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As the end-of-summer and early fall "season" approaches for acute flaccid myelitis (AFM), federal health officials want health care providers to are on the alert for the crippling disorder that has already affected 11 young children this year.
"I urge doctors to look for symptoms and report suspected cases in order to accelerate efforts to combat this serious disease," CDC director Robert Redfield said in a press release.
"We are seeking your help for the early recognition of patients with symptoms of MAP, the rapid collection of samples for testing and the immediate notification of suspected cases to the health departments," said the deputy director of the CDC, Anne Schuchat, during a press briefing.
Recognizing the AFM is a challenge, recognizes the CDC. The disease is rare and there is currently no diagnostic test in the laboratory. The main cause of the disease remains elusive. In the majority of cases, patients with AFM are otherwise young, healthy children who suffer from a mild respiratory disease or a fever consistent with a viral infection. They then develop AFM.
The CDC began following the AFM in 2014, when the first outbreak, involving 120 cases, occurred. Another epidemic, involving 149 cases, occurred 2 years later, in 2016. An epidemic occurred again 2 years later, in 2018. This epidemic, which involved 233 cases in 41 states, was the most important up to now. In 2019, 11 confirmed cases were reported in eight states; 57 cases are under investigation.
The AFM has so far followed a seasonal and biennial trend, with cases ranging from August to October every two years.
"The model from one year to two is intriguing," Schuchat said. The trend indicates that viruses are a potential actor ", but we can not deduce that this is a long-term trend, as we have only really been tracking this phenomenon since 2014. But we want clinicians and parents are ready for a possible major outbreak this year. "
"Delay hinders our ability to understand"
In a report released today, CDC researchers updated clinical, laboratory and outcome data from the 233 confirmed cases that were reported to the CDC in 2018.
As in the first two foci, the average age of patients with MMA was about 5 years. Most had respiratory symptoms or fever within 4 weeks of developing limb weakness.
"Patients have been severely affected by the AFM," said Tom Clark, MD, deputy director of the Division of Viral Diseases, at the briefing. 98% of patients were hospitalized, 60% required intensive care unit care and 27% needed mechanical ventilation. "They quickly received medical care," he said.
On average, patients were hospitalized in the day that followed the onset of limb weakness. The samples were collected for testing within 2 to 7 days on average. However, suspected cases were reported to the CDC 18 to 36 days after the onset of symptoms. "This delay hampers our ability to understand the causes of the AFM," Clark said.
In 44% of confirmed cases, laboratory tests revealed several types of enteroviruses and rhinoviruses, mainly in respiratory and stool samples. Virus types include enterovirus D68 (EV-D68) and enterovirus A71 (EV-A71).
Of the 74 cases for which a cerebrospinal fluid sample was available, only two were positive for enteroviruses – one with EV-A71 and one with EV-D68. No stool sample was tested positive for poliovirus, a related enterovirus that can cause AFM.
Since 2014, the CDC has tested the cerebrospinal fluid of most AFM patients. In only a few of these tests, a pathogen has been identified. "When a virus is detected in the cerebrospinal fluid, this proves to the evidence that it is the cause of the patient's disease," Clark said.
The CDC continues to monitor trends and clinical presentations of the AFM. They are conducting research to identify possible risk factors, using advanced laboratory tests and research to understand how viral infections can lead to MFA. They also track the long-term outcome of patients with MAF.
Clark pointed out that since the first outbreak in 2014, 70% to 80% or more of children with AFM have had persistent limb weakness several months after the onset of symptoms. There is some evidence that "early and aggressive rehabilitation" is helpful, he said. The CDC has published interim considerations for clinical management on its website.
Morb Mortal Rep Wkly. Posted on July 9, 2019. Full text
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