What’s the latest on the mysterious polio-like disease affecting US kids?
It's been estimated that more than 100 cases of acute flaccid myelitis, which causes full or partial paralysis in one or more of their arms or legs have been seen in children across the US in recent months, and the CDC recently weighed in a how to treat it.
The Centers for Disease Control and Prevention recently released a request that all providers stop using several immunomodification treatments on a newly recognized, seemingly post-viral, syndrome in children called acute flaccid myelitis.
It's being called acute because it occurs suddenly, and flaccid because the weakness or paralysis in the limb does not have an obvious cause. Myelitis involves the infection or the inflammation of the white matter or gray matter of the spinal cord that acts as a bridge between the brain and the rest of the body.
More than 100 cases of the syndrome causing full or partial paralysis, usually temporarily, in one or more of their arms or legs have been seen in children across the United States in recent months, according to doctors attending the annual meeting of the Child Neurology Society as reported in the Atlantic in late October.
As of November 12, the CDC has verified reports of 75 cases in 29 states. They are working with healthcare professionals and state and local officials to investigate all of these cases, and in the process of verifying less than half a dozen additional reports. There have been six confirmed cases seen at Children's Hospital of Philadelphia.
In the latest statement, the CDC says none of these treatments have been seen to improve this disease. These therapies (primarily immunoglobulin, steroids and plasmaphoresis) do not appear to be effective, attempts to treat using them can have serious side effects including severe allergic reactions, and additional infections and breakdown of blood cells. They can also be impressively expensive.
The children who get this syndrome are very ill and it is hard on both practitioners and family to just watch and support them with fluids, oxygen if needed and good nursing care. Experts do not know the cause although at one point a new enterovirus called D68 was suspected. Also, the outcome is unpredictable: some of these paralyzed kids recover quickly and others linger and may never completely recover.
As I mentioned in my recent blog on overdiagnosis and overtreatment, not treating is always harder than treating for a doctor or a mother. My cardiologist was discussing that blog and said as a doctor of very ill people she is always trying to minimize the use of antibiotics to prevent antibiotic resistance and to prevent antibiotic side-effects, but as a mother, she always has to bite her tongue when the pediatrician says to her about her children. "It is only a virus, no antibiotic is needed." She knows in her head the pediatrician is correct, but emotionally they are her children and in her heart they should get everything they can to get better.
It is still unknown what's causing acute flaccid myelitis and whether it can be spread from person to person, but the CDC advises that it is best for everyone in your house to follow basic steps to stay healthy and avoid infections: wash your hands frequently with soap and water, stay away from sick people, and disinfect objects that a sick person has touched.
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