Global & Disaster Medicine

Archive for the ‘Kids-Infants’ Category

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.

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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


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

 


“UN Secretary-General António Guterres condemned an air strike by pro-Yemini Government coalition forces, which killed scores of children who were on board a bus travelling through a busy market area…..”

UN

9 August 2018

UN Secretary-General António Guterres on Thursday condemned an air strike by pro-Yemini Government coalition forces, which killed scores of children who were on board a bus travelling through a busy market area in the northern province of Saada.

While the exact death toll remains to be confirmed, initial news reports indicate that the number of casualties could be well above 60, with dozens severely injured. Most of the children were reported to be aged between 10 and 13.

In his  statement, the UN chief called “on all parties to respect their obligations under international humanitarian law, in particular the fundamental rules of distinction, proportionality and precautions in attack,” emphasising that all parties must take “constant care to spare civilians and civilian objects in the conduct of military operations”.

The Secretary-General called for an “independent and prompt investigation” into this incident and extended his “deepest condolences” to the families of the victims.

The Head of the UN Children’s Fund (UNICEF) also strongly condemned the incident and urged the warring parties and international community “to do what’s right for children and bring an end to this conflict”.

“Attacks on children are absolutely unacceptable,” she said UNICEF Executive Director Henrietta Fore  on Twitter. “I’m horrified by the reported airstrike on innocent children, some with UNICEF backpacks. Enough is enough.”

“How many more children will suffer or die before those who can act, do by putting a stop to this scourge?”  said UNICEF’s chief in a statement.

“Attacking children is the lowest any party of this conflict can go,” UNICEF Yemen Resident Representative Meritxell Relaño told UN News. “There is no justification whatsoever to attacking children.”

According to the UN Children’s Fund, since conflict between pro-Government forces and Houthi rebels escalated in 2015, about 2,400 children have been killed and 3,600 maimed in Yemen.

The head of the UN agency there called all warring parties to “respect international humanitarian law,” and spare children, civilians and civilian infrastructure to prevent Yemen from falling “further into the abyss and the humanitarian catastrophe” it has been facing for over three years.

Yemen’s conflict has its roots in uprisings that date back to 2011, but fighting escalated in March 2015, when an international coalition led by Saudi Arabia intervened militarily at the request of Yemen’s President.

Attacks against civilians have been the scourge of this conflict. According to the UN Office for the Coordination of Humanitarian Affairs (OCHA), “tens of civilians were killed in violence in several governorates” in the past 10 days alone. On 3 August, during a particularly deadly attack, one of the last functioning hospitals, Al Thawra in Al Hudaydah, was struck, reportedly causing the death of dozens of vulnerable, sick and injured civilians.

“It’s hard to believe we live in a world where children should live in fear of such attacks, yet here we are. This doesn’t have to be their reality though. Parties to the conflict and those who have influence over them, including Security Council members, can and should choose to end this catastrophe for the sake of Yemen’s children,” stressed the UNICEF chief.

“We’ve said this before and we are saying it again – parties to the conflict are obliged to do everything possible to protect civilians and civilian infrastructure. This is not a voluntary commitment – it is mandatory on all belligerents,” said Lise Grande, UN Humanitarian Coordinator in Yemen, in the latest OCHA report on the situation there. “So many people have died in Yemen – this conflict has to stop.”


Yemen: Allegedly, an airstrike by the Saudi-led coalition fighting Shiite rebels hit a bus in a market in northern Yemen on Thursday, killing at least 43 people, including children, and wounding as many as 63


2018: A year punctuated by brutal crimes against young girls in India.

NYT

The world’s most dangerous countries for women 2018


Boise, Idaho: 6 children, ages four to 12, were injured in a knife attack, along with 3 adults who rushed to their defense.

CBS

Pacific Northwest sector loop

 


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