NYT

“…..beggars congregate outside supermarkets filled with goods; markets are filled with produce in towns where the hungry eat boiled leaves; and restaurants selling rich food are a few hundred yards from hunger wards filled with desperation, pain and death...…”

UNICEF

“…..In the midst of this national catastrophe, desperate families are increasingly turning to child marriage: Today, more than two thirds of girls are married off before the age of 18, compared to 50 percent before the crisis began.

Parents marry off their daughters to be relieved of the cost of their care, or because they believe a husband’s family can offer better protection. Families also sell their daughters for dowry payments to cope with conflict-related hardship. Child brides are especially common in parts of Yemen that host large numbers of displaced people…..”

CDC

Resources:

• Helping children after a disaster
• AAP Children and Disasters
• American Psychological Association Help Center
• CDC Coping with a Disaster or Traumatic Event
• Reactions and Guidelines for Children Following Crisis and Trauma
• Helping children cope after a disaster
• Federal Emergency Management Agency
• Coalition to Support Grieving Students
• Comprehensive web-based trauma tool
• National Association of Child Psychologists
• National Child Truamatic Stress Network
• Psychological First Aid
• Substance Abuse and Mental Health Services Administration Disaster Distress Hotline
• National Center for School Crisis and Bereavement
• Tips for talking with and helping children cope after a disaster

BMJ

Elgar FJ, Donnelly PD, Michaelson V, et al

“…..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.….”

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

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.

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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.

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

• CSTE Standardized Case Definition for Acute Flaccid Myelitis
• Resources and References

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…..”

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…….”

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.

History