US - CDC Health Advisory: Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children

[sharon sanders]

Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children





http://emergency.cdc.gov/han/han00370.asp# http://emergency.cdc.gov/han/han00370.asp# http://www.addthis.com/bookmark.php

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This is an official
CDC HEALTH ADVISORY





Distributed via the CDC Health Alert Network
September 26, 2014, 17:00 ET
CDCHAN-00370
Summary

The Centers for Disease Control and Prevention (CDC) is working closely with the Colorado Department of Public Health and Environment (CDPHE) and Children?s Hospital Colorado to investigate a cluster of nine pediatric patients hospitalized with acute neurologic illness of undetermined etiology. The illness is characterized by focal limb weakness and abnormalities of the spinal cord gray matter on MRI. These illnesses have occurred since August 1, 2014 coincident with an increase of respiratory illnesses among children in Colorado. The purpose of this HAN Advisory is to provide awareness of this neurologic syndrome under investigation with the aim of determining if children with similar clinical and radiographic findings are being cared for in other geographic areas. Guidance about reporting cases to state and local health departments and CDC is provided. Please disseminate this information to infectious disease specialists, intensive care physicians, pediatricians, neurologists, radiologists/neuroradiologists, infection preventionists, and primary care providers, as well as to emergency departments and microbiology laboratories.
Background

The CDPHE, Children?s Hospital Colorado, and CDC are investigating nine cases of acute neurologic illness among pediatric patients.



The cases were identified during August 9?September 17, 2014 among children aged 1?18 years (median age 10 years). Most of the children were from the Denver metropolitan area. All were hospitalized. Common features included acute focal limb weakness and specific findings on magnetic resonance imaging (MRI) of the spinal cord consisting of non-enhancing lesions largely restricted to the gray matter. In most cases, these lesions spanned more than one level of the spinal cord. Some also had acute cranial nerve dysfunction with correlating non-enhancing brainstem lesions on MRI. None of the children experienced altered mental status or seizures. None had any cortical, subcortical, basal ganglia, or thalamic lesions on MRI. Most children reported a febrile respiratory illness in the two weeks preceding development of neurologic symptoms. In most cases, cerebrospinal fluid (CSF) analyses demonstrated mild-moderate pleocytosis (increased cell count in the CSF) consistent with an inflammatory or infectious process. CSF testing to date has been negative for West Nile virus and enteroviruses, including poliovirus. Nasopharyngeal specimens were positive for rhinovirus/enterovirus in six out of eight patients that were tested. Of the six positive specimens, four were typed as EV-D68, and the other two are pending typing results. Testing of other specimens is still in process. Eight out of nine children have been confirmed to be up to date on polio vaccinations. Epidemiologic and laboratory investigations of these cases are ongoing.
The United States is currently experiencing a nationwide outbreak of EV-D68 associated with severe respiratory disease. The possible linkage of this cluster of neurologic disease to this large EV-D68 outbreak is part of the current investigation. CDC is seeking information about other similar neurologic illnesses in all states, especially cases clustered in time and place. CDC has particular interest in characterizing the epidemiology and etiology of such cases.
Recommendations

• Patients who meet the following case definition should be reported to state and local health departments: Patients ≤21 years of age with
  
  1. Acute onset of focal limb weakness occurring on or after August 1, 2014;
  AND
  
  1. An MRI showing a spinal cord lesion largely restricted to gray matter.

• State and local health departments should report patients meeting the case definition to CDC using a brief patient summary form (www.cdc.gov/non-polio-enterovirus/investigation/). State health departments should send completed summary forms to CDC by email at limbweakness@cdc.gov.
• Providers treating patients meeting the above case definition should consult with their local and state health department for laboratory testing of stool, respiratory, and cerebrospinal fluid specimens for enteroviruses, West Nile virus, and other known infectious etiologies.
• Health departments may contact CDC for further laboratory and epidemiologic support by phone through the CDC Emergency Operations Center (770-488-7100), or by email at limbweakness@cdc.gov. Confirmation of the presence of EV-D68 currently requires typing by molecular sequencing.

For more information:

Please visit the CDC enterovirus website (http://www.cdc.gov/non-polio-enterovirus/) for general information about enterovirus infections, including EVD-68, and for up-to-date guidance about infection control measures. For information about poliovirus, please visit the CDC poliovirus website (http://www.cdc.gov/vaccines/vpd-vac/polio/in-short-both.htm). For information about West Nile Virus, please visit the CDC West Nile Virus website (http://www.cdc.gov/westnile/). State and local health departments with questions should contact the CDC Emergency Operations Center (770-488-7100).


The Centers for Disease Control and Prevention (CDC) protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national and international organizations.
Department of Health and Human Services

HAN Message Types

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• Health Advisory: Provides important information for a specific incident or situation; may not require immediate action. Example: HAN00346
• Health Update: Provides updated information regarding an incident or situation; unlikely to require immediate action. Example: HAN00342
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This message was distributed to state and local health officers, state and local epidemiologists, state and local laboratory directors, public information officers, HAN coordinators, and clinician organizations.
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http://emergency.cdc.gov/han/han00370.asp

 

[Emily]

Re: US - CDC Health Advisory: Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children

They are finding evidence of infection with common viruses, (of which EV68 is currently one), but that could be coincidental, or at most an indication of general immune dysfunction in the body's response to infection.

http://www.forbes.com/sites/robertglatter/2014/09/27/cdc-evaluating-limb-paralysis-associated-with-enterovirus-d68-outbreak/

Robert Glatter, MD Contributor
Pharma & Healthcare 9/27/2014 @ 11:24PM 2,472 views
CDC Evaluating Limb Paralysis Associated With Enterovirus D68 Outbreak

...

At this time, the CDC is investigating whether the enterovirus D68 was the actual cause of the neurologic symptoms. Recent reports have indicated infection within spinal fluid samples, but no evidence of any specific virus within the fluid itself. Tests to evaluate for polio or west nile virus have also been negative thus far. And in rare cases, it is possible that enteroviruses may display infectious features that can mimic infection with polio viruses..

So is that high IgE in the CSF without positive viral PCR tests? That sounds autoimmune/inflammatory.

Is it premature to assign this thread to EV68 at this point?

http://www.denverpost.com/news/ci_26613816/virus-probed-paralysis-cases-9-colorado-kids

Officials have test results for eight of the nine children, Wolk said. Four children tested positive for enterovirus 68, and the other four were positive for rhinovirus or another enterovirus.

Eight of nine children have been confirmed to have up-to-date polio vaccinations, a CDC health advisory said.

Wolk said he wanted to emphasize that myelitis, an infection or inflammation of the gray matter of the spinal cord, is "a rare but not unexpected complication" of viral infections.

"We've seen this in the past and have studied these kinds of clusters in the past," Wolk said...

http://moon.ouhsc.edu/kfung/JTY1/Com05/Com501-1-Diss.htm

January 2005, Case 501-1. Quiz set!

A 10 year-old boy with a history of asthma and lower-extremity weakness.

Waseem Ahmad, M.D. 1, Kalliopi Petropoulou, M.D.2, Kar-Ming Fung, M.D., Ph.D.3 Last update: August 1, 2005.

1 Department of Neurology, 2 Department of Radiology, and 3 Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.

...

Several cases of “acute myelitis” were described in the nineteenth century, and pathologic analysis revealed that some were due to vascular lesions and others to acute inflammation. In 1922 and 1923, physicians in England and Holland became aware of a rare complication of smallpox vaccination: inflammation of the spinal cord and brain. Given the term post-vaccinal encephalomyelitis, over 200 cases were reported in those two years alone. Pathologic analyses of fatal cases revealed inflammatory cells and demyelination.” In 1928, it was first postulated that many cases of acute myelitis are “post-infectious rather than infectious in cause” since the signs and symptoms of myelitis appear after the fever and rash had resolved. It was proposed, therefore, that the myelitis was an “allergic” response to a virus rather than the virus itself that caused the spinal cord damage. It was in 1948 that the term “acute transverse myelitis” (ATM) was utilized in reporting a case of fulminant inflammatory myelopathy complicating pneumonia...

Hopkins syndrome emerged in 1974:

A NEW SYNDROME: POLIOMYELITIS-LIKE ILLNESS ASSOCIATED WITH ACUTE ASTHMA IN CHILDHOOD
Flaccid paralysis of the limbs after an asthmatic attack.
Hopkins syndrome associated with Mycoplasma infection.

But so far it hasn't been reported that all the children had asthma in the CO cluster. Also, here is a possible similar case from August and no viral infection was found:

4-yr-old Iowa girl paralyzed after car trip to Disneyland - autoimmune encephalitis suspected

She had myelitis, too.

 

[Pathfinder]

Re: US - CDC Health Advisory: Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children

CDC investigates kids' limb paralysis; is enterovirus to blame?

By Jacque Wilson, CNN
updated 5:37 PM EDT, Mon September 29, 2014

(CNN) -- Health officials are looking for the cause of a neurologic illness that's affected 10 children in Colorado.

The children were hospitalized between August 9 and September 28 with muscle weakness in their limbs, according to the Centers for Disease Control and Prevention.

Something is affecting the children's motor nerves, causing weakness primarily in their shoulders, triceps, biceps and hips, says Dr. Joyce Oleszek, a pediatric rehabilitation specialist at Children's Hospital Colorado. Doctors are also seeing some weakness in the neck and facial muscles in these patients.

"It seems to be attacking the spinal cord and brain stem," Oleszek said at a press conference Monday.

MRI tests spotted abnormalities in the children's spinal gray matter. Most of the children experienced a respiratory illness before being admitted to the hospital, although only two had a history of asthma.

The latest case was a girl who arrived at Children's Hospital Colorado over the weekend. She and three of the other patients are still at the hospital. The rest have been discharged, said Dr. Sam Dominguez, a microbial epidemiologist at the hospital. Doctors do not know if the neurological damage will be permanent.
...
Tests of the children's cerebrospinal fluid came back negative for enteroviruses and West Nile virus. But a test of their nasal passages found enterovirus in six out of eight patients who were tested.
...

http://www.cnn.com/2014/09/29/health/colorado-paralysis-enterovirus/

 

[Emily]

Re: US - CDC Health Advisory: Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children

http://www.reuters.com/article/2014/09/29/us-health-enterovirus-usa-idUSKCN0HO1Y220140929

Colorado, CDC probing 10 cases of virus-related paralysis in kids
By Julie Steenhuysen
CHICAGO Mon Sep 29, 2014 2:16pm EDT

...

"It's obviously not just D68 in and of itself," Wolk said. "The question is, is there something else that ties these 10 cases together."

All of the children in the Colorado cluster are under 21, and most live in the Denver area. Of those involved, six have been discharged from the hospital. Nine of the 10 were treated at Children's Hospital Colorado in Aurora...

 

[Emily]

Re: US - CDC Health Advisory: Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children

http://www.bizjournals.com/denver/news/2014/09/23/denver-among-top-five-5-counties-for-man-made.html?page=all

Denver among top 5 counties for man-made environmental hazards
Sep 23, 2014, 2:12pm MDT Updated: Sep 23, 2014, 3:00pm MDT
Heather Draper Reporter- Denver Business Journal

 

[Emily]

Re: US - CDC Health Advisory: Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children

Kansas City, MO: 3 children with polio-like paralysis NEGATIVE for EV-68

 

[Emily]

Re: US - CDC Health Advisory: Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children

Boston Children?s Hospital Treating Patients With Polio-Like Symptoms (So far NEGATIVE for EV-68, more tests in progress)

 

[alert]

Re: US - CDC Health Advisory: Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children

Yeah, looks like we have a situation going on. It is important to remember that the US does NOT do routine AFP surveillance, looking for polio cases, because it is assumed that polio is eliminated in the country. Hopefully, that is not an unreasonable assumption.

By comparison, Mexico, with one-third the population, where AFP surveillance still exists (but polio does not) reports 500 AFP cases a year on average. That would correspond to 1,500 cases a year across the US.

It is entirely possible these outbreaks could be just noise, with multiple causes including various viruses, bacteria, toxins, and autoimmune conditions.

 

[Emily]

Re: US - CDC Health Advisory: Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children

I agree, Alert, that we could be seeing unexplained paralysis reports from around the country that might not represent an increase from baseline for the U.S., whatever the causes.

More on what seems distinctive in the Colorado cluster:

Colorado's cluster of paralysis-like cases shows distinctive features
By Electa Draper
The Denver Post
Posted: 09/30/2014 03:11:38 PM MDT
Updated: 09/30/2014 03:15:14 PM MDT
...

"It seems our cluster of cases in Colorado has some distinctive features," said Children's Hospital Colorado pediatric neurologist Terri Schreiner, including facial muscle weakness causing drooping, double vision and difficulties swallowing and breathing...

Colorado also has a notably high rate of multiple sclerosis:
http://www.denverpost.com/ci_18479818

Naturally I wonder about heavy metal pollution given that CO has a long history of mining along with the Denver area toxic sites listed in the article above. An old mine in Silverton is due to be cleaned up.
http://www.kjct8.com/home/headlines/Silverton-Mine-will-be-cleaned-up-277363111.html

SILVERTON, Colo. An abandoned Silverton mine that leaks about 800 gallons of toxic waste every minute into the Animas River watershed is due for a federal cleanup next year.

Here's a study on the heavy metal connection to demyelinating disorders:

http://journals.lww.com/amjforensicmedicine/Abstract/1989/09000/Clustering_of_Multiple_Sclerosis_in_Galion,_Ohio,.8.aspx

American Journal of Forensic Medicine & Pathology:
September 1989
Clustering of Multiple Sclerosis in Galion, Ohio, 1982-1985.
Ingalls, Theodore H. M.D.

Abstract

Epidemiologic evidence indicates that the outbreak of 30-40 cases of multiple sclerosis and other demyelinating syndromes in Galion, Ohio, USA, during 1982-1985 was related to an excess concentration of heavy-metal wastes, especially of cadmium and chromium in sewage and river water. Both multiple sclerosis and myasthenia gravis were diagnosed by board-certified neurologists

(C) Lippincott-Raven Publishers.

Viral stimulation of the immune response might be a trigger, but not the 'cause'.

 

[alert]

Re: US - CDC Health Advisory: Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children

Two such cases in British Columbia:

Published Date: 2014-09-30 21:39:47
Subject: PRO/EDR> Polio-like illness - North America: Canada (BC)
Archive Number: 20140930.2819618

POLIO-LIKE ILLNESS - NORTH AMERICA: CANADA (BRITISH COLUMBIA)
************************************************** ***********
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: 30 Sep 2014
From: Dr. Danuta Skowronski <danuta.skowronski@bccdc.ca>


In response to the [27 Sep 2014] ProMED request for information about possible neurological manifestations of enterovirus D68 [EV-D68] (Archive number 20140927.2809908), we would like to share the following information from the province of British Columbia (BC), Canada.

Among the 8 laboratory-confirmed cases of EV-D68 detected as of [30 Sep 2014] in BC, there were 2 individuals reported to the BC Centre for Disease Control (BCCDC) with paralytic symptoms, including a child aged 5-10 years and a young adult aged 15-20 years. Both are male, previously healthy and had symptom onset in late August 2014. They reside several hundred kilometres apart and are not epidemiologically linked. Unlike other areas affected by EV-D68, a general increase in severe respiratory illness visits to emergency rooms or hospitals has not yet been observed in BC. However, all public primary and secondary schools had been closed in BC due to a teacher's strike that recently ended and with school only having resumed from summer recess on [22 Sep 2014].

The younger child presented with a 5-day history of fever, cough, rhinorrhea and congestion. Household members, both adult and pediatric, had similar cold-like symptoms. Two days prior to admission, the child experienced headache and neck pain radiating to the left shoulder, worsened by coughing. The child developed sudden onset of left arm weakness. Examination at admission identified left arm flaccid paralysis and areflexia without any sensory findings. CSF examination showed elevated leukocytes consisting of a mix of neutrophils and lymphocytes with slight predominance of the latter, normal glucose and elevated protein (0.5 g/L). MRI identified asymmetric swelling from C2 to T1. Nerve conduction and EMG examination confirmed findings consistent with anterior horn cell involvement but normal sensory findings. CSF was negative for enterovirus RNA but the nasopharyngeal swab was PCR-positive for enterovirus/rhinovirus, subsequently confirmed to be EV-D68 by sequencing of the 5' UTR at the BCCDC. Serology was IgM positive for Mycoplasma pneumoniae but nasopharyngeal swab was PCR-negative. There was no improvement in neurological symptoms during the 9-day course in hospital and the child was discharged with outpatient follow-up. There remains no neurological improvement nearly one-month post-admission.

The young adult had a prior history of shingles in the late spring and respiratory symptoms over the past 2-3 months. For the current episode, the patient awoke with right arm weakness and presented to hospital with one-day history of flu-like symptoms including mild fever, general aches and fatigue. No other family members had cold-like symptoms. The patient rapidly deteriorated over the ensuing 24 hours with difficulty breathing requiring intubation and mechanical ventilation. CSF specimen showed elevated leukocytes consisting of a mix of neutrophils and lymphocytes with slight predominance of the former, normal glucose and elevated protein (0.63 g/L). CSF was negative for enterovirus and VZV, but tracheal aspirate was positive for enterovirus/rhinovirus, determined by sequencing to be EV-D68 at the BCCDC. MRI showed longitudinal high signal within the cervical cord. Nearly one month post-admission, the patient still requires assistance with ventilation.

The detection of EV-D68 from respiratory specimens in association with neurological findings does not prove causality particularly in the absence of virus detection in the CSF. It is possible that other etiologies were present and that the detection of EV-D68 was the result of contemporaneous viral shedding. In the current outbreak, EV-D68 has more often been reported in association with severe respiratory illness but neurologic findings in association with EV-D68 have also been reported previously elsewhere [1-3]. Most laboratories do not currently have the capacity to diagnose or characterize EV-D68 in order to systematically assess the extent of its circulation or the spectrum of its clinical involvement. Given the seriousness and prolonged duration of paralytic findings in these 2 recent cases of laboratory-confirmed EV-D68 in BC, we thought it was pertinent that we share this information. A comparison of EV-D68 gene sequences collected from patients across the 2014 outbreak in North America is also warranted and may help identify unique virus features associated with more severe complications, including possible neurologic manifestations.

Michelle Murti MD, FRCPC
Fraser Health Authority

Sue Pollock MD, FRCPC
Interior Health Authority

Mel Krajden MD, FRCPC
Patrick Tang MD, PhD, FRCPC
Catharine Chambers MSc
Danuta M Skowronski MD, FRCPC
BC Centre for Disease Control
British Columbia, Canada

References
1. Polio-like illness - USA: (California) Enterovirus 68 Suspected, Request for Information. ProMED 2014-02-24. Archive Number: 20140224.2296126.
2. Kuehn BM. Poliolike cases probed in California: CDC says rare cases not cause for widespread alarm. JAMA 2014;311:1280-81.
3. Kreuter JD, Barnes A, McCarthy JE, et al. A fatal central nervous system enterovirus 68 infection. Arch Pathol Lab Med 2011;135:793-96.

--
Communicated by:
Danuta M Skowronski MD, FRCPC
BC Centre for Disease Control
<danuta.skowronski@bccdc.ca>

[ProMED-mail would like to thank Dr. Danuta Skowronski and colleagues for their rapid response to our RFI (request for information) on the reports of a polio-like illness possibly associated with infection with enterovirus D68 (EV-D68) and for sharing the details of these 2 patients. The above report submitted by them is the 1st official report describing clinical history, physical examination, supportive laboratory and MRI studies and epidemiologic studies conducted on cases matching the case definition provided by CDC: Patients less than or equal to 21 years of age with acute onset of focal limb weakness occurring on or after [1 Aug 2014]; and an MRI showing a spinal cord lesion largely restricted to grey matter. The absence of identification of the EV-D68 in cerebrospinal fluid (CSF) does not necessarily rule out etiology as recovery of poliovirus (another member of the enterovirus family) from CSF is not a frequent occurrence.

A disturbing mention in the above report is that primary and secondary schools opened late following the summer recess (on 22 Sep 2014), so that these early cases of neurologic disease were identified before the expected surge in cases of EV-D68 seen when children who may be shedding the virus are congregated in the school setting.

 

[Ronan Kelly]

Re: US - CDC Health Advisory: Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children

Role of EV-D68 in polio-like illnesses still unclear
Filed Under: Enterovirus; Misc Emerging Topics
Robert Roos | News Editor | CIDRAP News | Oct 03, 2014
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childrens_hospital_colorado_denver.jpg
Children's Hospital Colorado in Denver
Wikimedia Commons
At least 9 cases involving neurologic symptoms have been reported at Children's Hospital Colorado in Denver.
As the nationwide outbreak of enterovirus D68 (EV-D68) infections grew again today, federal and state health officials said they still have no idea whether the virus is contributing to a number of prolonged polio-like illnesses that have cropped up in a few states, especially California and Colorado.

The count of EVD-68 cases, almost all of them in children, climbed to 538, up 24 from yesterday, the Centers for Disease Control and Prevention (CDC) announced today. The number of affected states stayed level at 43.

Colorado officials reported recently that 4 children out of 9 at Children's Hospital Colorado in Denver who had neurologic illness involving limb weakness and cranial nerve dysfunction tested positive for EV-D68. Today, California health officials reported that a patient in Los Angeles County with a similar illness tested positive for the virus in August.

As reported earlier, the virus was also found in two other California patients with neurologic symptoms in 2012.
...
http://www.cidrap.umn.edu/news-perspective/2014/10/role-ev-d68-polio-illnesses-still-unclear

Enterovirus D68 in the United States, 2014
What We Know

EV-D68 infections have recently been documented across the United States.

From mid-August to October 3, 2014, CDC or state public health laboratories have confirmed a total of 538 people in 43 states and the District of Columbia with respiratory illness caused by EV-D68. Learn about states with confirmed cases. This indicates that at least one case has been detected in each state listed but does not indicate how widespread infections are in each state.

Enteroviruses commonly circulate in summer and fall. We?re currently in middle of the enterovirus season, and EV-D68 infections are likely to decline later in the fall.

Many state health departments have reported increases this year in cases of severe respiratory illness in children.

This increase could be caused by many different viruses that are common during this time of year. EV-D68 appears to be the predominant type of enterovirus this year and may be contributing to the increases in severe respiratory illnesses.

Hospitals in Missouri and Illinois were the first to document this increase that was later identified to be caused predominantly by EV-D68 infection. Read more.

CDC is prioritizing testing of specimens from children with severe respiratory illness. There are likely many children affected with milder forms of illness. Of the specimens tested by the CDC lab, about half have tested positive for EV-D68. About one third have tested positive for an enterovirus or rhinovirus other than EV-D68. See map of states with lab-confirmed EV-D68 infections for more information.

Almost all the confirmed cases this year of EV-D68 infection have been among children. Many of the children had asthma or a history of wheezing.

EV-D68 has been detected in specimens from four* patients who died and had samples submitted for testing. The role that EV-D68 infection played in these deaths is unclear at this time; state and local health departments are continuing to investigate.

*Investigations are ongoing; CDC will review and update available data every Wednesday.

What CDC Is Doing about EV-D68
CDC is
continuing to collect information from states and assess the situation to better understand
EV-D68 and the illness caused by this virus and
how widespread EV-D68 infections may be within each state and the populations affected.
helping states with diagnostic and molecular typing for EV-D68.
working with state and local health departments and clinical and state laboratories to
enhance their capacity to identify and investigate outbreaks, and
perform diagnostic and molecular typing tests to improve detection of enteroviruses and enhance surveillance.
developing and validating a diagnostic test to detect EV-D68 in specimens. CDC will explore options for providing test kits and protocols to state public health labs.
providing information to healthcare professionals, policymakers, general public, and partners in numerous formats, including Morbidity and Mortality Weekly Reports (MMWRs), health alerts, websites, social media, podcasts, infographics, and presentations.

Related Pages
Overview of Enterovirus D68
Enterovirus D68 for Health Care Professionals
States with lab-confirmed cases of EV-D68 infection
http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-outbreaks.html

 

[Pathfinder]

Re: US - CDC Health Advisory: Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children

Doctors Target Virus as Link to Solve Polio-Like Illness

By Shannon Pettypiece Oct 6, 2014 11:01 PM CT
Oct. 6 (Bloomberg) --
...
Enterovirus typically causes only mild cold symptoms in most patients. Now, though, U.S. health officials are probing whether EV-D68 is directly linked to the paralysis. At the same time, more than 50 doctors at top U.S. hospitals are holding regular calls and pooling research, seeking to pinpoint physical changes that may lead to a treatment or a vaccine.
...
They are in a race against time as the EV-D68 outbreak has yet to wane. ?We don?t want to repeat mistakes of history,?? said Greenberg, of the University of Texas Southwest Medical Center. ?If we could have accelerated the polio vaccine by a decade we could have saved a lot of people from the illness.?
...
To Greenberg?s surprise, almost every doctor on the call, from Boston to Chicago to Los Angeles, had seen at least one case of unexplained paralysis in the past several months, and some had seen as many as 10.
...
In cases where children develop paralysis, the symptoms usually start with those similar to a cold or stomach bug. They are followed by a fever, headaches, neck pain and, within a few days or weeks, a swift and sudden paralysis that in the most severe cases left children bound to a wheelchair, unable to speak or breathe on their own, said Keith Van Haren, a Stanford School of Medicine neurologist who has been studying a link between the virus and paralysis since 2012.
...
While there were some variations, most images from medical scans of those with paralysis looked strikingly similar, with the connection between the spinal cord and the muscles killed off with little chance of rebuilding the bridge -- just like seen in scans of those infected with polio, Greenberg said.

?There were remarkable similarities,? said Van Haren, who was also on the doctors? conference call. ?They sounded like interchangeable cases.?
The CDC hasn?t determined definitively whether the virus is causing the paralysis. EV-D68 hasn?t been detected in all of the paralyzed patients and given its widespread circulation, its presence could be coincidental, the agency said last week.
...
The cases have doctors brushing up on their knowledge of polio, which hasn?t naturally occurred in the U.S. since 1979 after a vaccine was introduced in the 1950s. When Greenberg started seeing the polio-like cases, he called an older colleague at the National Institutes of Health who had trained in India to get a crash course on the disease and compare notes.
...

Full text:
http://www.bloomberg.com/news/2014-...irus-as-link-to-solve-polio-like-illness.html