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The number of American children with acute flaccid myelitis (AM) continues to grow and federal health officials still do not know what triggers polio-like paralysis characterized by sudden weakness or loss of muscle tone in the arms or legs.
As of November 13, there were a total of 90 confirmed cases of MFA in 27 states, according to the US Centers for Disease Control and Prevention (CDC). These 90 confirmed cases are among 252 reports that CDC received on patients under investigation for AFM.
The 90 confirmed cases reported today are up from 80 confirmed cases (out of a total of 219 being investigated) in 25 states that the CDC reported a week earlier November 5th.
"To date, no deaths have been reported among AFM patients reported to the CDC in 2018," said Nancy Messonnier, director of the National Center for Immunization and Disease Control. Respiratory diseases of the CDC, during a press briefing.
However, she acknowledged that "one of the shortcomings of our program is that we do not ensure long-term follow-up in all patients with AFM and that we are working to correct them."
In this regard, the CDC has asked the US Departments of Health to establish a cross-check list of AFM cases (this year and previous years) with their death records to identify any deaths that may have been caused by the MFA.
Messonnier said most MFA cases involved children aged 2 to 8 years and half of them were men. Almost all cases of fever and / or respiratory illness have been reported within 3 to 10 days prior to limb weakness. In almost all patients, a senior member was involved. In about half, only one upper limb was involved.
"Some patients recover completely from the AFM, but at least half of the patients do not recover and have very serious sequelae" and we do not know why, she noted.
Messonnier said the CDC had tested 125 samples of spinal fluid, respiratory and stool among 71 confirmed cases of AFM. Of the samples tested for the respiratory tract and stool, about half were positive for enterovirus (EV) or rhinovirus, including EV-A71 and EV-D68. The liquid of the spinal cord was positive in two cases. One had evidence of the EV-A71 and another evidence of the EV-D68. However, it is too early to identify one of the viruses.
"We know that most AFM mycosis patients have fever and / or respiratory symptoms before developing this disease, but at this time of year, many children have fever and symptoms. to determine what triggers could cause someone to develop the AFM, "said Messonnier.
She also warned that the confirmation process for new AFM cases may take "a week to a few weeks," adding that the CDC "is working to speed up the process."
Clinical management
The CDC has expanded its network of neurologists to assist and confirm MFA cases. The agency has also set up a working group composed of experts in several disciplines to develop a comprehensive research program to better understand why the AFM affects some children and what triggers it.
"CDC is a science-based agency, and science does not give us an answer at the moment," said Messonnier.
Later this week, the CDC plans to post up-to-date considerations for AFM clinical management that reflect the experience of clinicians dealing with AAF cases.
"Unfortunately, as we do not yet know the cause of all AFM cases, these considerations are not as specific as we would like," said Messonnier. "There is currently no treatment or targeted intervention with enough evidence to approve or discourage their use.We recommend clinicians to expedite neurology and infectious disease consultations to discuss treatment and management considerations. "she advised.
The CDC is actively investigating the AFM, testing samples and monitoring the disease since 2014, when an increase in the number of cases was detected. In 2014, there were 120 confirmed cases in 34 states and in 2016, 149 confirmed cases in 39 states. Last year, 33 cases were confirmed in 16 states.
Messonnier said it would be "premature to predict how many cases we will see this year.But up to now, the 2018 curve is similar to that of 2016".
The CDC continues to report the number of cases updated each Monday afternoon on its website.
The CDC has developed a toolkit for health professionals that includes information on the AFM and instructions for reporting patients under investigation to the health department.
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