the CDC has found no relationship between vaccines and children diagnosed with AFM from the 2014 cases. Officials said they will be conducting additional analysis on this year’s cases. “Our medical team has been reviewing vaccine records when available during this year’s investigation and do not see a correlation,” said CDC spokeswoman Kristen Nordlund. The disorder has been diagnosed in unvaccinated children and also in children who have received some of their recommended vaccinations, she said.

https://www.washingtonpost.com/health/2 ... s-cdc-says


Hadn't caught this before.
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Re: Mysterious polio-like illness affects children 22 US sta

Postby seemslikeadream » Tue Oct 23, 2018 12:54 pm

155 cases of polio-like illness now under investigation, CDC says

polio-like illness abigail's story_00001016
(CNN)The US Centers for Disease Control and Prevention reported Monday that there are 155 patients under investigation this year for acute flaccid myelitis, a condition that that can cause paralysis and mostly affects children.

Of these, 62 have been confirmed by the CDC in 22 states, and the remainder continue to be investigated.

Acute flaccid myelitis, also called AFM, is a rare but serious condition that affects the nervous system -- specifically, the area of the spinal cord called gray matter. It affects fewer than one in a million people each year across the country, the CDC estimates.

The number of patients under investigation is up from 127 patients a week ago, though no new confirmed cases have been reported.
Young survivor of rare polio-like illness now thriving
The average age of patients confirmed to have the condition is just 4 years old, and more than 90% of cases overall occur in children 18 and younger, according to Dr. Nancy Messonnier, director of the agency's National Center for Immunization and Respiratory Diseases.

"CDC has been actively investigating AFM, testing specimens and monitoring disease since 2014, when we first saw an increase in cases," Messonnier told reporters last week. "Most AFM cases occur in the late summer and fall," but no geographic clustering has been found and there is no other "unifying factor to explain the peaks," which seem to occur every other year, she added.

The CDC received information on 33 confirmed cases of AFM in 2017, 149 cases in 2016, 22 cases in 2015, and 120 cases in the latter part of 2014.

"There is a lot we don't know about AFM," including the cause in a majority of cases, Messonnier said. While potential causes may include certain viruses, environmental toxins and genetic disorders, the CDC says, "AFM can be difficult to diagnose because it shares many of the same symptoms as other neurologic diseases."
It is also unclear who could be at higher risk of developing AFM, Messonnier said. The CDC does not fully understand long-term consequences or why some patients recover quickly while others continue to experience paralysis and weakness.

The CDC urges parents to be aware of this illness and to seek medical care right away if family members develop sudden weakness or loss of muscle tone in the arms or legs.

"This is a mystery so far, and we haven't solved it yet, so we have to be thinking broadly," Messonnier said.

'Not knowing'


"What makes it worse is not knowing what caused it," said Erica Palacios, whose 2-year-old daughter, Abigail, began showing signs of AFM last month.

"It was one of the most horrific experiences of my life," said Palacios, of Columbus, Georgia.

Abigail Palacios, 2, was diagnosed with acute flaccid myelitis.
Abigail Palacios, 2, was diagnosed with acute flaccid myelitis.
All four of her children had come down with a cold at the same time, but young Abigail's condition continued to worsen despite her mother's best efforts to keep her kids healthy.

After a few days, she noticed that Abigail's arm had gone limp and rushed her daughter to the hospital, where doctors initially drew blanks, she said, adding that at one point Abigail couldn't move below the neck.

"They ran every test known to mankind," Palacios said.

Doctors transferred Abigail to Children's Healthcare of Atlanta, where she required breathing and feeding tubes in the ICU. She was later transferred to the healthcare system's Inpatient Rehabilitation Program at Scottish Rite hospital, where she regained some movement in one arm, and can now hold her head up and walk with assistance.

"At this point, she is making almost daily gains," said one of Abigail's doctors, pediatric rehabilitation physician Dr. Laura Jones.

Still, the 2-year-old will be returning home in a wheelchair. Palacios said her daughter wants to get up and play, but gets frustrated and doesn't understand why she can't.

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"We don't know a lot about the long-term prognosis of AFM right now. That's something that we're still really learning about," Jones said. "We know that some kids have great recovery and recover really quickly, and other kids continue to have a lot of weakness going forward, but we haven't determined what factors decide which kids fall into which category yet."

Palacios says she wants answers to what causes AFM, and how to prevent and treat it -- for Abigail, and for other families who have been affected by it.

"She was at that age where was just learning how to be independent, and now she's dependent again," Palacios said.

"No parent should ever have to experience that."

CNN's Susan Scutti, Elizabeth Cohen and John Bonifield contributed to this report.
https://www.cnn.com/2018/10/22/health/a ... index.html
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Re: Mysterious polio-like illness affects children 22 US sta

Postby liminalOyster » Thu Oct 25, 2018 7:53 pm

The Main Suspect Behind an Ominous Spike in a Polio-Like Illness
A common virus seems to be behind a puzzling condition that’s paralyzing children, but uncertainties remain.


Petarg / Shutterstock / The Atlantic
ED YONG 12:55 PM ET HEALTH

As the summer of 2014 gave way to fall, Kevin Messacar, a pediatrician at Children’s Hospital Colorado, started seeing a wave of children with inexplicable paralysis. All of them shared the same story. One day, they had a cold. The next, they couldn’t move an arm or a leg. In some children, the paralysis was relatively mild, but others had to be supported with ventilators and feeding tubes after they stopped being able to breathe or swallow on their own.

The condition looked remarkably like polio—the viral disease that is on the verge of being eradicated worldwide. But none of the kids tested positive for poliovirus. Instead, their condition was given a new name: acute flaccid myelitis, or AFM. That year, 120 people, mostly young children, developed the condition across 34 states. The cases peaked in September and then rapidly tailed off.

“We didn’t know if it would go away,” Messacar says. “Unfortunately, it came back.”

After just a few dozen new cases the following year, AFM returned in force in 2016, afflicting 149 more people. The next year: another lull. And in 2018: another spike, with 62 confirmed cases so far and at least 93 more under investigation. Parents have described their children collapsing mid-run like “marionette dolls,” or going to bed with a fever and waking up paralyzed from the neck down.

This third wave confirms what many doctors had feared: AFM wasn’t a one-off, but likely a new biennial normal. It’s still rare, affecting just one in a million people, but that’s little comfort for the roughly 400 children who’ve been affected, many of whom are looking at lifelong disability or paralysis. “It’s exceptionally frustrating to see it again this year, when we know how much people’s lives are overturned,” says Priya Duggal from the Johns Hopkins Bloomberg School of Public Health. “We don’t really know much more than we knew in 2014—but we’re trying.”

AFM is a new term, but not a new syndrome. Its package of symptoms can be caused by a wide range of factors including, as the Centers for Disease Control and Prevention notes, poliovirus, West Nile virus, environmental toxins, and genetic disorders. The question isn’t what causes AFM per se, but what is specifically behind the biennial spikes that have appeared since 2014. (There was a small peak in 2012, too, before the condition came to national attention.)

That has proven to be a tough problem to crack. In this era, it seems that scientists could easily grab tissue samples, sequence the genes of everything in them, and pinpoint some consistent microbial culprit. But that hasn’t happened—so far, no single germ has shown up in every case. Despite all the tools of modern science, new diseases, especially rare ones, can be very hard to understand.

Afm is uncommon enough that a hospital might get just a handful of cases in a given year, if any. Many centers must join forces to pull off a rigorous study—and that’s logistically complicated. The condition is also geographically unpredictable. Some places had cases in 2014 but none this year, and vice versa.

More importantly, it’s too risky to take biopsies of the actual affected tissues—the nerves of the brain and spine. Instead, doctors have mostly drawn and analyzed samples of spinal fluid, and there’s no guarantee that whatever causes AFM is actually there.

So far, most of the signs point toward a virus as the cause, and specifically some kind of enterovirus. Unlike influenza, which circulates in the winter, enteroviruses are infections of the autumn, which is when AFM cases peak. They mostly infect young children, and the average AFM patient is 4 years old. Enteroviruses need a large enough population of susceptible hosts in which to circulate, so many lie low after waves of infection and crop up in cycles of two or three years—just as AFM does. And although many enteroviruses circulate widely but have little effect, they have a track record of occasionally infecting the spinal cord and causing paralytic illnesses.

“It’s not too far of a jump [to suspect them],” says Roberta DeBiasi, an infectious-disease chief at Children’s National Health System.

One particular enterovirus, known as EV-D68, has emerged as the lead suspect. First discovered in 1962, it seemed rare and unexceptional. But in 2014, it caused a huge surge of respiratory illness throughout the United States. That year, “our hospital was the busiest it’s ever been,” Messacar recalls. “The floors were packed, and we hit capacity.” And when paralyzed children started showing up at the same time, he put two and two together. He and others noted that in 2014 and 2016, EV-D68 was the most commonly identified virus in people with AFM.

Read: How will Trump lead during the next global pandemic?

But it’s not in every patient. So far, the CDC has only found the virus in the spinal fluid of a single child, and in fewer than half of the stool samples or nasal swabs they tested. “I am frustrated that, despite all of our efforts, we haven’t been able to identify the cause of this mystery illness,” said Nancy Messonnier, who directs the CDC’s National Center for Immunization and Respiratory Diseases, in a recent press briefing. The agency notes on its website that “the cause of most of the AFM cases remains unknown.”

Messacar thinks that the case for EV-D68 is stronger than the CDC is admitting. Certainly, caution is commendable; the wrong viruses have been blamed for perplexing illnesses before. But “I don’t think AFM is as much of an unknown as it’s portrayed,” he says. He is frustrated with its billing as a “mystery illness.”

Enteroviruses, he says, are not like typical nerve-infecting germs. They can move through nerves directly, so they don’t always show up in spinal fluid. And EV-D68 isn’t even like typical enteroviruses. Unlike other members of its family, it is quickly destroyed in the gut, and doesn’t show up in stool. It mostly thrives at the back of the nose—a place that few doctors thought to examine when AFM first showed up. Why look inside the respiratory tract of a child with a neurological disease?

Even when doctors did take nasal swabs, their odds of finding EV-D68 were low. In many neurological infections, the worst symptoms aren’t caused by the virus itself, but by the body’s disproportionate immune response. That response can continue even after the virus has been cleared, which means that patients often test negative for whatever first triggered their illness. All the researchers I spoke to think that AFM likely behaves in this way, especially since there can be a seven-day gap between the condition’s initial cold-like symptoms and the severe paralytic ones. By the time parents seek medical help, their children could be suffering from their bodies’ misplaced attempts to fight an enemy that’s no longer there. “The expectation that you’ll find a pathogen in every case is unrealistic because you’re already behind the clock,” says Messacar.

As a work-around, researchers could take the complicated steps of analyzing the bodily fluids of AFM patients for immune cells or antibodies that specifically recognize EV-D68. Their existence would at least suggest that the virus was once present. But even without such confirmation, there are other lines of incriminating evidence.

Read: We might absorb billions of viruses every day

After the EV-D68 epidemic of 2014, a few hospitals, including Messacar’s, started actively searching for the virus in nasal swabs taken from patients with generic cold symptoms. Their surveillance showed that the virus disappeared in 2015 and returned a year later, coinciding with the second AFM wave. It vanished again in 2017 and returned this summer. When the latest AFM wave hit, Children’s Hospital Colorado actually saw it coming.

There’s also compelling evidence from laboratory studies. Last year, Alison Hixon at the Colorado School of Medicine showed that EV-D68 strains from the 2014 outbreak can paralyze mice by infecting and killing the movement-controlling neurons in their spines. When Hixon isolated the virus from those neurons and injected them into another group of mice, those rodents also became paralyzed. That fulfills all the traditional criteria for causality. It falls short of a slam-dunk case only because the experiments were done in mice.

Another enterovirus, EV-71, has also been implicated in AFM. It’s endemic to East Asia, where it infrequently causes a similar polio-like illness with the same two-to-three-year periodicity. Messacar’s team detected it in Colorado this spring, and they’ve found it in 11 patients with AFM. Several enteroviruses could be behind the AFM cases.

But even if that’s true, it doesn’t explain why the disease suddenly became a national problem in 2014. Conspiratorial corners of the internet were quick to suggest that immigrants had imported a mystery virus—a ludicrous hypothesis, since EV-D68 was first identified in California five decades ago.

It’s possible, though, that the virus has changed since then. In one experiment, strains from 1962 didn’t paralyze mice in the same way that those from 2014 did. This would hardly be the first time that long-known viruses suddenly became more dangerous. Zika virus, for example, was thought to be innocuous when it was discovered in the 1940s, but only recently acquired a mutation that seemingly allows it to cause severe neurological problems.

“For me, it’s not really about the viruses,” says Duggal. “I’m really trying to figure out what causes the paralysis.” Much like polio virus, which paralyzed just 1 percent of those it infected, it’s likely that AFM is caused by widely circulating viruses that only lead to problems for a small, susceptible minority. That’s why you don’t hear news reports of entire schools coming down with AFM. The disease doesn’t even sweep through entire families: Whenever an affected child has had a sibling, Duggal says, that other child has always been always healthy. In one dramatic case, scientists isolated genetically identical strains of EV-D68 from two California siblings, one of whom had AFM and the other of whom had the sniffles.

Duggal is now sequencing the genes of people from 60 affected families, to see if the ones with AFM have any unique mutations. Other factors might be relevant, too. Gut bacteria, for example, can affect an animal’s susceptibility to polio. And since humidity and temperature affect the global circulation of enteroviruses, Carlos Pardo-Villamizar from the Johns Hopkins School of Medicine wonders if the world’s changing climate is influencing the new trends in AFM.

To an extent, every disease behaves like this. No germ sickens every person it infects. Instead, the outcomes of encounters between pathogens and hosts almost always depend on their respective genes, and other factors like climate, diet, the microbiome, and more.

The point is: Diseases are complicated. If anything, scientists have been lucky to study many viruses—flu, Ebola, and smallpox, to name a few—that are potent enough for their consequences to be clear, regardless of other variables. But there’ll be many instances in which the threads of cause and effect are harder to untangle. Epstein-Barr virus, for example, infects half of Americans before they get to middle school, and 90 percent of them by adulthood. It usually does nothing, sometimes leads to mono, and very infrequently causes cancers.

AFM is similar, and its emergence provides a new opportunity for researchers to confront age-old questions. How do you prove what causes a disease? When does your evidence become strong enough? And while you’re collecting that evidence, what do you do for the people who are affected?

“In 2014 and 2016, there were only one or two cases of full recovery,” says Duggal. This year, for whatever reason, the children in Colorado infected with EV-71 are recovering more quickly. But at least one child has died, and some are facing long-term disabilities. Every patient immediately gets intensive physical therapy. If that fails, doctors have tried antibody infusions and plasmapheresis (a process that filters blood) to reduce inflammation, but it’s unclear if these do any good. “There’s no proven efficacy, but also little risk,” says DeBiasi. “Once you get to other therapies, you’re starting to go up the risk equation. It’s not a cookbook approach.”

There’s no clear line on prevention, either. With uncertainty lingering around viral causes, the CDC’s advice is generic: “It’s always important to practice disease prevention steps, such as staying up-to-date on vaccines, washing your hands, and protecting yourself from mosquito bites.” Basically: Do the stuff that prevents other diseases.

Messacar would like them to be bolder. By all means, he says, be open to changing evidence and continue looking at other possible causes, but in the meantime, proceed as if EV-D68 is the actual culprit. That means two things. First, begin developing vaccines, a process that could take years. “It may seem early to start thinking about that, but if we don’t do the groundwork, and AFM comes back in a bigger way, we’re going to be years behind,” he says.

Read: How misinfodemics spread disease

Second, Messacar says, public-health workers should actively search for the virus in the same way that they do for flu. The CDC does have a surveillance program for enteroviruses, but it’s a passive system that relies on clinicians sending in samples. A more active program, of the kind that only a few hospitals do, would specifically test for EV-D68 in the noses of any child who gets admitted with respiratory problems.

A month ago, after the third wave of AFM had started, Pardo-Villamizar began convening a nationwide group of colleagues from hospitals that were seeing cases. Their goal is to share as much information as possible on how best to study, diagnose, and treat the illness. “We always depend on the CDC, but they’re designed to establish surveillance for diseases, not management and diagnosis,” he says. “We, as clinicians and scientists, should be doing that.”

For Messacar, the most important step is to take the disease seriously. “Right now, it’s very uncommon compared to polio in the 1950s, which caused tens of thousands of cases a year,” he says. “But I don’t want to downplay this as a rare disease, because of the long-term consequences. It’s jumping up the list of public-health priorities, and it deserves increased funding and attention.” A fourth wave is likely to hit in 2020. He wants the country to be ready.

https://www.theatlantic.com/health/arch ... en/573982/
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Re: The CDC could use a shot of History

Postby Sounder » Thu Nov 01, 2018 4:48 pm

https://thevaccinereaction.org/2018/10/ ... als-polio/

OPV Vaccine Plus A Shot of Antibiotics Equals Polio
by Barbara Loe Fisher
Published October 31, 2018 | Vaccination, History
OPV Vaccine Plus A Shot of Antibiotics Equals Polio

BACK TO THE FUTURE: Following is an article from the historical archives of The Vaccine Reaction newspaper journal. It was published in May 1995.

Investigating why large numbers of Romanian children were coming down with polio disease after being vaccinated with live oral polio vaccine (OPV), officials from the Centers for Disease Control and Prevention (CDC) found that if children were injected with a shot of antibiotics within one month of receiving OPV, they were eight times more likely to come down with polio than children who were not given an injection of antibiotics.

In a study published in the Feb. 23, 1995 New England Journal of Medicine, researchers found that if OPV was followed by two injections of antibiotics, the risk of vaccine associated paralytic poliomyelitis increased 27-fold. With 10 or more antibiotic injections following OPV, the risk of developing polio was 182 times greater than expected.
Polio Vaccine Virus May Enter Nerve Endings

The weakened strain of live poliovirus used in OPV can survive for a month or more in the intestinal tract where it can sometimes revert to a more virulent “wild type” form capable of causing disease. CDC investigators speculated that the problem emerged in Romania because, unlike in the U.S., Romanian doctors frequently give antibiotics by injection rather than in liquid form. The investigators speculated that when the muscle is injured during an injection, it may allow the live polio vaccine virus to get into the nerve endings where it can cause the disease.

[Researchers concluded that, “Provocation paralysis, previously described only for wild-type poliovirus infection, may rarely occur in a child who receives multiple intramuscular injections shortly after exposure to oral poliovirus vaccine, either as a vaccine recipient or through contact with a recent recipient. This phenomenon may explain the high rate of vaccine-associated paralytic poliomyelitis in Romania, where the use of intramuscular injections of antibiotics in infants with febrile illness is common.]1
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Re: Mysterious polio-like illness affects children 22 US sta

Postby DrEvil » Thu Nov 01, 2018 5:15 pm

^^Seeing how old that piece is you would think that it would be taken into account in the current vaccination program.

My money is on diseases spreading and/or mutating due to the changing climate.
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Re: Mysterious polio-like illness affects children 22 US sta

Postby seemslikeadream » Tue Nov 27, 2018 2:35 pm

CDC Confirms 116 Cases Of Polio-Like AFM Illness In 31 States

Acute flaccid myelitis generally affects children more than adults, and its cause is unknown.

Nina Golgowski
A mysterious polio-like illness that is sickening and in some cases paralyzing children is on the rise with at least 116 confirmed cases of acute flaccid myelitis so far this year, federal health officials said.

The latest number of confirmed AFM cases, spread across 31 states, is slightly more than double the number reported in October by the Centers for Disease Control and Prevention, which released its latest findings on Monday.

An additional 170 possible cases remain unconfirmed and under investigation, the CDC said.

AFM is an extremely rare but serious neurological condition that causes the body’s muscles and reflexes to become weak. Its cause remains unknown, and it generally affects children ― the average age of 4 ― more than adults. There is no vaccine or treatment, though health officials urge people to seek medical care immediately should they develop its symptoms, which typically begin with a mild respiratory illness or fever consistent with a viral infection.

The CDC last week established an AFM task force to help determine a cause and treatment for the condition, which is generally more prominent in the fall during the respiratory and flu season.


“I want to reaffirm to parents, patients, and our Nation CDC’s commitment to this serious medical condition,” CDC Director Robert R. Redfield said in a news release. “This Task Force will ensure that the full capacity of the scientific community is engaged and working together to provide important answers and solutions to actively detect, more effectively treat, and ultimately prevent AFM and its consequences.”



The majority of the cases this year in the U.S. have been in Colorado, where there have been 15 confirmed cases. Texas has the second-highest number with 14.

Image
There are 116 confirmed cases of acute flaccid myelitis in 31 states, the CDC said.
The number of cases reported this year are not the highest ever seen.

In 2016 there were 149 confirmed cases in 39 states and D.C., while in the last five months of 2014 there were 120 confirmed cases in 34 states.

The number of AFM cases appears to rise every other year. Last year there were just 33 confirmed cases in 16 states, while 2015 saw just 22 confirmed cases in 17 states.
https://www.huffingtonpost.com/entry/ac ... 6d9313cc04
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