Published Date: 2014-10-06 21:55:55
Subject: PRO/EDR> Polio-like illness - North America (05): USA, RFI
Archive Number: 20141006.2837556
POLIO-LIKE ILLNESS - NORTH AMERICA (05): USA, REQUEST FOR INFORMATION
*********************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
In this update:
[1] Colorado, 1 new case - media report
[2] USA, overview - media report
******
[1] Colorado, 1 new case - media report
Date: 6 Oct 2014
Source: Denver Post [edited]
http://www.denverpost.com/news/ci_26673730/colorado-health-dept-says-12-children-stricken-partial?source=infinite
A 12th case of partial paralysis in a child treated in Colorado for viral respiratory illness was confirmed Monday [6 Oct 2014] by the Colorado Department of Public Health and Environment.
The latest case was reported by Denver Health Medical Center. The 1st 11 cases were treated at Children's Hospital Colorado, where 3 children remain hospitalized.
The U.S. Centers for Disease Control and Prevention is investigating a possible link between the cases and enterovirus D-68, which is suspected in a nationwide outbreak of cold-like symptoms and severe respiratory illness among children and adults.
Denver Health officials said their patient was treated and discharged last week, and no further information was available.
The cases included in the CDC and health department investigation are those in which children have experienced severe polio-like muscle weakness in one or more limbs after a fever, and who have lesions on their spinal cord.
"We don't have any new information from the CDC," said CDPHE director Larry Wolk. "We are expecting one or 2 more additional cases. We think the outbreak of enteroviruses and rhinoviruses peaked a couple of weeks ago and will continue to decline."
Enterovirus and rhinovirus cases are not reported to the state, and the health department doesn't track statewide numbers. The information on paralysis cases is based on surveillance data from 5 hospitals in 4 regions of the state, including the Denver-metro area, Montrose/Delta, El Paso and Mesa counties, as well as from outpatient visits to a large Denver-area system.
"We're doing the best possible surveillance we can under the circumstances," Wolk said.
[Byline: Electa Draper]
--
Communicated by:
ProMED-mail
******
[2] USA, overview - media report
Date: 7 Oct 2014
Source: NZ Stuff.co.nz [edited]
http://www.stuff.co.nz/world/americas/61731966/poliolike-virus-infects-hundreds-in-us
Amid fears of the Ebola virus, a more enigmatic virus is suspected of causing paralysis in dozens of children in the United States as doctors race to solve one of the most perplexing mysteries of their careers.
Enterovirus D68, which has hospitalised hundreds of children in almost every state and been linked to at least 4 deaths, may also have caused unexplained paralysis cases from Boston to San Diego, doctors said. Researchers said they fear the virus known as EV-D68 could be this generation's version of polio, said Ben Greenberg, a neurologist at the University of Texas Southwest Medical Center.
Non-polio enterovirus is related to the common cold, and this rare strain has hit children hardest. There have been 538 confirmed cases of EV-D68 in 43 states, beginning in the Midwest in August 2014, according to the Centers for Disease Control and Prevention, though doctors said the number is probably far greater since not all those infected are tested. Most only experience symptoms such as a runny nose, though a small percentage develop serious breathing difficulties, especially those with a history of such issues including asthma.
In rare cases, some children develop a fever, then headaches, neck pain, and within a few days or weeks, a swift and sudden paralysis that in the most severe cases left children bound to a wheelchair, unable to speak or breathe on their own, said Keith Van Haren, a Stanford School of Medicine neurologist who has been studying a link between the virus and paralysis since 2012.
The CDC so far hasn't determined whether the virus is causing the paralysis cases. EV-D68 hasn't been detected in all of the paralysed patients, and, given its widespread circulation, its presence could be coincidental, the agency said last week.
As the CDC investigates a possible connection between the virus and paralysis, more than 50 doctors at the country's top hospitals are holding regular calls, pooling research and studying those infected in hopes they can find a link that will lead to a drug or vaccine. They are racing against time as EV-D68 shows no signs of waning in many parts of the country.
Greenberg and his colleagues said they didn't realise the full scope of the outbreak until early last week. After reports of a cluster of 10 paralysis cases in Colorado, he and 30 other neurologists, infectious disease experts and public health officials hastily organised a conference call on 29 Sep 2014. To his surprise, almost every doctor on the phone had seen at least one case of unexplained paralysis in the past several months, some as many as 10.
While there were some variations, most images from medical scans looked strikingly similar, with the connection between the spinal cord and the muscles killed off with little chance of rebuilding the bridge, just like seen in those infected with polio, Greenberg said.
"There were remarkable similarities," said Van Haren, who was also on the doctors' conference call. "They sounded like interchangeable cases."
While the CDC continues to study the paralysis cases, "as a member of the clinical community, I think it is just a matter of time before we establish a definitive link between EV-D68 and this polio-like illness that follows," Van Haren said.
The virus has also been documented in at least 4 deaths. Elie Waller, a 4-year-old New Jersey boy, was kept home from school by his mother one day last month [September 2014] because he was developing a little bit of pinkeye, said Jeff Plunkett, the health officer for Hamilton Township where the boy lived. That night, he died in his sleep. The Mercer County medical examiner's office listed EV-D68 as the cause of death.
There are currently no vaccines in development for the virus, which was rarely seen until this year [2014], and before work on one can begin, researchers need more data to prove the virus is the cause of the paralysis, Greenberg said. Too often, samples aren't taken in time to detect the virus, and it's possible multiple viruses may be to blame.
As of last week, the CDC has begun a national surveillance and testing program, and Greenberg and other neurologists have formed a group to study patients more in depth.
The cases have doctors brushing up on their knowledge of polio, which hasn't naturally occurred in the US since 1979, after a vaccine was introduced in the 1950s. When Greenberg started seeing the polio-like cases, he called an older colleague at the National Institutes of Health who had trained in India to get a crash course on the disease and compare notes.
In contrast to enterovirus, there has been just one case so far of Ebola that was brought into the US from a patient infected in Liberia. Though Ebola can be lethal, with a mortality rate in Africa as high as 60 per cent, it is much less easily transmitted from person to person. Enterovirus is spread through casual contact, such as when an infected person sneezes or coughs, while Ebola is only transmitted through the sharing of bodily fluids, like blood, vomit or saliva.
Carrie Baker-Bailey fears her son William, 8, is one of those who may have lost the use of his arm from the virus. At the end of August 2014, she took him to the hospital near their San Diego home with neck pain, headache and a fever. An X-ray showed some inflammation in his chest, and his doctor sent him home with antibiotics, Baker-Bailey said in a telephone interview.
Two days later, he was feeling worse and had a stomachache, was constipated and was complaining of pain all over his body. They went back to the hospital, where doctors did a spinal tap, diagnosed him with spinal meningitis, and sent him home again.
That night, Baker-Bailey said she remembers him screaming in pain as he lay with her at 3:00 am trying to fall back asleep. The next morning, she knew something wasn't right and took him back to the hospital again. By then, he said he couldn't move his arm.
An MRI showed inflammation of his spinal cord, and he was admitted to the hospital where he spent 13 days in the intensive care unit. He tested positive for enterovirus, though doctors never did further testing to determine which of the more than 100 types of enterovirus he had.
Now, back at home, he still can't lift or move his arm and has weakness in his back. The once-active little boy who played baseball year-round and swam competitively now has difficulty sitting up on his own in a chair, can't dress himself, and hasn't been able to start the 3rd grade.
Baker-Bailey thinks the virus had something to do with her son's paralysis, but doctors haven't been able to give her a clear answer for what caused it or whether he will ever regain use.
"How did he get it; what did he even have, and is it ever going to get better? We don't have any answers," she said. "Sitting in the ICU for 13 days asking why? why? why? and not having any answers, that has been the hardest part."
[Byline: Shannon Pettypiece]
--
Communicated by:
ProMED-mail
[According to the above media report in [1], there have now been 12 cases of polio-like paralysis reported by Colorado. One of the cases reported earlier was mentioned to have been from another state in the catchment area for the Children's Hospital Colorado, but the state was not identified at that time (see prior ProMED-mail posts referenced below for more details).
Acute onset of weakness or paralysis not caused by infection with poliovirus has not been an officially reportable disease in the USA. On 26 Sep 2014, CDC issued an alert following the report of a cluster of 9 such cases in Colorado and requested that cases meeting the following case definition be reported to their state and local health departments: Patients less than 21 years of age with an acute onset of focal limb weakness occurring on or after 1 Aug 2014, and, an MRI showing a spinal cord lesion largely restricted to grey matter.
In response to a ProMED RFI on 27 Sep 2014 (see Polio-like illness - USA (02): (CO) enterovirus 68 susp, alert, RFI 20140927.2809908), we received a 1st hand report from the British Columbia Provincial Centre for Disease Control (BCCDC) on 2 cases that met the case definition (see Polio-like illness - North America: Canada (BC) 20140930.2819618). There was a CDC MMWR report providing more details on the original 9 cases reported by Colorado, and a detailed report on earlier reports of similar such cases identified in California during the period December 2012 and February 2014 (and previously reported on ProMED -- see Polio-like illness - USA: (CA) enterovirus 68 susp, RFI 20140224.2296126) published on 3 Oct 2014. Other than the CDC and and BCCDC reports as described above, all other case reports have come from media reports and not official sources.
In many of the cases, either infection with EV-D68 has been identified or a history of an antecedent respiratory illness compatible with that seen with EV-D68 infection was observed, so that current thinking is leaning towards a possible association with EV-D68. But caution has been raised that this may well be a coincidental finding, as it is coinciding with reports of major EV-D68 activity in North America at this time. A causal relationship has not as yet been established/confirmed.
That being said, according to the media reports, there have been a total of 30 cases identified in the USA from 9 (or possibly 10 states if the one case in Colorado was from a state not previously mentioned: Alabama, California, Colorado, Massachusetts, Michigan, Missouri, Pennsylvania, Texas and Virginia) and 13 cases identified in Canada from 3 provinces (Alberta, British Columbia and Ontario).
More information on the current status of reporting of cases meeting the CDC case definition would be greatly appreciated.
For the HealthMap/ProMED map of the USA see http://healthmap.org/promed/p/106. - Mod.MPP]
Subject: PRO/EDR> Polio-like illness - North America (05): USA, RFI
Archive Number: 20141006.2837556
POLIO-LIKE ILLNESS - NORTH AMERICA (05): USA, REQUEST FOR INFORMATION
*********************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
In this update:
[1] Colorado, 1 new case - media report
[2] USA, overview - media report
******
[1] Colorado, 1 new case - media report
Date: 6 Oct 2014
Source: Denver Post [edited]
http://www.denverpost.com/news/ci_26673730/colorado-health-dept-says-12-children-stricken-partial?source=infinite
A 12th case of partial paralysis in a child treated in Colorado for viral respiratory illness was confirmed Monday [6 Oct 2014] by the Colorado Department of Public Health and Environment.
The latest case was reported by Denver Health Medical Center. The 1st 11 cases were treated at Children's Hospital Colorado, where 3 children remain hospitalized.
The U.S. Centers for Disease Control and Prevention is investigating a possible link between the cases and enterovirus D-68, which is suspected in a nationwide outbreak of cold-like symptoms and severe respiratory illness among children and adults.
Denver Health officials said their patient was treated and discharged last week, and no further information was available.
The cases included in the CDC and health department investigation are those in which children have experienced severe polio-like muscle weakness in one or more limbs after a fever, and who have lesions on their spinal cord.
"We don't have any new information from the CDC," said CDPHE director Larry Wolk. "We are expecting one or 2 more additional cases. We think the outbreak of enteroviruses and rhinoviruses peaked a couple of weeks ago and will continue to decline."
Enterovirus and rhinovirus cases are not reported to the state, and the health department doesn't track statewide numbers. The information on paralysis cases is based on surveillance data from 5 hospitals in 4 regions of the state, including the Denver-metro area, Montrose/Delta, El Paso and Mesa counties, as well as from outpatient visits to a large Denver-area system.
"We're doing the best possible surveillance we can under the circumstances," Wolk said.
[Byline: Electa Draper]
--
Communicated by:
ProMED-mail
******
[2] USA, overview - media report
Date: 7 Oct 2014
Source: NZ Stuff.co.nz [edited]
http://www.stuff.co.nz/world/americas/61731966/poliolike-virus-infects-hundreds-in-us
Amid fears of the Ebola virus, a more enigmatic virus is suspected of causing paralysis in dozens of children in the United States as doctors race to solve one of the most perplexing mysteries of their careers.
Enterovirus D68, which has hospitalised hundreds of children in almost every state and been linked to at least 4 deaths, may also have caused unexplained paralysis cases from Boston to San Diego, doctors said. Researchers said they fear the virus known as EV-D68 could be this generation's version of polio, said Ben Greenberg, a neurologist at the University of Texas Southwest Medical Center.
Non-polio enterovirus is related to the common cold, and this rare strain has hit children hardest. There have been 538 confirmed cases of EV-D68 in 43 states, beginning in the Midwest in August 2014, according to the Centers for Disease Control and Prevention, though doctors said the number is probably far greater since not all those infected are tested. Most only experience symptoms such as a runny nose, though a small percentage develop serious breathing difficulties, especially those with a history of such issues including asthma.
In rare cases, some children develop a fever, then headaches, neck pain, and within a few days or weeks, a swift and sudden paralysis that in the most severe cases left children bound to a wheelchair, unable to speak or breathe on their own, said Keith Van Haren, a Stanford School of Medicine neurologist who has been studying a link between the virus and paralysis since 2012.
The CDC so far hasn't determined whether the virus is causing the paralysis cases. EV-D68 hasn't been detected in all of the paralysed patients, and, given its widespread circulation, its presence could be coincidental, the agency said last week.
As the CDC investigates a possible connection between the virus and paralysis, more than 50 doctors at the country's top hospitals are holding regular calls, pooling research and studying those infected in hopes they can find a link that will lead to a drug or vaccine. They are racing against time as EV-D68 shows no signs of waning in many parts of the country.
Greenberg and his colleagues said they didn't realise the full scope of the outbreak until early last week. After reports of a cluster of 10 paralysis cases in Colorado, he and 30 other neurologists, infectious disease experts and public health officials hastily organised a conference call on 29 Sep 2014. To his surprise, almost every doctor on the phone had seen at least one case of unexplained paralysis in the past several months, some as many as 10.
While there were some variations, most images from medical scans looked strikingly similar, with the connection between the spinal cord and the muscles killed off with little chance of rebuilding the bridge, just like seen in those infected with polio, Greenberg said.
"There were remarkable similarities," said Van Haren, who was also on the doctors' conference call. "They sounded like interchangeable cases."
While the CDC continues to study the paralysis cases, "as a member of the clinical community, I think it is just a matter of time before we establish a definitive link between EV-D68 and this polio-like illness that follows," Van Haren said.
The virus has also been documented in at least 4 deaths. Elie Waller, a 4-year-old New Jersey boy, was kept home from school by his mother one day last month [September 2014] because he was developing a little bit of pinkeye, said Jeff Plunkett, the health officer for Hamilton Township where the boy lived. That night, he died in his sleep. The Mercer County medical examiner's office listed EV-D68 as the cause of death.
There are currently no vaccines in development for the virus, which was rarely seen until this year [2014], and before work on one can begin, researchers need more data to prove the virus is the cause of the paralysis, Greenberg said. Too often, samples aren't taken in time to detect the virus, and it's possible multiple viruses may be to blame.
As of last week, the CDC has begun a national surveillance and testing program, and Greenberg and other neurologists have formed a group to study patients more in depth.
The cases have doctors brushing up on their knowledge of polio, which hasn't naturally occurred in the US since 1979, after a vaccine was introduced in the 1950s. When Greenberg started seeing the polio-like cases, he called an older colleague at the National Institutes of Health who had trained in India to get a crash course on the disease and compare notes.
In contrast to enterovirus, there has been just one case so far of Ebola that was brought into the US from a patient infected in Liberia. Though Ebola can be lethal, with a mortality rate in Africa as high as 60 per cent, it is much less easily transmitted from person to person. Enterovirus is spread through casual contact, such as when an infected person sneezes or coughs, while Ebola is only transmitted through the sharing of bodily fluids, like blood, vomit or saliva.
Carrie Baker-Bailey fears her son William, 8, is one of those who may have lost the use of his arm from the virus. At the end of August 2014, she took him to the hospital near their San Diego home with neck pain, headache and a fever. An X-ray showed some inflammation in his chest, and his doctor sent him home with antibiotics, Baker-Bailey said in a telephone interview.
Two days later, he was feeling worse and had a stomachache, was constipated and was complaining of pain all over his body. They went back to the hospital, where doctors did a spinal tap, diagnosed him with spinal meningitis, and sent him home again.
That night, Baker-Bailey said she remembers him screaming in pain as he lay with her at 3:00 am trying to fall back asleep. The next morning, she knew something wasn't right and took him back to the hospital again. By then, he said he couldn't move his arm.
An MRI showed inflammation of his spinal cord, and he was admitted to the hospital where he spent 13 days in the intensive care unit. He tested positive for enterovirus, though doctors never did further testing to determine which of the more than 100 types of enterovirus he had.
Now, back at home, he still can't lift or move his arm and has weakness in his back. The once-active little boy who played baseball year-round and swam competitively now has difficulty sitting up on his own in a chair, can't dress himself, and hasn't been able to start the 3rd grade.
Baker-Bailey thinks the virus had something to do with her son's paralysis, but doctors haven't been able to give her a clear answer for what caused it or whether he will ever regain use.
"How did he get it; what did he even have, and is it ever going to get better? We don't have any answers," she said. "Sitting in the ICU for 13 days asking why? why? why? and not having any answers, that has been the hardest part."
[Byline: Shannon Pettypiece]
--
Communicated by:
ProMED-mail
[According to the above media report in [1], there have now been 12 cases of polio-like paralysis reported by Colorado. One of the cases reported earlier was mentioned to have been from another state in the catchment area for the Children's Hospital Colorado, but the state was not identified at that time (see prior ProMED-mail posts referenced below for more details).
Acute onset of weakness or paralysis not caused by infection with poliovirus has not been an officially reportable disease in the USA. On 26 Sep 2014, CDC issued an alert following the report of a cluster of 9 such cases in Colorado and requested that cases meeting the following case definition be reported to their state and local health departments: Patients less than 21 years of age with an acute onset of focal limb weakness occurring on or after 1 Aug 2014, and, an MRI showing a spinal cord lesion largely restricted to grey matter.
In response to a ProMED RFI on 27 Sep 2014 (see Polio-like illness - USA (02): (CO) enterovirus 68 susp, alert, RFI 20140927.2809908), we received a 1st hand report from the British Columbia Provincial Centre for Disease Control (BCCDC) on 2 cases that met the case definition (see Polio-like illness - North America: Canada (BC) 20140930.2819618). There was a CDC MMWR report providing more details on the original 9 cases reported by Colorado, and a detailed report on earlier reports of similar such cases identified in California during the period December 2012 and February 2014 (and previously reported on ProMED -- see Polio-like illness - USA: (CA) enterovirus 68 susp, RFI 20140224.2296126) published on 3 Oct 2014. Other than the CDC and and BCCDC reports as described above, all other case reports have come from media reports and not official sources.
In many of the cases, either infection with EV-D68 has been identified or a history of an antecedent respiratory illness compatible with that seen with EV-D68 infection was observed, so that current thinking is leaning towards a possible association with EV-D68. But caution has been raised that this may well be a coincidental finding, as it is coinciding with reports of major EV-D68 activity in North America at this time. A causal relationship has not as yet been established/confirmed.
That being said, according to the media reports, there have been a total of 30 cases identified in the USA from 9 (or possibly 10 states if the one case in Colorado was from a state not previously mentioned: Alabama, California, Colorado, Massachusetts, Michigan, Missouri, Pennsylvania, Texas and Virginia) and 13 cases identified in Canada from 3 provinces (Alberta, British Columbia and Ontario).
More information on the current status of reporting of cases meeting the CDC case definition would be greatly appreciated.
For the HealthMap/ProMED map of the USA see http://healthmap.org/promed/p/106. - Mod.MPP]
