Global & Disaster Medicine

Archive for October, 2018

CDC: 92 people infected with the outbreak strain of Salmonella Infantis have been reported from 29 states after coming in contact with raw chicken products


Latest Outbreak Information

Illustration of a megaphone.

At A Glance

  • Ninety-two people infected with the outbreak strain of Salmonella Infantis have been reported from 29 states.
    • Twenty-one people have been hospitalized, and no deaths have been reported.
  • Epidemiologic and laboratory evidence indicates that many types of raw chicken products from a variety of sources are contaminated with Salmonella Infantis and are making people sick.
    • In interviews, ill people report eating different types and brands of chicken products purchased from many different locations.
    • The outbreak strain has been identified in samples taken from raw chicken pet food, raw chicken products, and live chickens.
  • Antibiotic resistance testing conducted by CDC on Salmonella bacteria isolated from ill people shows that the outbreak strain is resistant to multiple antibiotics. Read the Advice to Clinicians.
  • A single, common supplier of raw chicken products or of live chickens has not been identified.
  • The outbreak strain of Salmonella Infantis is present in live chickens and in many types of raw chicken products, indicating it might be widespread in the chicken industry. CDC and USDA-FSIS have shared this information with representatives from the chicken industry and asked about steps that they may be taking to reduce Salmonella contamination.

Epi curve of people infected with the outbreak strain of Salmonella, by date of illness onset, as of October 15, 2018

Map of United States - People infected with the outbreak strain of Salmonella, by state of residence, as of October 15, 2018

Crimea: A student went on a rampage and at least 17 people were killed and 40 injured in a school shooting



10/17/1989: An earthquake hits the San Francisco, killing 67 and causing more than $5 billion in damages.

History Channel

“…..Forty-one of the 67 victims of this disaster were motorists on the lower level of the Nimitz, who were killed when the upper level of the road collapsed and crushed them in their cars……”

The United Nations: 13 million people in Yemen are facing starvation.


A 64-year-old man from Afif, Riyadh region, is hospitalized for MERS-CoV

Saudi MOH

“……Since 2012, at least 2,262 cases of MERS have been recorded, including 803 fatalities……”

The world is ignoring millions of suffering people.


“……Only one in 27 people with depression in developing countries receives adequate treatment, according to the report. Developed countries do a bit better – one in five people with depression get treatment. But overall, wealthier countries have a poor enough record of providing adequate services…..”


CDC: 62 cases of acute flaccid myelitis (AFM)


Acute flaccid myelitis (AFM) is a rare condition. It affects a person’s nervous system, specifically the spinal cord, causing weakness in one or more limbs. AFM or neurologic conditions like it have a variety of causes such as viruses, environmental toxins, and genetic disorders.

Since August 2014, CDC has seen an increased number of people across the United States with AFM. We have not confirmed the cause for the majority of these cases. CDC has been actively investigating these AFM cases, and we continue to receive information about suspected AFM cases.

Confirmed AFM cases reported to CDC: Aug-14 = 21, Sep-14 = 51, Oct-14 = 24, Nov-14 = 15, Dec-14 = 9, Jan-15 = 2, Feb-15 = 2, Mar-15 = 1, Apr-15 = 0, May-15 = 1, Jun-15 = 0, Jul-15 = 2, Aug-15 = 3, Sep-15 = 1, Oct-15 = 4, Nov-15 = 2, Dec-15 = 4, Jan-16 = 1, Feb-16 = 0, Mar-16 = 6, Apr-16 = 1, May-16 = 6, Jun-16 = 9, Jul-16 = 12, Aug-16 = 30, Sep-16 = 44, Oct-16 = 27, Nov-16 = 9, Dec-16 = 4, Jan-17 = 1, Feb-17 = 5, Mar-17 = 5, Apr-17 =3, May-17 =2, Jun-17 = 3, Jul-17 = 2, Aug-17 = 1, Sep-17 = 4, Oct-17 = 0, Nov-17 = 2, Dec-17 = 4, Jan-18 = 0, Feb-18 = 4, Mar-18 = 0, Apr-18 = 2, May-18 = 2, Jun-18 = 7, Jul-18 =6, Aug-18 = 18, Sep-18 = 23


Updated October 16, 2018

^ Confirmed AFM cases that CDC has been made aware of as of October 16, 2018 with onset of the condition through September 30, 2018. The case counts are subject to change.

* The data shown from August 2014 to July 2015 are based on the AFM investigation case definition: onset of acute limb weakness on or after August 1, 2014, and a magnetic resonance image (MRI) showing a spinal cord lesion largely restricted to gray matter in a patient age ≤21 years.

† The data shown from August 2015 to present are based on the AFM case definition adopted by the Council of State and Territorial Epidemiologists (CSTE): acute onset of focal limb weakness and an MRI showing spinal cord lesion largely restricted to gray matter and spanning one or more spinal segments, regardless of age.

For more information, visit the Case Definitions page.

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What This Graph Shows

The graph shows the number of AFM cases confirmed by CDC as of October 16, 2018, with onset of the condition through September 30, 2018.

  • So far in 2018, there are 62 confirmed cases of AFM. (Note: The cases occurred in 22 states across the U.S.)
    Note: These 62 confirmed cases are among the total of 127 reports that CDC received of patients under investigation (PUIs). CDC recently received increased reports for PUIs with onset of symptoms in August and September. CDC and state and local health departments are still investigating some of these PUIs. With enhanced efforts working with local and state health departments and hospitals, we were able to confirm a number these cases faster. CDC is now providing the number of patients still under investigation so people can better anticipate increases in confirmed cases over the coming months.
  • In 2017, CDC received information for 33 confirmed cases of AFM. (Note: The cases occurred in 16 states across the U.S.)
  • In 2016, 149 people were confirmed to have AFM. (Note: The cases occurred in 39 states across the U.S. and DC)
  • In 2015, 22 people were confirmed to have AFM. (Note: The cases occurred in 17 states across the U.S.)
  • From August to December 2014, 120 people were confirmed to have AFM. (Note: The cases occurred in 34 states across the U.S.)
  • The case counts represent only those cases for which information has been sent to and confirmed by CDC.

It is currently difficult to interpret trends of the AFM data. Collecting information about suspected AFM cases is relatively new, and it is voluntary for most states to send this information to CDC. There may initially be more variability in the AFM data from year to year making it difficult to interpret or compare case counts between years.

We defer to the states to release additional information on cases as they choose.

Number of confirmed AFM cases by year of illness onset, 2014-2018*

Number of confirmed AFM cases by year of illness onset table
Year Number confirmed cases Number of states with confirmed cases
2014 (Aug-Dec) 120 34
2015 22 17
2016 149 39 (includes DC)
2017 33 16
2018 (Jan-Oct 16) 62 22

*The case counts are subject to change.

What We Know

Since 2014, CDC has learned the following about the AFM cases:

  • Most patients are children.
  • The patients’ symptoms have been most similar to complications of infection with certain viruses, including poliovirus, non-polio enteroviruses, adenoviruses, and West Nile virus.
    • All of the AFM cases have tested negative for poliovirus.
    • Enteroviruses most commonly cause mild illness. They can also cause neurologic illness, such as meningitis, encephalitis, and AFM, but these are rare.
  • CDC has tested many different specimens from AFM patients for a wide range of pathogens (germs) that can cause AFM. To date, no pathogen (germ) has been consistently detected in the patients’ spinal fluid; a pathogen detected in the spinal fluid would be good evidence to indicate the cause of AFM since this condition affects the spinal cord.
  • The increase in AFM cases in 2014 coincided with a national outbreak of severe respiratory illness among people caused by enterovirus D68 (EV-D68). Among the people confirmed with AFM, CDC did not consistently detect EV-D68 in every patient. During 2015, CDC did not receive information about large EV-D68 outbreaks in the United States, and laboratories reported only limited EV-D68 detections to CDC’s National Enterovirus Surveillance System (NESS). During 2016, CDC was informed of a few localized clusters in the United States. Learn more about EV-D68.

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What We Don’t Know

Among the people who were diagnosed with AFM since August 2014:

  • The cause of most of the AFM cases remains unknown.
  • We don’t know what caused the increase in AFM cases starting in 2014.
  • We have not yet determined who is at higher risk for developing AFM, or the reasons why they may be at higher risk.
  • We do not yet know the long-term effects of AFM. We know that some patients diagnosed with AFM have recovered quickly, and some continue to have paralysis and require ongoing care.

See prevention for information about how to protect your family from viruses that may cause AFM.

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What CDC Is Doing

CDC is actively investigating AFM cases and monitoring disease activity. We are working closely with healthcare providers and state and local health departments to increase awareness for AFM. We are encouraging healthcare providers to recognize and report suspected cases of AFM to their health departments, and for health departments to send this information to CDC to help us understand the nationwide burden of AFM. CDC is also actively looking for risk factors and possible causes of this condition.

CDC activities include:

  • urging healthcare providers to be vigilant for AFM among their patients, and to send information about suspected cases to their health departments
  • verifying clinical information of suspected AFM cases submitted by health departments, and working with health departments and neurologists to classify cases using a case definition adopted by the Council of State and Territorial Epidemiologists (CSTE)
  • testing specimens, including stool, blood, and cerebrospinal fluid, from suspected AFM cases
  • working with healthcare providers, experts, and state and local health departments to investigate and better understand the AFM cases, including potential causes and how often the condition occurs
  • providing new and updated information to healthcare providers, health departments, policymakers, the public, and partners in various formats, such as scientific journals and meetings, and CDC’s AFM website and social media
  • using multiple research methods to further explore the potential association of AFM with possible causes as well as risk factors for AFM. This includes collaborating with experts to review MRI scans of people from the past 10 years to determine how many AFM cases occurred before 2014, updating treatment and management protocols, and engaging with several academic centers to conduct active surveillance simultaneously for both AFM and respiratory viruses.

For more information, see

10/16/1996: A stampede of soccer fans in Guatemala City kills 84 and seriously injures more than 100

History Channel


10/16/1991: George Jo Hennard drives his truck through a window in Luby’s Cafeteria in Kileen, Texas, and then opens fire on a lunch crowd of over 100 people, killing 23 and injuring 20 more.

History Channel


Myanmar’s military allegedly posted inflammatory rhetoric on Facebook


“……Members of the Myanmar military were the prime operatives behind a systematic campaign on Facebook that stretched back half a decade and that targeted the country’s mostly Muslim Rohingya minority group, the people said. The military exploited Facebook’s wide reach in Myanmar, where it is so broadly used that many of the country’s 18 million internet users confuse the Silicon Valley social media platform with the internet. Human rights groups blame the anti-Rohingya propaganda for inciting murders, rapes and the largest forced human migration in recent history...…”



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