Global & Disaster Medicine

Archive for the ‘Kids-Infants’ Category

From August 2014 through October 2018, CDC has received information on a total of 404 confirmed cases of AFM across the US; most of the cases have occurred in children.

CDC

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


Supporting Children & Families Disasters: On-Line Resources

Resources:


How does a national prohibition on corporal punishment affect violence in kids?

BMJ

Elgar FJ, Donnelly PD, Michaelson V, et al

Corporal punishment bans and physical fighting in adolescents: an ecological study of 88 countries

 

“…..Country prohibition of corporal punishment is associated with less youth violence. Whether bans precipitated changes in child discipline or reflected a social milieu that inhibits youth violence remains unclear due to the study design and data limitations. However, these results support the hypothesis that societies that prohibit the use of corporal punishment are less violent for youth to grow up in than societies that have not.….”


“…..There is now a clear and present danger of an imminent and great, big famine engulfing Yemen…..”

NYT

“……And in the hushed hunger wards, ailing infants hover between life and death. Of nearly two million malnourished children in Yemen, 400,000 are considered critically ill — a figure projected to rise by one quarter in the coming months...….”

 


CDC: 62 cases of acute flaccid myelitis (AFM)

CDC

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.

Top of Page

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.

Top of Page

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.

Top of Page

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


Nobel Peace Prize Awarded To Fighters Against Sexual Slavery

NYT

…..Dr. Mukwege campaigned relentlessly to shine a spotlight on the plight of Congolese women, even after nearly being assassinated a few years ago. Ms. Murad, who was enslaved by the Islamic State, also known as ISIS, has told and retold her story of suffering to organizations around the world, helping to persuade the United States State Department to recognize the genocide of her people at the hands of the terrorist group…..”


More than half of the 330,000 childhood deaths attributable to diarrhea in 2015 took place in just 55 out of 782 African states, provinces, or regions.

NEJM

Document:  Diarrhea

“Diarrheal diseases are the third leading cause of disease and death in children younger than 5 years of age in Africa and were responsible for an estimated 30 million cases of severe diarrhea (95% credible interval, 27 million to 33 million) and 330,000 deaths (95% credible interval, 270,000 to 380,000) in 2015…….”

 

 


UN: Child Mortality

Document:  Levels and Trend in Childhood Mortality

Over the last two decades, the world made substantial progress in reducing mortality among children and young adolescents (including children under age 5, children aged 5−9 and young adolescents aged 10−14).

Still, in 2017 alone, an estimated 6.3 million children and young adolescents died, mostly from preventable causes.

Children under age 5 accounted for 5.4 million of these deaths, with 2.5 million deaths occurring in the first month of life, 1.6 million at age 1–11 months, and 1.3 million at age 1−4 years.

An additional 0.9 million deaths occurred among children aged 5−14.

Among children and young adolescents, the risk of dying was highest in the first month of life at an average rate of 18 deaths per 1,000 live births globally in 2017.

In comparison, the probability of dying after the first month and before reaching age 1 was 12 per 1,000, the probability of dying after age 1 and before age 5 was 10 per 1,000, and the probability of dying after age 5 and before age 15 was 7 per 1,000.


9/1/2004: an armed gang of Chechen separatist rebels enters a school in southern Russia and takes more than 1,000 people hostage. Ultimately, about 340 people (1/2 kids) died during the siege.

History

 


India, 2016: Severe Manifestations of Chikungunya Fever in Kids

CHIKV-EID

“……A total of 49 children had chikungunya fever; 36 had nonsevere disease and 13 had severe disease. All patients with severe disease were admitted to the PICU; 11 had illness consistent with the case definition of severe sepsis and septic shock, and 2 had acute liver failure. Of the 36 patients with nonsevere disease, 16 were admitted to the PICU (11 had seizures, 4 had fluid-responsive shock, 1 had peripheral cyanosis and mottling) and 20 were admitted to the pediatric high-dependency unit (3 had bleeding manifestations, 4 had severe abdominal pain, 2 had underlying cyanotic congenital heart disease, 2 had body temperature >40.3°C with irrelevant talking, 7 had dehydration, and 2 had severe rash). The median age was 12 years for patients with severe disease and 6.5 years for patients with nonsevere disease; male sex predominated in both groups (Table). Frequency of fever, body ache, arthralgia, and vomiting were similar for both groups. Peripheral cyanosis, along with mottling of skin and encephalopathy, was significantly higher in the group with severe disease. Serum albumin was significantly lower in the group with severe disease (3 vs. 3.75 g/dL). Of the 11 children with septic shock, 8 were admitted to the hospital within 24 hours of developing fever; 9 had hypotensive shock, and 2 had compensated shock. In this group, 6 children required 1 vasoactive agent, 3 children required 2 vasoactive agents, and 2 children required 3 vasoactive agents. Dopamine was used in 8 patients, dobutamine in 5 patients, epinephrine in 2 patients, and norepinephrine in 2 patients. The median duration of vasoactive support was 56 hours (range 31–114 hours), and the median vasoactive inotropic score in the first 24 hours was 10 (range 5–90; score >15–20 is considered serious). A vasoactive inotropic score >20 was seen in 2 children. Mean pH was 7.26 (reference range 7.35–7.45), mean lactate 5.1 mmol/L (reference range <2 mmol/L), mixed venous saturation 55% (reference range 70%–80%), and mean base excess at admission –7.7 mEq (reference range –2 to 2 mEq). Of the 2 children with acute liver failure with encephalopathy, 1 had dengue virus (positive dengue IgM by enzyme immunoassay) and the other had hepatitis E virus (reactive anti–hepatitis E IgM by enzyme immunoassay) co-infection…..”

Sharma PK, Kumar M, Aggarwal GK, Kumar V, Srivastava R, Sahani A, et al. Severe Manifestations of Chikungunya Fever in Children, India, 2016. Emerg Infect Dis. 2018;24(9):1737-1739. https://dx.doi.org/10.3201/eid2409.180330

 


Categories

Recent Posts

Archives

Admin