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  • Polio-Like Illness Paralyzes about 20 Kids in California - Enterovirus 68 suspected

    Polio-Like Illness Paralyzes 5 Kids in California
    BY JONEL ALECCIA
    Scientists in California say that an emerging infection that mimics the worst symptoms of polio paralyzed at least five children in that state in a single year.

    The infections, possibly caused by a virus, are still very rare and there’s no widespread cause for alarm. But researchers at the University of California, San Francisco, say they’re concerned about the mysterious illnesses detected in kids ages 2 to 16 between August 2012 and July 2013.

    “The recovery has been, in the best cases, marginal,” said Emmanuelle Waubant, a professor of neurology and pediatrics at UCSF. “In the worst cases, there has been no recovery at all.”

    She and her colleagues will report on the case series at the American Academy of Neurology’s annual meeting in Philadelphia in April but released their findings Sunday.
    ...
    http://www.nbcnews.com/health/kids-h...ifornia-n34981
    Twitter: @RonanKelly13
    The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

  • #2
    Re: Polio-Like Illness Paralyzes 5 Kids in California

    POLIO-LIKE VIRUS SUSPECTED IN KIDS’ PARALYSIS
    By SFBay Wires
    1:41 pm
    February 23, 2014

    PHILADELPHIA, Feb. 23, 2014 /PRNewswire-USNewswire/ -- Researchers have identified a polio-like syndrome in a cluster of children from California over a one-year period, according to a case report released today that will be presented at the American Academy of Neurology's 66th Annual Meeting in Philadelphia, April 26 to May 3, 2014.

    "Although poliovirus has been eradicated from most of the globe, other viruses can also injure the spine, leading to a polio-like syndrome," said case report author Keith Van Haren, MD, with Stanford University in Palo Alto, Calif., and a member of the American Academy of Neurology and co-author Emanuelle Waubant, MD, with the University of California-San Francisco. "In the past decade, newly identified strains of enterovirus have been linked to polio-like outbreaks among children in Asia and Australia. These five new cases highlight the possibility of an emerging infectious polio-like syndrome in California."

    ...
    The five children experienced paralysis of one or more arms or legs that came on suddenly and reached the height of its severity within two days of onset. Three of the children had a respiratory illness before the symptoms began. All of the children had been previously vaccinated against poliovirus.
    ...
    More at SFBay: http://sfbay.ca/2014/02/23/polio-lik...#ixzz2uBxM4nYr
    Twitter: @RonanKelly13
    The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

    Comment


    • #3
      Re: Polio-Like Illness Paralyzes 5 Kids in California

      Follow the link for full article with more details - Ro

      Mysterious polio-like illness affects kids in California
      5:09 AM, Feb 24, 2014 |

      (USATODAY.com) - A mysterious polio-like syndrome has affected as many as 25 California children, leaving them with paralyzed limbs and little hope of recovery.

      "What's we're seeing now is bad. The best-case scenario is complete loss of one limb, the worst is all four limbs, with respiratory insufficiency, as well. It's like the old polio," said Keith Van Haren, a pediatric neurologist at Lucile Packard Children's Hospital in Palo Alto, Calif.

      The first known case appeared in 2012. Sofia Jarvis in Berkeley began to experience wheezing and difficulty breathing. The 2-year-old spent days in the intensive care unit at Children's Hospital Oakland. Doctors thought she had asthma.
      ...
      "We don't have a final case count, but it's probably in the neighborhood of 25 cases, all in California," said Van Haren. The median age of those stricken is 12.

      "The California Department of Public Health has asked health care providers to report any polio-like cases they might identify and send specimens so that we can better assess the situation," said Carol Glaser, chief of the encephalitis and special investigation section of the California Department of Public Health in Sacramento.
      ...
      "The cause of most of these cases is not known. Some clinical and laboratory features, such as the pattern of inflammation seen in the spinal cord on MRI, are consistent with a viral process," said Glaser.

      Van Haren suspects the culprit is an enterovirus. That is a family of viruses that includes polio but also the milder hand, foot and mouth disease, common in infants and children.
      ...
      http://www.wtsp.com/news/national/ar...-in-California
      Twitter: @RonanKelly13
      The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

      Comment


      • #4
        Re: Polio-Like Illness Paralyzes 5 Kids in California

        The article contains the text:

        Testing confirmed that the children in California "definitely do not have polio," Van Haren said.

        Assuming that is correct (that both wild and vaccine-derived polioviruses have been excluded), the obvious place to begin testing is for a novel enterovirus.

        I also wonder about the relationship between this outbreak and several Guillain-Barre-like outbreaks in the Southwest US and in Mexico over the past few years, some of which had tentative links to Campylobacter outbreaks. While polio and GBS are usually quite distinct in thier presentations, the symptomatic descriptions in those outbreaks often did seem to blur the lines.

        Comment


        • #5
          Re: Polio-Like Illness Paralyzes 5 Kids in California

          And here we go:

          Published Date: 2014-02-24 03:46:37
          Subject: PRO/EDR> Polio-like illness - USA: (CA) enterovirus 68 susp, RFI
          Archive Number: 20140224.2296126

          POLIO-LIKE ILLNESS - USA: (CALIFORNIA) ENTEROVIRUS 68 SUSPECTED, REQUEST FOR INFORMATION
          ************************************************** **************************************
          A ProMED-mail post
          http://www.promedmail.org
          ProMED-mail is a program of the
          International Society for Infectious Diseases
          http://www.isid.org

          [1]
          Date: Sun 23 Feb 2014
          Source: Los Angeles Times [edited]
          http://www.latimes.com/local/lanow/l...#axzz2uCOiiuQV


          A small number of children in California have come down with polio-like illnesses since 2012 -- suffering paralysis in one or more limbs and other symptoms -- and physicians and public health officials do not yet know why.

          A virus may play a role, said Dr Carol Glaser, leader of a California Department of Public Health team investigating the illnesses, which are occurring sporadically throughout the state.

          The afflicted kids suffer severe weakness or paralysis, which strikes rapidly -- sometimes after a mild respiratory illness. Scans of the patients' spinal cords show patterns of damage similar to that found in polio sufferers, Glaser said. 2 of the affected children tested positive for enterovirus 68, a virus that is usually associated with respiratory illness but which has been linked to polio-like illnesses as well.

          Dr Keith Van Haren, a pediatric neurologist at Stanford University's Lucile Packard Children's Hospital who has worked with Glaser's team, will present the cases of 5 of the children at the American Academy of Neurology's upcoming annual meeting in Philadelphia.

          All 5 patients had paralysis in one or more arms or legs that reached its full severity within 2 days, he said. None had recovered limb function after 6 months.

          "We know definitively that it isn't polio," Van Haren added, noting that all had been vaccinated against that disease.

          State health investigators have been tracking the new California cases closely since a physician first requested polio testing for a child with severe paralytic illness in the fall of 2012, Glaser said. She called that request "concerning," because polio has been eradicated in the US, and the patient had not traveled abroad.

          In the year that followed, Glaser's team continued to hear about additional children with symptoms that could not be chalked up to known causes like West Nile virus or botulism. The median age of the children was 12 years. Glaser did not disclose the total number of illnesses; Van Haren said he was aware of around 20.

          [A 4 year old female] Berkeley resident is one of Van Haren's patients. The girl suffered paralysis in her left arm following a brief asthma-like illness in November 2012. "She went to grab a toy, and mid-grasp her arm stopped working," said [her] mother.

          [The girl] did not test positive for an enterovirus. Her 2 older brothers have no signs of illness.

          Glaser said that it was possible that children who tested negative still may have contracted their illnesses from viruses that couldn't be detected because test samples were "not optimal." She urged doctors to report new cases of acute paralysis so that investigators can attempt to figure out a possible cause.

          "We want to hear from local public health jurisdictions and physicians who are seeing similar illnesses," she said.

          Van Haren said that most people who are infected by polio or viruses like it never develop symptoms, with only 1 percent developing neurologic complications like paralysis. Scientists do not know why certain people are affected so severely.

          [Byline: Eryn Brown]

          --
          Communicated by:
          ProMED-mail Rapporteur Mary Marshall

          ******
          [2]
          Date: Mon 24 Feb 2014
          Source: BBC News [edited]
          http://www.bbc.co.uk/news/health-26289614


          US doctors are warning of an emerging polio-like disease in California where up to 20 people have been infected.

          A meeting of the American Academy of Neurology heard that some patients had developed paralysis in all 4 limbs, which had not improved with treatment.

          The US is polio-free, but related viruses can also attack the nervous system leading to paralysis.

          Doctors say they do not expect an epidemic of the polio-like virus and that the infection remains rare.

          Polio is a dangerous and feared childhood infection. The virus rapidly invades the nervous system and causes paralysis in 1 in 200 cases. It can be fatal if it stops the lungs from working. Global vaccination programmes mean polio is endemic in just 3 countries -- Afghanistan, Nigeria, and Pakistan.

          There have been 20 suspected cases of the new infection, mostly in children, in the past 18 months.

          A detailed analysis of 5 cases showed enterovirus 68 -- which is related to poliovirus -- could be to blame.

          In those cases all the children had been vaccinated against polio.

          Symptoms have ranged from restricted movement in one limb to severe weakness in both legs and arms.

          Dr Emmanuelle Waubant, a neurologist at the University of California, San Francisco, told the BBC: "There has been no obvious increase in the pace of new cases so we don't think we're about to experience an epidemic, that's the good news.

          "But it's bad news for individuals unlucky enough to develop symptoms which tend to be moderate to severe and don't appear to improve too much despite reasonably aggressive treatment."

          The cases have been spread over a 100-mile diameter (160 km) so the research team do not think the virus represents a single cluster or outbreak.

          However, many more people could have been infected without developing serious symptoms -- as was the case with polio.

          Dr Waubant suspects similar cases in Asia could explain why California is affected, but not the rest of the US.

          Fellow researcher Dr Keith Van Haren, from Stanford University, said the cases "highlight the possibility of an emerging infectious polio-like syndrome" in California.

          He added: "We would like to stress that this syndrome appears to be very, very rare. Any time a parent sees symptoms of paralysis in a child, the child should be seen by a doctor right away."

          Commenting on the findings, Jonathan Ball, a professor of virology at the University of Nottingham, told the BBC: "Since the near-eradication of poliovirus, other enteroviruses have been associated with paralysis, but these viruses usually cause a very mild cold-like illness and severe complications are very rare.

          "Two children showed evidence of being infected by a strain of virus called enterovirus 68, which has become strongly associated with outbreaks of respiratory illness.

          "Whether or not this strain of enterovirus has caused these or other cases of paralysis is possible but remains conjecture, further studies will be needed to determine this."

          --
          Communicated by:
          ProMED-mail
          <promed@promedmail.org>

          [The 2 media reports above provide somewhat differing reports on the occurrence of a polio-like paralytic illness identified since 2012 in California. The details provided in the media reports are sparse but suggest that there may have been up to 20 cases presenting with an acute flaccid paralysis (AFP) following a mild respiratory illness. 2 out of 5 cases specified in the 1st report have had an enterovirus 68 isolated from stool specimens (whereas in the 2nd report 5 cases had enterovirus 68 identified). Actual details of the clinical presentations of the cases were not reported.

          Non-polio enteroviruses (NPEVs) have been associated with polio-like paralytic disease. As part of the global polio eradication initiative, stool specimens are to be collected and sent for virus isolation on all cases of acute flaccid paralysis (AFP) that are identified. This massive laboratory supported effort has led to the identification of many non-polio enteroviruses associated with AFP (see references listed below for a representative sampling of the types of viruses associated with AFP. Of these NPEVs, EV71 has been most notably associated with paralytic disease, and more recently, sub-genogroup C4a was associated with AFP in Australia (see ProMED-mail Human enterovirus 71 - Australia: sub-genogroup C4a, acute flaccid paralysis 20130526.1738087). While EV68 has been anecdotally associated with AFP, it has been identified as a cause of severe respiratory disease (see ProMED-mail Human enterovirus 68 - novel pathogen, worldwide 20110929.2945 with a Morbidity and Mortality Weekly Report (MMWR) article summarizing the reports of respiratory illness associated with EV68).

          More information on the actual numbers of cases, ages of cases, geographic distribution, number of cases with adequate specimens processed for viral etiology studies, results of laboratory studies, and whether there have been virologic studies of contacts of these AFP cases will be appreciated. All of these are questions that need to be addressed to assist in interpreting the significance of the reports above.

          For a map showing the location of California in the USA, see http://healthmap.org/r/3DHP.

          Selected references
          -------------------
          1. The National Committee for the Certification of Wild Poliovirus Eradication in Hong Kong (NCC). Fifteen years of acute flaccid paralysis surveillance in Hong Kong: Findings from 1997 to 2011. J Paediatr Child Health. 2014 Feb 17. [Epub ahead of print]; abstract available at http://www.ncbi.nlm.nih.gov/pubmed/24528511.
          2. Kim H, Kang B, Hwang S, et al: Clinical and enterovirus findings associated with acute flaccid paralysis in the republic of Korea during the recent decade. J Med Virol. 2013 Sep 23. [Epub ahead of print]; abstract available at http://www.ncbi.nlm.nih.gov/pubmed/24114945.
          3. Peacey M, Hall RJ, Wang J, et al: Enterovirus 74 infection in children. PLoS One. 2013 Oct 2; 8(10): e76492; full article available at http://www.plosone.org/article/info%...l.pone.0076492.
          4. Laxmivandana R, Yergolkar P, Gopalkrishna V, Chitambar SD: Characterization of the non-polio enterovirus infections associated with acute flaccid paralysis in South-Western India. PLoS One. 2013 Apr 22;8(4):e61650. Print 2013; full article available at http://www.plosone.org/article/info%...l.pone.0061650.
          5. Rao CD, Yergolkar P, Shankarappa KS: Antigenic diversity of enteroviruses associated with nonpolio acute flaccid paralysis, India, 2007-2009. Emerg Infect Dis. 2012 Nov; 18(11): 1833-40; full article available at http://wwwnc.cdc.gov/eid/article/18/...57_article.htm.
          6. Shaukat S, Angez M, Alam MM, et al: Characterization of non-polio enterovirus isolates from acute flaccid paralysis children in Pakistan reflects a new genotype of EV-107. Virus Res. 2012 Dec; 170(1-2): 164-8. Epub 2012 Oct 2; abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23041515.
          7. Shahmahmoodi S, Mehrabi Z, Eshraghian MR, et al: First detection of enterovirus 71 from an acute flaccid paralysis case with residual paralysis in Iran. J Clin Virol. 2008 Aug;42(4):409-11. Epub 2008 Apr 9; abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18403258.
          8. Junttila N, Leveque N, Kabue JP, et al: New enteroviruses, EV-93 and EV-94, associated with acute flaccid paralysis in the Democratic Republic of the Congo. J Med Virol. 2007 Apr; 79(4): 393-400; abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17311342.
          9. Huang CC, Liu CC, Chang YC, et al: Neurologic complications in children with enterovirus 71 infection. N Engl J Med. 1999 Sep 23; 341(13): 936-42; full article available at http://www.nejm.org/doi/full/10.1056...99909233411302.
          10. Dietz V, Andrus J, Olive JM, et al: Epidemiology and clinical characteristics of acute flaccid paralysis associated with non-polio enterovirus isolation: the experience in the Americas. Bull World Health Organ. 1995; 73(5): 597-603; full article available at http://whqlibdoc.who.int/bulletin/19...29_597-603.pdf.
          11. Hayward JC, Gillespie SM, Kaplan KM, et al: Outbreak of poliomyelitis-like paralysis associated with enterovirus 71. Pediatr Infect Dis J. 1989 Sep; 8(9): 611-6; abstract available at http://www.ncbi.nlm.nih.gov/pubmed/2797956.
          - Mod.MPP]

          Comment


          • #6
            Re: Polio-Like Illness Paralyzes about 20 Kids in California - Enterovirus 68 suspected

            Acute Flaccid Paralysis Cases In California




            Credit CDC – Non Polio-Enteroviruses


            # 8325

            Overnight the news media has been filled with numerous reports of an – as yet, unidentified – polio-like paralytic illness that has stricken a small number of children in California over the past two years. Crof already has a couple of media reports on his blog (see US: A polio-like illness in California children & US: More on the polio-like illness in California), and ProMed Mail released a summary this morning.

            The basic facts are recounted in the following excerpt from the Los Angeles Times report, after which I’ll have more:
            Mysterious polio-like illnesses reported in some California children
            By Eryn Brown
            February 23, 2014
            (excerpt)
            The afflicted kids suffer severe weakness or paralysis, which strikes rapidly -- sometimes after a mild respiratory illness. Scans of the patients' spinal cords show patterns of damage similar to that found in polio sufferers, Glaser said. Two of the affected children tested positive forenterovirus-68, a virus that is usually associated with respiratory illness but which has been linked to polio-like illnesses as well.

            Dr. Keith Van Haren, a pediatric neurologist at Stanford University's Lucile Packard Children's Hospital who has worked with Glaser's team, will present the cases of five of the children at the American Academy of Neurology's upcoming annual meeting in Philadelphia.

            All five patients had paralysis in one or more arms or legs that reached its full severity within two days, he said. None had recovered limb function after six months.

            "We know definitively that it isn't polio," Van Haren added, noting that all had been vaccinated against that disease.
            (Continue . . . )
            This report, along with others, suggest that 20 to 25 children in California may have developed Acute Flaccid Paralysis (AFP) following a mild respiratory illness over the past couple of years, and investigators expect that once clinicians know to look for it, they may discover it beyond California.
            Non-polio AFP is a complex and broad clinical syndrome that can be caused by a wide range of pathogens, including West Nile Virus (and other mosquito-borne encephalopathies), echoviruses, adenoviruses, Campylobacter jejuni (leading cause of Guillain-Barre syndrome), a large group of enteroviruses, along with a variety of toxins and poisons.
            While the exact cause (or causes) of these California cases remains unknown, a viral infection is strongly suspected, and high on the list of suspects are members of the ubiquitous non-polio enterovirus family of viruses or NPEVs (which includes Coxsackievirus A, Coxsackievirus B, Echoviruses & numerous other Enteroviruses).

            According to theCDC, NPEVs cause 10 to 15 million – mostly mild and often asymptomatic – infections in the United States each year, primarily among infants, children, and teenagers. Fever, runny nose, sneezing, coughing, a skin rash or mouth blisters, and body and muscle aches are the most commonly reported symptoms.

            NPEV infection may also lead to viral conjunctivitis, hand, foot, and mouth disease (HFMD), or viral meningitis and less commonly, a person may develop myocarditis, pericarditis, encephalitis - or in rare cases - even paralysis.
            The CDC lists the following common Outbreaks of Various Non-Polio Enteroviruses
              • Coxsackievirus A16 is the most common cause of hand, foot, and mouth disease (HFMD) in the United States. However, in 2011 and 2012, coxsackievirus A6 was a common cause of HFMD in this country; some of the infected people became severely ill.
              • Coxsackievirus A24 and enterovirus 70 have been associated with outbreaks of conjunctivitis.
              • Echoviruses 13, 18, and 30 have caused outbreaks of viral meningitis in the United States.
              • Enterovirus 71 has caused large outbreaks of HFMD worldwide, especially in children in Asia. Some infections from this virus have been associated with severe neurologic disease, such as brainstem encephalitis.


            We’ve looked at HFMD outbreaks in the past, most often caused by the Coxsackie A16 virus (and more rarely by Coxsackie A10) here in the United States. In recent years, we’ve also seen the recent emergence of the Coxsackie A6 virus which has been linked to somewhat more severe HFMD cases (see MMWR: Coxsackievirus A6 Notes From The Field).



            But it is the Enterovirus 71 that has been most often linked to severe cases of HFMD – particularly across Asia - with serious outbreaks recorded over the past 15 years in places like China, Taiwan, Malaysia, Hong Kong, and two years ago in both Vietnam and Cambodia (see Updating The Cambodian EV71 Story).
            Last year, in Australia: Acute Flaccid Paralysis & EV71, we looked at a report from the National Enterovirus Reference Laboratory in Australia that described 5 recent cases of acute flaccid paralysis (AFP) in children who tested positive for the EV71 virus.
            Concerns over the evolution and spread of EV71 have grown in recent years, as detailed in the following 2008 report from The Lancet: Enterovirus 71 infection: a new threat to global public health?

            While a potential cause, EV71 is just one of the possible suspects behind these California cases. Indeed, AFP can be caused by a variety of viral infections, and so there may be more than one etiology involved

            At least two of the children in California have tested positive for Enterovirus-68, which we looked at in some depth back in 2011 (see MMWR: Clusters Of HEV68 Respiratory Infections 2008-2010). First detected in California in 1962, but rarely seen since that time, that report summarized six clusters of HEV68 from Asia, Europe, and the United States between 2008-2010. Those clusters included severe illness, and three fatalities.
            Although the full spectrum of illness that EV-68 infection can produce has not been well established, it has previously been more commonly associated with respiratory symptoms than with paralysis.

            So whether EV-68 is actually the cause of these recent California paralysis cases, or simply an incidental finding, is something that will require more research to establish. Despite their outward similarity to NPEV infections, these AFP cases in California may be due to something altogether different. New viral discoveries are made practically every year.

            But most `mystery illnesses’ usually end up being due to previously identified diseases that have either evolved or mutated a bit, or have migrated to a new area.
            While it is too soon to speculate on the exact cause of these AFP cases, the CDC’s recommendations to prevent NPEV transmission are universally good hygiene suggestions, and are worth following:
            You can help protect yourself and others from non-polio enterovirus infections by—
            • Washing your hands often with soap and water, especially after using the toilet and changing diapers,
            • Avoiding close contact, such as touching and shaking hands, with people who are sick, and
            • Cleaning and disinfecting frequently touched surfaces.

            Posted by Michael Coston at <a class="timestamp-link" href="http://afludiary.blogspot.com/2014/02/acute-flaccid-paralysis-cases-in.html" rel="bookmark" title="permanent link"><abbr class="published" itemprop="datePublished" title="2014-02-24T07:04:00-05:00">7:04 AM</abbr>

            Comment


            • #7
              Re: Polio-Like Illness Paralyzes about 20 Kids in California - Enterovirus 68 suspected

              Q & A: Rare polio-like disease emerges in California
              February 24, 2014 | Erin Digitale
              PEDIATRICS, RESEARCH AND INNOVATION.

              Keith Van Haren, MD, pediatric neurologist at Lucile Packard Children’s Hospital Stanford and an instructor in neurology and neurological sciences at the School of Medicine, recently identified a very rare disease that shares some characteristics with polio. Below, he answers questions about this new disease.

              Q: What is the new illness?

              A: Physicians around California have begun to observe a new type of acute flaccid paralysis, a disease in which patients quickly and permanently lose muscle function in an arm or leg. In some cases, patients have had respiratory symptoms before the paralysis begins. The disease resembles but is not the same as polio.

              Q: How common is it?

              A: This disease is very rare. About 20 cases have been identified in the U.S. so far, all in California, and all occurring in the past 18 months.

              Q: What causes the new disease?

              A: Doctors are not sure, but suspect it may be caused by a virus. Some of the children identified with this disease have had enterovirus-68, which is from the same family as the polio viruses. This virus is suspected in part because a similar type of paralysis caused by another enterovirus has been seen for many years in Asia and Australia. Another possibility is that the disease may be autoimmune.
              ...
              Keith Van Haren, MD, will meet the media to answer questions tonight, February 24, at 6pm.

              When/Where

              6 pm – 7 pm

              February 24, 2014

              Lucile Packard Children’s Hospital Stanford

              725 Welch Rd.

              Palo Alto, CA 94025

              Contact

              Robert Dicks

              (650) 387-7500

              rdicks@lpch.org

              http://healthier.stanfordchildrens.o...tent=neurology
              Twitter: @RonanKelly13
              The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

              Comment


              • #8
                Re: Polio-Like Illness Paralyzes 5 Kids in California

                Originally posted by alert View Post
                The article contains the text:

                Testing confirmed that the children in California "definitely do not have polio," Van Haren said.

                Assuming that is correct (that both wild and vaccine-derived polioviruses have been excluded), the obvious place to begin testing is for a novel enterovirus.

                I also wonder about the relationship between this outbreak and several Guillain-Barre-like outbreaks in the Southwest US and in Mexico over the past few years, some of which had tentative links to Campylobacter outbreaks. While polio and GBS are usually quite distinct in thier presentations, the symptomatic descriptions in those outbreaks often did seem to blur the lines.
                Here's the link to that thread, alert.

                Sonora, Mexicali, and Baja California, Mexico and Wyoming and Arizona, United States: Unusual cluster of Guillain Barre cases - links to Campylobacter infection?

                Water quality problems, possibly exacerbated by drought was suspected as driving those clusters. Now we have another paralytic expression of another pathogen in another drought-stricken region. (Though there has been some relief on that very recently.)
                Never forget Excalibur.
                “‘i love myself.’ the quietest. simplest. most powerful. revolution ever.” ---- nayyirah waheed
                Avatar: Franz Marc, Liegender Hund im Schnee 1911 (My posts are not intended as advice or professional assessments of any kind.)

                Comment


                • #9
                  Re: Polio-Like Illness Paralyzes 5 Kids in California

                  Originally posted by Emily View Post
                  Here's the link to that thread, alert.

                  Sonora, Mexicali, and Baja California, Mexico and Wyoming and Arizona, United States: Unusual cluster of Guillain Barre cases - links to Campylobacter infection?

                  Water quality problems, possibly exacerbated by drought was suspected as driving those clusters. Now we have another paralytic expression of another pathogen in another drought-stricken region. (Though there has been some relief on that very recently.)
                  I was actually suggesting a more direct link than that between the two outbreaks. Calculations that I ran during that outbreak in that thread indicated that many times the number of AFP cases were occurring than could be attributed to Campylobacter-linked GBS. I think most of those cases remain unexplained.

                  Whatever pathogen is causing the current outbreak (which may or may not be EV68) should be investigated in those cases as well.

                  Here is another such outbreak, across the border in Mexico:

                  http://www.flutrackers.com/forum/sho...d.php?t=156348

                  Comment


                  • #10
                    Re: Polio-Like Illness Paralyzes about 20 Kids in California - Enterovirus 68 suspected

                    Hat-tip Crof. This is a good point; the expected number of AFP cases per year in California is apparently 80, so this could in fact be background noise:

                    http://www.scientificamerican.com/ar...use-for-alarm/

                    [snip]

                    These children did not test positive for polio, but two of the children did test positive for a different kind of enterovirus, enterovirus 68. What’s your theory for what’s going on here?
                    Acute flaccid paralysis, that’s acute paralysis of parts of the body–in this case the limbs, can result from a variety of viruses including polio virus and non-polio enteroviruses including enterovirus 68, West Nile Disease, echovirus and adenoviruses. Most people who get enteroviruses have mild symptoms and no testing is ever done on them. I think we’re looking at a rare outcome in these children.

                    Are we seeing these symptoms in places other than California?
                    Acute flaccid paralysis is not a nationally notifiable disease in this country so we’re really not able to assess the significance of this number of cases. Our understanding is that what happened here is these cases came from people that came in at first for testing of polio virus, or at least some of them did. That’s great. We don’t want physicians to forget about polio virus and they need to keep testing for it and be alert for it because polio could come from parts of the world where polio is endemic.

                    In countries that are performing regular surveillance there is at least one case of acute flaccid paralysis per year for every 100,000 people under 15 years old. We don’t have that same system in place here but if we did the same numbers would apply. We would expect at least 80 cases of acute flaccid paralysis--at least--from California since they have a population of children under 15 of eight million. So, again, if we were conducting surveillance for acute flaccid paralysis we would expect at least 80 cases.

                    So then are you saying this is expected or we should not be concerned?
                    These researchers only report on five cases in the abstract, two of which tested positive for enterovirus 68. Based on that we are not unduly alarmed. We are in touch with California but not have been in touch with the researchers at Stanford that put the abstract together.

                    Have there been other cases where enterovirus 68 causes paralysis?
                    CDC tracks enteroviruses that circulate around the country using a passive reporting system from labs that happen to test for those viruses. That just gives us no idea about the total numbers. It just tells us which viruses are circulating from year to year. We have had at least one reported case [of paralysis] as you can see in a Morbidity and Mortality Weekly Report from 2006. This is just the absolute tip of the iceberg of what may be occurring around the country though, because the reports don’t reflect the total numbers in the country. We don’t have total surveillance. We are aware of 47 cases of enterovirus 68 since 2000. Those are just the ones we know have been isolated in laboratories and most were respiratory disease.

                    Other than polio, would enterovirus 68 or any other enteroviruses be more likely to cause paralysis?
                    No, they are not commonly known to cause paralysis.
                    The most important thing to know is that enteroviruses are common and most people don’t get very sick from them. It’s only rare that these cause severe illness. With any case of paralysis a clinician should consider if it’s polio virus and request testing for that.

                    So what would spark an enterovirus to cause paralysis when that’s such a rare symptom?
                    It’s probably a combination of how the host interacts with the virus. If you think about a condition like chicken pox it used to infect basically every single child in the U.S. With four million cases a year a hundred kids died. Why did those kids die? It’s really hard to explain. It’s an interaction of the virus and the host. Either genetically they didn’t cope with the virus as well or they got an unusually high dose of the virus, it’s hard to say.

                    [snip]

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                    • #11
                      Re: Polio-Like Illness Paralyzes about 20 Kids in California - Enterovirus 68 suspected

                      I would like to know how many of the 80 probable cases in California each year are permanently disabled by some polio-type illness as the cases from the above referenced paper - for a reference point.

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                      • #12
                        Re: Polio-Like Illness Paralyzes about 20 Kids in California - Enterovirus 68 suspected

                        We live in the Sacramento Area and KCRA 3 local news just had an piece on the news about this paralyzes and they posted all the warning signs and symptoms.
                        I am very confused if this has been going on why we are just hearing about it and it is being publicized so much if it is not a huge risk.
                        The media says they have contacted CDPH and they will not return calls regarding which counties have had it. I do know San Joaquin County has had as I read that.
                        I have never seen anything about this ever on CDPH, so this is a big concern.
                        As I get more links or info, I will post.

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                        • #13
                          Re: Polio-Like Illness Paralyzes about 20 Kids in California - Enterovirus 68 suspected

                          I was wondering about autoimmunity playing a role in these illnesses. Here's a couple of sources exploring that:

                          http://www.sfgate.com/health/article...ad-5267792.php
                          Mystery illness causing paralysis not widespread, doctors say
                          Erin Allday
                          Updated 7:43 am, Wednesday, February 26, 2014

                          ...

                          Vikash eventually was tested for enterovirus-68, but that was months after he'd been sick and no trace of the virus was found, his mother said. By the time he saw Waubant at UCSF, Vikash had been diagnosed with, and received treatment for, an autoimmune disease, but his doctors no longer believe that was the cause of his paralysis...
                          http://hereandnow.wbur.org/2014/02/2...ess-california
                          Tuesday, February 25, 2014
                          Researchers Look For Clues To Polio-Like Illness In California Children

                          ...

                          HAREN: Yeah. I met Sofia back in the fall of 2012, and she came to our office referred with a diagnosis of possible transverse myelitis. And transverse myelitis, when we normally see it, is considered an autoimmune phenomenon, meaning that the immune system inappropriately attacking the body itself. And it is a reasonably common diagnosis, most common setting we see it is in the spectrum of multiple sclerosis.

                          The things that were different about Sofia's case is that she had a sudden onset of weakness, which we see in other instances as well. But her muscle strength was - and muscle tone was completely flaccid. So her arm was dangling rather than stiff, and that was unique. Most of the cases we see, when we have an injury to the spinal cord as we do with transverse myelitis, the muscles become very stiff. The reflexes become very strong and brisk. And this - so this struck me as very different.

                          Looking at her MRI with some colleagues, we noticed that the part of the spinal cord that was affected was not the part that's normally affected in traditional transverse myelitis. The part of the spinal cord that was affected in Sofia was the very center of the spinal cord - actually the parts of the spinal cord that control motor function.

                          So Sofia had an injury to the anterior horn cells. Those are the same cells that are affected in old-fashioned polio, and those cells can also be affected by other viruses. Other viruses include West Nile virus and other viruses in the enterovirus family. Enterovirus family is a family - a very large family of viruses...
                          Never forget Excalibur.
                          “‘i love myself.’ the quietest. simplest. most powerful. revolution ever.” ---- nayyirah waheed
                          Avatar: Franz Marc, Liegender Hund im Schnee 1911 (My posts are not intended as advice or professional assessments of any kind.)

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                          • #14
                            Re: Polio-Like Illness Paralyzes about 20 Kids in California - Enterovirus 68 suspected

                            Doctors hunting rare polio-like illness getting tripped up
                            Erin Allday
                            Updated 7:39 am, Thursday, March 20, 2014

                            Stanford University and UCSF neurologists leading the investigation into a rare polio-like paralysis that's affected at least two dozen children in California are still hunting for the source of the illness, and they're finding themselves hampered by delays in reporting cases and questions about how to even describe the disease.

                            The California Department of Public Health last week released the first geographic data on 20 cases it has investigated. Of those 20, five are in the Bay Area and six are in other parts of Northern California. The two Bay Area doctors heading the state investigation say an additional four or five cases in California are being investigated, including a child from Los Angeles who became sick in January. The first patients got sick in September 2012. Cases have been scattered throughout the state, and one involved a child who was hospitalized in California but lives in another state.

                            In almost every case, the patients - mostly children, although there have been one or two adults with milder illnesses - weren't tested for a possible viral cause of their paralysis until long after any pathogen may have left their bodies. That has made it challenging for investigators to identify the cause of the illness, although they believe it's probably a virus.
                            ...
                            http://www.sfgate.com/health/article...ng-5332776.php
                            Twitter: @RonanKelly13
                            The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

                            Comment


                            • #15
                              Re: Polio-Like Illness Paralyzes about 20 Kids in California - Enterovirus 68 suspected

                              Document updated March 4th 2014:

                              Enhanced Surveillance for Acute Flaccid Paralysis
                              The California Department of Public Health (CDPH) is currently conducting enhanced viral
                              testing and surveillance for patients with acute flaccid paralysis. We are seeking
                              information and specimens on patients meeting the following case definition:

                              Acute flaccid paralysis, including absent or significantly diminished reflexes in one or more
                              limbs AND
                              o MRI showing grey matter involvement of the spinal cord OR
                              o EMG showing anterior horn cell disease
                              o With or without accompanying mental status changes
                              o Without a confirmed traumatic, neoplastic, arboviral, or vascular etiology

                              To optimize laboratory testing, we are requesting the following sample types, collected as
                              close to onset date as possible:
                              □ CSF (2-3cc, if available)
                              □ Acute phase serum, collected prior to treatment with IVIG (2-3cc in red or tiger
                              top tube)
                              □ Nasopharynx swab (in viral transport media)
                              □ Throat swab (in viral transport media)
                              □ Two stool samples collected >24 hours apart (quarter-sized amount in sterile
                              wide-mouth container). Rectal swab in VTM acceptable if stool is unavailable.

                              Please note that these specimen guidelines differ from those outlined for standard
                              Neurologic Surveillance and Testing (NST) submissions.
                              All other submission requirements are identical to those of NST, including the 2-page case
                              history form and the requirement that submitters obtain approval from NST staff prior to
                              submission of samples. Submitters are also required to notify their local health
                              departments of all cases tested through NST. Specimens will not be tested until the case
                              has been reported to the local health department.
                              Samples can be sent on dry ice or cold packs to the below address for delivery Monday
                              through Friday:
                              ATTN: Specimen Receiving
                              Viral and Rickettsial Disease Laboratory
                              850 Marina Bay Parkway
                              Richmond, CA 94804

                              If you are aware of a case meeting the above definition, or you are interested in submitting
                              patient samples, please contact Heather Sheriff (heather.sheriff@cdph.ca.gov; 510-307-
                              8608) or Patrick Ayscue (patrick.ayscue@cdph.ca.gov; 510-620-5847).
                              http://www.cdph.ca.gov/programs/vrdl...3%204%2014.pdf
                              Twitter: @RonanKelly13
                              The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

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