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A dispatch of the front lines of acute flaccid myelitis



To Parents and the press, the "new" disease that paralyzes children is a mystery. Media coverage of acute flaccid myelitis (AD), which causes sudden limb weakness and paralysis in children, has given families the impression that health care providers and public health officials are sat silently and helpless in the face of the disease that threatens their health. .

This is simply not the case.

Parents have the right to worry about this disease. But they must also know that the AFM is rare, an event on a million. It does not spread in families, hospitals or cities. Although a virus called Enterovirus D68, as well as other viruses responsible for respiratory and diarrheal diseases, have been linked to the disease, no definitive cause has yet been identified. It is not because we are not looking for: doctors, scientists and public health officials are working tirelessly to find the answers and the best treatments.

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Progress has been made on several fronts since 2014, the year of onset of acute flaccid myelitis in news headlines and in public awareness. In the clinical field, multidisciplinary and multicenter collaborations have harnessed the collective wisdom of experts in infectious diseases, neurology, neuroradiology and rehabilitation, leading to the development of best practices for clinical care. Epidemiological and disease research data is shared among centers to optimize and standardize how children with this disease are cared for in any center of the country.

Within the national health system for children in Washington, DC, where we work, specialized programs have long existed to combat emerging infections and neuroinflammatory disorders. These two factors are related to acute flaccid myelitis due to its association with viruses and the nerve inflammation that it causes. Through our program and similar programs set up in other pediatric medical centers, standardized clinical procedures, based on evidence, now guide the assessment and treatment of each child suspected of acute flaccid myelitis.

As with other types of brain and spinal cord injury, the best results are often obtained with early mobilization. Rehabilitation begins early, sometimes even when a child with AFM is in the intensive care unit. Pediatric physiotherapists are trained so that children with weak limbs feel like champions, whether it be infants, toddlers or older children. .

On the epidemiological and public health fronts, disease control and prevention centers have standardized and made public case definitions so that children with AFD can be identified. And the CDC recently announced the creation of a new working group on flaccid acute myelitis. Its work, which will be coordinated by the director's office, aims to make its first report public in early December.

Several medical centers and surveillance networks have undertaken more intense and extensive efforts to examine patterns of circulation of respiratory viruses and diarrhea in communities and have implemented targeted viral surveillance to detect frequency peaks that may occur. 39 to be associated with a subsequent increase in the number of MFA cases.

On the scientific side, researchers have applied advanced molecular techniques, including complete exome genetic sequencing, to better understand the enterovirus D68, as well as to exclude other agents that may contribute to the # 39; AFM.

Researchers have also successfully developed laboratory models and animal models of acute flaccid myelitis closely mimicking human disease. These preclinical models help to better understand how the AFM hurts the spinal cord and have helped identify possible therapeutic targets. Researchers are also examining drugs and commercially available compounds that may work for these targets. They have already tested and reported on the safety and efficacy of promising treatments.

Our health system has set up a research biobank for blood and cerebrospinal fluid samples of children with neuro-inflammatory diseases. The study of these specimens could lead to discoveries on the AFM and to new insights into how it affects individuals. Through a unique research partnership between Children's National and the National Institute of Allergic and Infectious Diseases, we are developing antiviral treatments tailored to each patient and targeting exactly the virus with which they have been infected. This approach can save lives in life-threatening viral infections in patients with impaired immune systems. In the future, this targeted cell therapy technology could potentially be applied to viruses that target and deactivate the nervous system, including enteroviruses.

The first polio outbreak in the United States began in 1894; Franklin Delano Roosevelt had polio in 1921; Dr. Jonas Salk gave his vaccine to his family in 1953; and the vaccine developed by Dr. Albert Sabin was licensed in 1960. It is a 66-year period. The extremely effective polio vaccine commonly used by Sabin is often underestimated for its vital role in protecting health and preventing a disease that paralyzed up to 20,000 children a year before the adoption of the vaccination.


Thanks to modern techniques and multicenter collaborations, we hope that the resolution time for acute flaccid myelitis will be much shorter than for poliomyelitis. But that will not happen overnight. Doctors and scientists need the support of the public and the government to accelerate progress. To effectively combat the AFM – and the next emerging infectious disease – the country needs to strengthen and intensify existing surveillance networks for viral diseases, broaden the models of laboratory investigation to determine how the disease occurs and how to treat it, and help the major pediatric hospital networks to share data. , conduct clinical trials and optimize care.

While this is happening, clinicians in our program and similar centers in other pediatric centers across the country are applying constantly updated information to guide a standardized approach to assessing and treating children with acute myelitis. flaccid and help them to get the best possible chance of recovery.

Roberta L. DeBiasi MD, Head of Pediatric Infectious Diseases Division, Elizabeth M. Wells, MD, Medical Director of the Neuroscience Unit, and Jessica Carpenter, MD, Associate Professor of Pediatrics and Neurology, all at Children & # 39 National Health System in Washington, DC


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