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Acute flaccid myelitis (AFM), a rare disease that causes polio-like paralysis, has circulated in the United States. As of 30 September, 38 confirmed cases had been reported to the Centers for Disease Control and Prevention (CDC) in 16 states, but their numbers appear to be increasing.
In Washington State, six children have now had a sudden onset of paralysis of one or more limbs. The last case was reported to the Washington State Department of Health on Thursday, October 11, and left Skagit County, north of Seattle. All reported cases are in counties in western Washington.
Also on Thursday, hospital officials at the Oishei Children's Hospital in Buffalo, NY, confirmed that doctors were treating a 3-year-old patient with a "high-risk" case. suspected "of MFA. The child and his family have been "in and out of the hospital these past two weeks and now the boy is unable to walk," reports WKBW in Buffalo.
Although the hospital completed its own AFM tests, samples were sent to the CDC for further evaluation.
The states involved include California, Colorado, Florida, Illinois, Massachusetts, the State of New York, Pennsylvania, Rhode Island, Texas, Virginia and the state of Washington.
True numbers difficult to determine
From August 2014 to August 2018, the CDC was informed of 362 cases of the disease, mainly in children. But even though the official number of cases is 38 for 2018 (as of September 30th), this may not reflect the actual number that will eventually be confirmed.
For example, Minnesota reported six cases; three children are treated in Pittsburgh; two are treated in Chicago; and eight cases were reported in Texas, one in Rhode Island and 14 in Colorado.
However, the 38 cases reported by the CDC do not include the 14 cases reported by Colorado, some having been confirmed after September 30th. They do not include those from Minnesota, as they have not been confirmed yet. In addition, nine cases were reported in children in northern Illinois, but they were also not confirmed by the CDC.
The CDC began actively investigating the AFM in August 2014, after seeing an increase in the number of reports of people with this type of disease across the country, but with no discernible cause. In 2014, a total of 120 cases were reported in 34 states.
The number fell in the following year to 22 cases reported in 17 states, but increased to 149 in 2016 in 39 states and the District of Columbia. The following year, their numbers declined further to 33 cases in 16 states.
The underlying cause of many cases this year has not yet been identified. The sharp increase in the number of AFM cases in 2014 coincided with an outbreak of serious respiratory illness caused by the enterovirus D68 (EV-D68). However, EV-D68 was not detected in all individuals in whom AFM was confirmed. In 2015, the CDC received no reports of significant epidemics from EV-D68, with local laboratories reporting only a limited number of EV detections. -D68. The following year, some localized clusters were reported.
Different Enterovirus seen in Colorado
While EV-68 has been associated with this syndrome, in Colorado many more cases have been linked to an enterovirus infection A71 (EV-A71). According to the Colorado Department of Public Health and the Environment (CDPHE), there have been 41 cases of EV-A71 infections related to neurological diseases in young children this year. Of these cases, 14 involved MFAs and 11 of these had been tested positive for EV-A71. Only one child tested positive for EV-D68 and two were EV negative.
"We have been monitoring enterovirus in Colorado for several years, which may explain why we have observed some of these trends," said Rachel Herlihy, MD, MPH, Chief Epidemiologist at the CDPHE. Medscape Medical News. "In 2003 and 2005, we detected cases of EV-A71, identified by the Children's Hospital."
These are cases involving a neurological disease in children, she explained. "In 2014, Colorado and other parts of the country had a much larger epidemic of EV-D68 associated with the MFA.We had 11 cases that year in Colorado.This year, Is therefore different from what we had in 2014, but the same as what we had in 2003 and 2005. "
The clinical course and presentation with EV-A71 are also quite different from those of EV-D68, said Herlihy. "Children with A71 do not have a respiratory disease, but may have a rash, diarrhea or fever, D68 is associated with a respiratory disease that can be followed by AFM."
In Washington State, all children had symptoms suggestive of a respiratory illness the week before the onset of AFM symptoms. Four children also had a fever of at least 100.4 degrees, but these symptoms do not precede all individuals who develop an AFM. These differences make the problem more difficult to classify in the country.
"I do not think we know what enterovirus is at the origin of the cases – it may be D68 in other parts of the country, but again, we do not see it. not in Colorado, "said Herlihy.
Any virus can cause neurological symptoms, the CDC says, and many have been associated with paralytic disease. To date, no specific pathogen has been consistently detected in the cerebrospinal fluid of affected patients.
The agency also points out that there is still much to be done on the AFM, as for example what has led to the increase in the number of cases starting in 2014. It is also unclear which individuals are most at risk to develop the AF, nor the reasons for which they risk higher risk.
"Enteroviruses can pose diagnostic problems," said Herilhy. "Cerebrospinal fluid is often not positive for enteroviruses, and we recommend that service providers take samples from alternative sites." We observe more positive cultures and fewer false negatives when samples are taken. on three sites – [cerebrospinal fluid], swabs of the throat and rectum. "
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