Menu

Close to 1,900 Cases of Vaping-Linked Lung Illness, CDC Says

THURSDAY, Oct. 31, 2019 — The number of Americans stricken with a severe, sometimes fatal lung illness tied to vaping has now reached 1,888, the U.S. Centers for Disease Control and Prevention reported Thursday.

That’s a rise from the 1,604 case total from a week ago.

Currently, cases have been reported in every state except Alaska, the agency noted.

The related death toll has also risen by three over the past week, to 37 fatalities, spread across 24 states and the District of Columbia. Deaths have involved patients ranging from the ages of 17 to 75, with the average age being 49.

No new data on possible factors driving these illnesses was released in the new report. However, last week the CDC noted that 86% of cases involved products that contained THC, the psychoactive ingredient in marijuana.

Young men are being especially affected, with 70% of patients being male and 79% under the age of 35.

While THC remains a main suspect in the CDC’s investigation, a recent study suggested other chemicals might play a role.

For example, researchers at the Mayo Clinic Arizona conducted an examination of 17 cases involving vaping-linked lung injury — including lung biopsies. All of the patients examined had severe forms of the illness, and two had died.

“Based on what we have seen in our study, we suspect that most cases involve chemical contaminants, toxic byproducts or other noxious agents within vape liquids,” said lead researcher Dr. Brandon Larsen. He’s a surgical pathologist at the Mayo Clinic Arizona in Scottsdale.

Those findings were published earlier this month in the New England Journal of Medicine.

Dr. Anne Schuchat, principal deputy director of the CDC, has stressed that nicotine-containing vaping products without THC cannot be ruled out as a potential cause of harm. Because of that, the CDC recommendation for everyone to stop vaping still stands, she said.

What is clear is that the illnesses that are affecting vapers can be sudden and severe. Symptoms include cough, shortness of breath and chest pains. Some patients have had so much trouble breathing that they wind up on oxygen, and in extreme cases are placed on a mechanical ventilator.

The CDC’s updated numbers come two weeks after Juul — the top-selling brand of electronic cigarettes in the United States — announced that it would no longer sell fruit or dessert flavors of its products.

The company’s decision comes as it faces widespread criticism that its flavored nicotine products are hooking a generation of teenagers on nicotine and vaping, the Associated Press reported.

The company also faces multiple investigations by U.S. Congress, the U.S. Food and Drug Administration and several state attorneys general. Juul is also being sued by adults and underage vapers who allege they became addicted to nicotine by using Juul’s products, the wire service said.

The Trump administration has also proposed banning nearly all e-cigarette flavors.

The flavors dropped by Juul will be mango, creme, fruit and cucumber, which account for 10% of its sales. The company will continue to sell its most popular flavors: mint and menthol, the AP reported.

Juul’s decision to continue selling mint and menthol shows “it isn’t serious about preventing youth use,” said Matthew Myers, from the Campaign for Tobacco-Free Kids.

“Juul knows that 64% of high school e-cigarette users now use mint or menthol flavors, and this number is growing all the time,” Myers said in a statement.

His group and others say the Trump administration should ban all vaping flavors except tobacco, the AP added.

More information

The American Lung Association has more about vaping and lung health.

© 2019 HealthDay. All rights reserved.

Posted: October 2019

Drugs.com – Daily MedNews

Cause of Paralyzing Illness in Kids Remains Elusive

By Amy Norton
HealthDay Reporter

MONDAY, Oct. 7, 2019 (HealthDay News) — There is still no clear cause for a mysterious paralytic condition that has been striking U.S. children over the past five years, government health officials report.

Researchers at the U.S. Centers for Disease Control and Prevention suspect that a virus of some kind is the culprit. But the specific germ causing the outbreaks remains unknown, according to the report published online Oct. 7 in the journal Pediatrics.

For several years, the CDC has been investigating the condition, called acute flaccid myelitis (AFM). It’s a rare disease that attacks tissue in the spinal cord, causing muscles and reflexes to weaken.

AFM mainly affects the arms and legs but can also impair muscles needed for breathing, and some patients end up on a ventilator. At least half of AFM patients do not fully recover, the CDC has said.

Sporadic cases of AFM — sometimes linked to various viral infections, but not always — have long been recognized. The CDC began closely monitoring the condition in 2014, after an unexpected surge in cases: 120 people in 34 states over a few months.

Since then, the United States has seen AFM outbreaks in a clear pattern — every two years, between August and October, almost entirely among children. In 2018, the CDC said that 235 cases were reported; so far this year, 20 are confirmed — in line with the pattern.

Based on what’s known about all three seasonal “surges” so far, the leading hypothesis is that a virus is to blame, according to Dr. Janell Routh of the CDC’s division of viral diseases.

One virus, called enterovirus D68 (EV-D68), has been considered a prime suspect, Routh noted. It’s one of a large group of viruses that are usually harmless or cause only cold symptoms. However, in 2014, the United States saw an outbreak of more-severe respiratory illnesses caused by EV-D68, coinciding with the first AFM surge.

As of now, though, there’s no “smoking gun,” Routh said.

In the new report, she and her colleagues describe the cases of 193 U.S. children who had confirmed cases of AFM between 2015 and 2017.

Continued

Most children had samples of spinal fluid taken, but only one showed evidence of a virus — coxsackievirus A16. Blood samples from another child showed evidence of EV-D68.

The CDC researchers found more microbes when they looked at mucus and stool samples, but there was no clear single cause. Overall, 28% of those samples tested positive for an enterovirus or rhinovirus (another cause of the common cold).

Many of the respiratory samples — 69% — did turn out to be positive for EV-D68, though.

“I think it’s fair to say it’s still the leading suspect in the biennial surges we’re seeing,” said Dr. Samuel Dominguez of Children’s Hospital Colorado and the University of Colorado School of Medicine, in Aurora.

Dominguez wrote an editorial published with the study.

Like other viruses, EV-D68 has a season, circulating in the summer to fall. In addition, there are year-to-year shifts in the types of enteroviruses in circulation in the United States, Dominguez explained. That fits the every-other-year pattern of AFM surges.

It’s not clear why the surges began — or, at least, were first recognized — in 2014, Routh said.

Researchers are looking into other questions, too: If a viral infection is driving the AFM outbreaks, how does it cause the condition? Is it through a direct assault on nerve cells, or does the virus trigger an abnormal immune response that damages nerve cells? And what makes some children vulnerable to developing AFM, while most do not?

If EV-D68, or another virus, is pinpointed as the cause, that would raise the question of what comes next.

Dominguez said, “If you know what the pathogen is, and this (AFM) is becoming more common, would it be worth developing a vaccine?”

For now, he and Routh said that while AFM remains relatively rare, parents should be aware of the signs: sudden weakness in the arms or legs; loss of muscle tone; and, in some cases, a “droop” on one side of the face or the eyelids.

“If you notice those symptoms, see a doctor right away,” Routh said.

And, she added, it’s always wise to avoid contracting or spreading any viral infection. Some preventive steps include regular hand-washing, staying home when you’re sick, and coughing or sneezing into your arm rather than your hand.

WebMD News from HealthDay

Sources

SOURCES: Janell Routh, M.D., M.H.S., medical officer, division of viral diseases, U.S. Centers for Disease Control and Prevention, Atlanta; Samuel Dominguez, M.D., Ph.D., associate professor, pediatrics, University of Colorado School of Medicine, and medical director, clinical microbiology lab, Children’s Hospital Colorado, Aurora; Oct. 7, 2019,Pediatrics, online

Copyright © 2013-2018 HealthDay. All rights reserved.

‘); } else { // If we match both our test Topic Ids and Buisness Ref we want to place the ad in the middle of page 1 if($ .inArray(window.s_topic, moveAdTopicIds) > -1 && $ .inArray(window.s_business_reference, moveAdBuisRef) > -1){ // The logic below reads count all nodes in page 1. Exclude the footer,ol,ul and table elements. Use the varible // moveAdAfter to know which node to place the Ad container after. window.placeAd = function(pn) { var nodeTags = [‘p’, ‘h3′,’aside’, ‘ul’], nodes, target; nodes = $ (‘.article-page:nth-child(‘ + pn + ‘)’).find(nodeTags.join()).not(‘p:empty’).not(‘footer *’).not(‘ol *, ul *, table *’); //target = nodes.eq(Math.floor(nodes.length / 2)); target = nodes.eq(moveAdAfter); $ (”).insertAfter(target); } // Currently passing in 1 to move the Ad in to page 1 window.placeAd(1); } else { // This is the default location on the bottom of page 1 $ (‘.article-page:nth-child(1)’).append(”); } } })(); $ (function(){ // Create a new conatiner where we will make our lazy load Ad call if the reach the footer section of the article $ (‘.main-container-3’).prepend(”); });

Pagination

WebMD Health

Getting to the Bottom of Vaping Illness Outbreak

Kyle Boyar, vice chair, Cannabis Chemistry Subdivision, American Chemical Society.

Laura Crotty Alexander, MD, associate professor of medicine, University of California San Diego.

Milton Teske, MD, public health officer, King County, CA.; emergency room doctor, Adventist Health, Hanford.

Statement, Vapor Technology Association, Sept. 30, 2019.

Morbidity & Mortality Weekly Report,Sept. 27, 2019.

News release, CDC, Sept. 27, 2019.

CDC: “Outbreak of Lung Injury Associated with E-Cigarette Use, or Vaping,” Sept. 27, 2019.

NBC: “Tests show bootleg marijuana vapes tainted with hydrogen cyanide.”

FDA: “Lung Illnesses Associated with Use of Vaping Products,” Sept. 26, 2019.

News release, New York State Department of Health, Sept. 5, 2019.

Environmental Health Perspectives, Feb. 21, 2018.

WebMD Health

Scary Diagnosis:’ Two Stories of Vaping Illness

Sept. 20, 2019 — Lincoln Rennie says he is known as a dedicated employee, not the type who would call in sick to play hooky. So in late August, when he woke up feeling ill, the 23-year-old welder from Orange, CA, went to work anyway. But once he got there, his stomachache worsened and his fever climbed.

He headed home, and his fiancé, Viri Alvarado, became concerned when his body temperature kept rising. When it got over 103 F, Alvarado talked him into seeing a doctor. He went two different times, but each time, he was told it was ”probably just a fever.”

Still, it didn’t break. Then it rose to more than 104, and he was beginning to ”talk crazy,” says Alvarado, 20. Rennie admits: “I was definitely losing some cognitive function. I woke up saying everything was a scam and the pillow was my internet.”

That was it for Alvarado, who insisted he go to the emergency room that day — August 31.

Rennie was admitted to the hospital from the ER. While doctors first thought he had a urinary tract infection, the final diagnosis was acute respiratory distress syndrome (ARDS).

“The diagnosis about vaping-related illness came about the third day,” Rennie recalls.

He stayed in the hospital 11 days, losing 22 pounds.

“I was on oxygen for 8 days,” he says. He was prescribed corticosteroids, and he is still taking them.

Rennie is among more than 500 cases of vaping-related illnesses in the U.S. Like many of the vapers stricken, he is young and male. Nearly three-quarters of patients are men; more than half are under age 25.

And while public health officials have yet to pinpoint one substance or product as the cause, Rennie was vaping THC — an ingredient linked to many of the cases — before he got sick.

Rennie says he’s used medical cannabis for years to help him sleep. He began vaping nicotine about 10 years ago and then tuned to vaping THC about 5 years ago. He would do them as separate vapes, he says.

In June, he gave up the nicotine vape and vaped THC only. Costs were becoming an issue, as he would typically spend $ 50 for about a gram — about a week’s supply for him, he says.

About a month before he got sick, Rennie started buying off-market vaping cartridges, which he says cut his costs in half. These are cartridges (which are also called “carts”) not sold in legitimate retail stores, but often bought from friends or associates. He noticed the taste and effect differed between the brand-name carts and the bootleg products.

‘They Couldn’t Believe I Was Still Breathing’

Nathan Fagundez, 28, says he also bought bootleg cartridges before he got sick. After a few weeks of using them, “I couldn’t breathe,” says Fagundez, an agricultural pest control technician in Hanford, CA. In mid-August, he saw a report about vaping on TV, and right away, he knew what he had.

He headed to the hospital on August 13, and they found his oxygen levels so low, ”they couldn’t believe I was still breathing.”

His doctor told him it was acute lung injury due to vaping. “I was on the verge of being ventilated,” or put on a machine to help him breathe, he says. But he improved enough to avoid that.

After 16 days in the hospital, on steroids and oxygen, he was released. He continues to take the steroids and use the oxygen.

“I have a plug-in oxygen” for use at home, he says. “And I have a portable tank to wheel around. I bring it for emergencies, if I exert too much.”

Fagundez, a regular marijuana user, says he started vaping it about a year ago because when he used regular marijuana, the odor annoyed people he worked with.

He’d buy about 2 grams a week. “It was always off market,” he says. That would knock the usual $ 100 price down to about $ 40, he says.

He relies on the vaping for his anxiety.

In the weeks before he got sick, he says, “I went with a buddy to pick up carts from LA.” The seller, he says, ”had a whole lab in his garage.”

Fagundez says he later tried to confront the seller, who denied doing anything wrong.

‘I Was Too Trusting’

Rennie says that looking back, there were signs of problems with the off-market carts. The difference, in taste and effects, was obvious.

Although none in his circle of friends got sick, he says his immediate friends weren’t buying from the same source.

”I was too trusting. I believe there are safe options,” Rennie says, and regulating the industry more would make it safer. “The scariest part of the bootleg [market] is, they look the same. They will take a brand-name cart, refill it, and say it’s the same brand.”

His doctors told him firmly: No more vaping. He agrees. “It was enough of a wake-up call, I wouldn’t chance it again,” he says. Alvarado says she, too, is giving up vaping.

But Rennie doesn’t want to give up marijuana entirely. “It’s always been a positive medicine in my life.” He hopes to go back to ”regular cannabis,” as he calls it, as does Alvarado. And perhaps they will keep testing edibles to see if they could help.

Fagundez says he, too, has stopped vaping. His experience has also inspired friends to drop the habit, he says. “As soon as I hit the hospital, and they found out it was due to vaping, about 10 people stopped.”

After his release, his doctor prescribed an anti-anxiety medication, he says. “It zonked me out.” He fell asleep for hours. So he’s decided edibles are better to help calm him. His current favorite are chocolate and THC gummies.

“Edibles take longer to metabolize. I’d say it’s a little more intense than vaping. [But] it gets the job done, and it helps with anxieties.”

Back to Work: Uncertain Timetable

Rennie and Fagundez hope to return to work soon, but they’re not strong enough yet. Rennie isn’t sure when his return date will be. “I still get really tired.”

Fagundez tried to go back, but the hot weather worked against him. “Even when I walk the dogs, I become short of breath,” he says. And that’s only going about five blocks. He says it will probably take 3 more months to be able to return to work.

Both men are still being monitored closely. And they both wonder what’s in store for their health. As Rennie says: “It’s a scary diagnosis. It was definitely not something I expected to go through at 23.”

Sources

Nathan Fagundez, 28, Hanford, CA.

Lincoln Rennie, 23, Orange, CA.

Briefing, CDC, Sept. 19, 2019.

CDC: “Outbreak of Lung Injury Associated with E-Cigarette Use, or Vaping. For Healthcare Providers; Recommendations for Clinicians,” Sept. 19, 2019.

© 2019 WebMD, LLC. All rights reserved.

‘); } else { // If we match both our test Topic Ids and Buisness Ref we want to place the ad in the middle of page 1 if($ .inArray(window.s_topic, moveAdTopicIds) > -1 && $ .inArray(window.s_business_reference, moveAdBuisRef) > -1){ // The logic below reads count all nodes in page 1. Exclude the footer,ol,ul and table elements. Use the varible // moveAdAfter to know which node to place the Ad container after. window.placeAd = function(pn) { var nodeTags = [‘p’, ‘h3′,’aside’, ‘ul’], nodes, target; nodes = $ (‘.article-page:nth-child(‘ + pn + ‘)’).find(nodeTags.join()).not(‘p:empty’).not(‘footer *’).not(‘ol *, ul *, table *’); //target = nodes.eq(Math.floor(nodes.length / 2)); target = nodes.eq(moveAdAfter); $ (”).insertAfter(target); } // Currently passing in 1 to move the Ad in to page 1 window.placeAd(1); } else { // This is the default location on the bottom of page 1 $ (‘.article-page:nth-child(1)’).append(”); } } })(); $ (function(){ // Create a new conatiner where we will make our lazy load Ad call if the reach the footer section of the article $ (‘.main-container-3’).prepend(”); });
WebMD Health

Health Tip: Mental Illness Warning Signs

— Determining if a child’s troubling behavior is “part of growing up” or a sign of a mental health problem can be difficult.

Parents should contact a mental health professional if symptoms last weeks or more and interfere with the child’s daily life, says the National Institute of Mental Health.

Warning signs of a mental illness may include:

  • Minimal interest in things that the person once enjoyed.
  • Low energy.
  • Too much or too little sleep.
  • Self-harming behaviors.
  • Smoking, drinking or drug use.
  • Excessive exercise or diet.
  • Thoughts of suicide.
  • Risky or destructive behavior.

© 2019 HealthDay. All rights reserved.

Posted: August 2019

More News Resources


Drugs.com – Daily MedNews

Many Elite Athletes Ashamed to Seek Help for Mental Illness

FRIDAY, May 17, 2019 — Athletes are supposed to be strong and self-assured, so many don’t seek help for mental health issues, a new study finds.

It’s not just the stigma of mental illness that prompts many to tough it out alone, but also busy schedules, gender stereotyping and lack of understanding about mental health issues.

That’s the consensus of researchers from Brazil, the Netherlands and the United States, who looked at 52 studies covering more than 13,000 elite athletes in 71 sports.

The findings were published May 16 in the British Journal of Sports Medicine.

“Athletes fear, possibly rightly so, that disclosing mental health symptoms or disorders would reduce their chances of maintaining or signing a professional team contract or an advertising campaign,” the researchers said in a journal news release.

It’s up to coaches and sport-governing bodies to help remove the stigma of mental illness and encourage mental well-being, the study authors added.

As many as one in three elite athletes suffers from mental illness. The demands of training to improve performance heighten the risk, the researchers noted.

Stigma was the most common factor in not seeking help, the investigators found. Mental illness was seen as a sign of weakness rather than the “hallmark of a winner,” according to the report.

“Coaches could be important agents for supporting positive mental health attitudes within the elite athlete environment, including fostering an environment of mental health treatment-seeking,” the study authors concluded.

Brian Hainline, of the National Collegiate Athletic Association, and professors at the University of Wisconsin-Madison and University of Nebraska-Lincoln were U.S.-based members of the research team.

The study dovetails with a recent stand taken by the International Olympic Committee (IOC) on mental illness among athletes.

“The IOC hopes that all involved in sport will increasingly recognize that mental health symptoms and disorders should be viewed in a similar light as other medical or surgical illnesses or injuries,” it said in a recent consensus statement.

More information

To learn more about mental health stigma, visit the National Alliance on Mental Illness.

© 2019 HealthDay. All rights reserved.

Posted: May 2019

Drugs.com – Daily MedNews

CDC: Cases of Polio-Like Illness May Have Peaked

Dec. 4, 2018 — The number of U.S. cases of a devastating polio-like disease striking kids, called acute flaccid myelitis (AFM), has now reached 134, the U.S. Centers for Disease Control and Prevention said.

However, this year’s outbreak appears to have peaked and is expected to decline for the remainder of 2018, agency officials added.

The mysterious illness is thought to be related to infection with a common type of virus called an enterovirus. AFM can cause paralysis.

As of Nov. 30, there had been 134 cases of AFM confirmed in 33 states out of 299 cases reported to the CDC. This is an increase of 18 confirmed cases from the previous week, but most of the latest confirmed cases occurred in September and October.

Even though fewer cases are expected in coming months, health officials will continue to study AFM in order to learn more about the condition in order to better diagnose, treat, and prevent it in the future, according to the CDC.

The agency noted that there is a pattern of higher numbers of confirmed cases every two years. There were 120 in 2014, 22 in 2015, 149 in 2016, and 33 in 2017.

Most cases are reported between August and October, with significant reductions in November. That pattern appears to be repeating this year, CDC said.

WebMD News from HealthDay

Copyright © 2013-2018 HealthDay. All rights reserved.


WebMD Health

Surgery Helps Boy Walk After Polio-Like Illness

Nov. 5, 2018 — A first-of-its-kind surgery has restored the ability to walk in a boy paralyzed by a polio-like condition called acute flaccid myelitis (AFM).

The condition occurs most often in children and includes symptoms such as sudden arm or leg weakness, and reflex loss, CBS News reported.

Brandon Noblitt was struck by the disease in 2016 and could no longer walk. He was eventually seen by Dr. Amy Moore, of Washington University in St. Louis.

“My goal with the children with AFM was to restore hip stability, and then motion of the upper legs,” she told CBS News.

Fourteen months ago, Moore performed nerve transfer surgery on Brandon’s leg at St. Louis Children’s Hospital. She said she’s the only doctor in the U.S. to perform nerve transfers on children’s lower extremities.

“I used what they have. They were wiggling their toes, and so I was able to move a nerve that wiggles the toes to the hips,” Moore told CBS News.

At a check-up last week, Brandon was walking again.

The cause of AFM is unknown, but it seems to develop after a viral illness. Nearly 400 people in the U.S. have been diagnosed since 2014, according to the Centers for Disease Control and Prevention. So far this year, there have been 72 confirmed cases in 24 states, CBS News reported.

CDC director Dr. Robert Redfield recently called for a special task force to investigate AFM, which affects about one in a million people.

WebMD News from HealthDay

Copyright © 2013-2018 HealthDay. All rights reserved.


WebMD Health

Polio-Like Illness Strikes Kids, Frustrates Doctors

Oct. 19, 2018 — Federal health officials know that a rare nervous system disorder is on the rise and that it is mostly affecting children across the country.

But what officials with the CDC don’t know about acute flaccid myelitis, a polio-like illness that can cause paralysis, is nearly everything else. 

What causes it is not clear. Why it affects some people and not others is unknown. Why it seems to spike every 2 years remains a mystery. How to treat it, too, has the CDC stumped. The agency has confirmed 62 cases in 22 states this year and are investigating another 65 reports of similar illnesses. But the who, what, where, and why of the disease are largely still unknown. 

“The reason why we don’t know about AFM — and I am frustrated that despite all of our efforts, we haven’t been able to identify the cause of this mystery illness — we continue to investigate to better understand the clinical picture of AFM cases, risk factors, and possible causes of the increase in cases,” Nancy Messonnier, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases, told reporters at a news conference this week.

“We know this can be frightening for parents,” Messonnier said. “I know many parents want to know what the signs and symptoms are that they should be looking for in their child.”

Parents, she said, should seek medical care immediately if a child suddenly has weakness or loss of muscle tone in the arms and legs.

The good news is that the disease is very rare. Only one in 1 million people are thought to get it. However, while some children do fully recover, research shows that AFM’s effects often linger. In a study published last yeary, children showed persistent weakness in the areas affected by AFM. New, yet to be published research suggests as many as 50% of children with AFM will require surgery to restore function.  But, because outbreaks of AFM are a relatively new phenomenon and the number of children affected so far has been small, researchers have limited data from which to draw firm conclusions.

“We work with what we have,” says Priya Duggal, PhD, director of the genetic epidemiology program at the Johns Hopkins Bloomberg School of Public Health in Baltimore. “The depth of information that we have is helpful even if we do not have breadth of cases.”

Because the disease is more likely to strike children, and because of the mysteries of it and because of the dramatic health effects, it gets more attention than it might otherwise.

Despite the current alarm, the disease is not unheard of.

“In 2014, the first patient I saw was a baby, who had a sudden onset of weakness in one leg,” recalls Marc Patterson, MD. “The leg was flaccid and did not recover.”

Since then, Patterson, chairman of the division of Child and Adolescent Neurology at the Mayo Clinic in Rochester, MN, has seen several children diagnosed with what’s come to be called acute flaccid myelitis, or AFM, a very rare disease that causes nerve-damaging inflammation in the gray matter of the spinal cord.

AFM can lead to weakness or paralysis in the arms and legs. Cranial nerves also can be affected, which can make your face weak, eyelids droop, or make it hard to swallow. In the most severe cases, AFM can cause trouble breathing and may require ventilator support.

“This disorder presents just like paralytic polio used to present back in the 1940s,” says Patterson, who’s also a Mayo Clinic professor of neurology, pediatrics, and medical genetics. “This is another form of polio, and I think that people have not used the term because of the tremendous emotional significance.”

This year, the third outbreak of AFM is still underway. Such outbreaks have arrived every 2 years since 2014, and the CDC’s current tally includes nearly 400 confirmed cases over the past 4 years. The federal health agency acknowledges that gathering data about AFM is a relatively new process, and that may make it difficult to interpret and compare what they’ve learned from each outbreak.

The number of cases likely will rise as health agencies investigate and confirm potential cases, a process that can take lots of time.

“The CDC is very careful in taking time to identify cases, and there may be a jump in the number as cases go through the verification process,” says Kevin Messacar, MD, a pediatrician at Children’s Hospital Colorado who specializes in infectious diseases. As an assistant professor at the University of Colorado School of Medicine, he has seen 12 children with AFM since spring.

“Our situation here in Colorado is unique because our outbreak has been ongoing since March, while it has started elsewhere in the summer months,” says Messacar.

The disorder itself is not new, says Patterson, as similar but isolated cases have been reported over the years. “But I think it was the fact that it was a cluster that first drew attention to this in 2014.”

Viruses a Possible Trigger

Many AFM cases have been linked to enteroviruses. Such viruses are not uncommon. In fact, the CDC estimates they cause as many as 15 million infections each year and tens of thousands of hospitalizations. But most infections cause only mild symptoms, such as gastrointestinal upsets, cold-like discomfort, and fever. Sometimes, they cause no symptoms at all. But some experts suspect that the viruses somehow trigger AFM in a very small number of people, most of them children.

Children are quite vulnerable to viruses, says Messacar, because they do not have fully developed immune systems. So their bodies can’t combat infection as successfully as adults. But AFM can strike adults whose immune systems don’t work well, such as those being treated for cancer.

The symptoms of AFM arrive suddenly, usually within a week of being ill with a virus. An arm or a leg, for example, becomes weak or can’t be moved at all. In study findings presented at scientific meetings this year though not yet published, about 70% of kids with AFM have more than one affected limb.

To diagnose AFM, doctors will use magnetic resonance imaging (MRI) of the patient’s spinal cord for signs of inflammation. They may also perform a spinal tap to allow them to examine the spinal fluid for signs of the illness.

In addition to making a positive diagnosis of AFM, doctors also aim to find its cause.

“If we’re lucky, we can identify a virus,” says Patterson, “but there are many cases where you can’t positively identify a specific virus or other cause.”

Currently, no drug treatment exists to counter AFM’s attack on the nervous system. And, says Roberta L. DeBiasi, MD, a single drug may not be enough.

“It’s important to keep in mind that not all AFM is linked to … enteroviruses,” says DeBiasi, who heads the Division of Infectious Diseases at Children’s National Health System in Washington, D.C. “So, even if one specific treatment works for some patients, it may not necessarily represent a potential treatment for all AFM.”

Muscle Therapy a Key Treatment

aims to strengthen the muscles around the areas affected by the disease.

“If a child has weakness in a limb,” says Patterson, “one of the most important things we can do is get one of our occupational or physical therapy colleagues involved as soon as the child is well enough to participate.”

That kind of therapy requires a lot of hard work.

“At centers experienced in working with children affected by AFM, treatment often means weeks or months of intensive therapy done on a daily basis,” says Messacar.

And even that may not be adequate, he continues: “The vast majority of cases are left with residual weakness and in some cases complete paralysis of the affected areas.”

For those children, surgery may be needed to help them regain their abilities. Los Angeles-based surgeon Mitchel Seruya, MD, has performed a complex procedure called a nerve transfer on 15 children with AFM. His patients come from all over the country: Wisconsin, New Mexico, Texas, Minnesota, and elsewhere.

During the procedure, the surgeon reroutes a nerve from elsewhere in the body to take over the work of the nerve affected by AFM. For example, if AFM has caused weakness in a child’s shoulder and elbow but not in the hand or forearm, Seruya, an assistant professor of clinical surgery, can work with the healthy nearby nerves.

“If I want the elbow to move, I am going to steal a wrist flexor, meaning I’m going steal something that makes your wrist bend and divert it to your elbow,” says Seruya, who’s also director of the Brachial Plexus and Peripheral Nerve Center at Children’s Hospital Los Angeles.

The repairs get much more complicated if the whole arm has been paralyzed. In such cases, the nerves most often used are those involved in breathing, located near the sternum.

“That nerve has to span the chest and reach underneath the armpit to connect it to the arm itself,” Seruya says.

Researchers Look at Role of Genes

One of the key questions that needs to be answered is why some children — keep in mind, it’s a very small number — get AFM and most others don’t. For example, if an entire family or, say, a classroom gets exposed to an enterovirus, why doesn’t everyone get AFM? Researchers at Johns Hopkins University in Baltimore suspect that genetics may play a role. They are comparing the genetic makeup of children with AFM to see what they might have in common. And in families, they are also looking for genetic differences between family members who remained healthy and the child diagnosed with AFM.

“We hope this helps us to understand susceptibility to AFM,” says Priya Duggal, PhD, director of the genetic epidemiology program at the Johns Hopkins Bloomberg School of Public Health. “No doubt that this is not going away — we keep seeing it — and we need to better understand how to diagnose AFM, how to treat it, and what factors are causing it … or we will watch more kids become paralyzed.”

Since there’s no vaccine or drug treatment, the CDC’s prevention guidelines follow standard but effective advice for cutting the chances of getting or spreading a virus: Wash your hands often. Getting vaccinated for poliovirus may also offer protection. Finally, use mosquito repellent and other means of preventing mosquito bites, which can spread West Nile virus, another virus associated with AFM.

DeBiasi of Children’s in Washington wants parents to be vigilant but also to keep in mind that AFM is quite rare. It occurs in about one in 1 million children.

“If your child presents with weakness in one or more limbs, drooping facial features, like eyelids, seek care immediately,” she stresses, “particularly if your child has just had an upper respiratory infection or fever.”

Sources

Roberta L. DeBiasi, MD, director, Division of Infectious Diseases, Children’s National Health System, Washington, D.C.

Priya Duggal, PhD, director, genetic epidemiology program, Johns Hopkins Bloomberg School of Public Health, Baltimore.

Kevin Messacar, MD, pediatrician and infectious diseases specialist, Children’s Hospital Colorado; assistant professor, University of Colorado School of Medicine.

Nancy Messonnier, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases

Marc Patterson, MD, professor of neurology, pediatrics, and medical genetics, and chairman of the division of Child and Adolescent Neurology, Mayo Clinic, Rochester, MN.

Mitchel Seruya, MD, assistant professor of clinical surgery and director of the Brachial Plexus and Peripheral Nerve Center, Children’s Hospital Los Angeles.

CDC: “About Acute Flaccid Myelitis.”

CDC: “AFM Investigation.”

Minnesota Department of Health: “Acute Flaccid Myelitis (AFM).”

© 2018 WebMD, LLC. All rights reserved.


WebMD Health

How to Keep Foodborne Illness at Bay

SATURDAY, Aug. 4, 2018 — When you’re having a barbecue or picnic, be sure you don’t invite foodborne illnesses caused by salmonella bacteria.

Each year in the United States, salmonella causes about 1.2 million illnesses and 23,000 hospitalizations, according to the U.S. Centers for Disease Control and Prevention.

Salmonella contamination can occur in many foods, including melons, cucumbers, chicken, eggs, raw tuna and sprouts, the Association for Professionals in Infection Control and Epidemiology (APIC) warns.

Salmonella-caused illness (salmonellosis) is most common during the summer months because of warm temperatures, delayed refrigeration and the types of foods people enjoy in the summer.

APIC suggests a number of ways to reduce the risk of salmonellosis:

  • Prevent cross-contamination by always washing your hands after handling raw meat.
  • Keep kitchen surfaces and utensils clean.
  • Wash fruits and vegetables before you cut or peel them. Use a scrub brush to reduce contaminants on the rough skin of foods like cantaloupe.
  • Use separate cutting boards and knives for uncooked meats and uncooked produce.
  • Keep hot foods hot and cold foods cold.
  • Cook food to recommended internal temperatures: whole meats 145 degrees Fahrenheit (F), ground meats 160 degrees F, and poultry 165 degrees F.
  • Refrigerate perishable food (including melon) within two hours. Throw away food that sits out longer than two hours.

Call a health care provider if you think you or someone else has salmonellosis. The symptoms include: diarrhea and a fever over 101.5 degrees F; dehydration; bloody stools; diarrhea that lasts three or more days; prolonged vomiting without being able to keep liquids down.

More information

The U.S. Centers for Disease Control and Prevention has more on salmonella.

© 2018 HealthDay. All rights reserved.

Posted: August 2018

More News Resources

Drugs.com – Daily MedNews

Report: Dog Illness Can Spread to Humans

By Dennis Thompson

HealthDay Reporter

WEDNESDAY, July 11, 2018 (HealthDay News) — A bacteria carried by dogs that haven’t been neutered can produce flu symptoms in humans and potentially jeopardize a pregnancy, a new study suggests.

Brucellosis infection is most commonly spread by livestock like sheep, cattle, goats and pigs.

But a strain of the bacterium carried by dogs — Brucella canis — could be widespread in humans, warned lead researcher Martha Hensel, a veterinarian with Texas A&M University.

“We don’t really know how prevalent this disease is in the United States,” Hensel said. “The information we have to draw conclusions on the public health risk is outdated, to say the least — something like 30 to 40 years old.”

B. canis is carried by dogs that can still reproduce, Hensel noted. It’s not clear exactly how the bacteria might spread to humans, but it’s most likely passed through contact with reproductive organs or urine.

People who regularly handle such dogs — vets, dog shelter employees, dog breeders — are most at risk for contracting brucellosis, Hensel said.

However, pet ownership is a likely risk factor for infection, particularly for young children and people with compromised immune systems, Hensel and her colleagues explained.

The researchers highlighted some case studies:

  • A 3-year-old New York City girl came down with brucellosis in 2012 after exposure to an infected puppy recently purchased from a pet store.
  • Several people with HIV have developed brucellosis in recent years, all linked to intact dogs they owned that were later diagnosed with B. canis infection.

“An average, healthy adult would probably not contract this disease unless they were exposed to a really high concentration of bacteria,” Hensel said.

Brucellosis primarily causes symptoms similar to the flu — fever, sweats, fatigue, headache and muscle pain, according to the U.S. Centers for Disease Control and Prevention.

The disease also can cause long-term or recurring symptoms, such as arthritis, swelling of the testicles, swelling of the heart, neurologic symptoms and chronic fatigue, the agency noted.

Brucellosis can also mean trouble for a pregnancy, said Dr. Amesh Adalja, a senior scholar with the Johns Hopkins Center for Health Security.

Continued

“Though brucellosis is a common cause of animal [miscarriages], it is also linked to fetal problems in women who are pregnant when they contract it — though at a lesser degree than with other animal species,” Adalja explained. “The diminished role is due to the lack of a specific compound produced in human placenta [erythritol] as well as anti-brucella activity in human amniotic fluid.”

The CDC recommends that pregnant women talk with their doctor if they’ve been exposed to brucellosis, saying that a short course of antibiotics could be “lifesaving for the fetus.”

Hensel and her colleagues suggested that better diagnostic tools should be developed to help determine the prevalence of B. canis in both dogs and humans.

“At this point, we don’t know what the incidence in the United States is, and how many dogs are carrying this bacteria,” Hensel said. “We would like to put that out there for clinicians to think about, in terms of the risk of transmission from dogs to people.”

The new study was published online July 11 in the journal Emerging Infectious Diseases.

WebMD News from HealthDay

Sources

SOURCES: Martha Hensel, DVM, Texas A&M University, College Station, Texas; Amesh Adalja, M.D., senior scholar, Johns Hopkins Center for Health Security, Baltimore; July 11, 2018,Emerging Infectious Diseases, online

Copyright © 2013-2018 HealthDay. All rights reserved.

WebMD Health

Report Warns of Dog Illness That Can Spread to Owners

WEDNESDAY, July 11, 2018 — A bacteria carried by dogs that haven’t been neutered can produce flu symptoms in humans and potentially jeopardize a pregnancy, a new study suggests.

Brucellosis infection is most commonly spread by livestock like sheep, cattle, goats and pigs.

But a strain of the bacterium carried by dogs — Brucella canis — could be widespread in humans, warned lead researcher Martha Hensel, a veterinarian with Texas A&M University.

“We don’t really know how prevalent this disease is in the United States,” Hensel said. “The information we have to draw conclusions on the public health risk is outdated, to say the least — something like 30 to 40 years old.”

B. canis is carried by dogs that can still reproduce, Hensel noted. It’s not clear exactly how the bacteria might spread to humans, but it’s most likely passed through contact with reproductive organs or urine.

People who regularly handle such dogs — vets, dog shelter employees, dog breeders — are most at risk for contracting brucellosis, Hensel said.

However, pet ownership is a likely risk factor for infection, particularly for young children and people with compromised immune systems, Hensel and her colleagues explained.

The researchers highlighted some case studies:

  • A 3-year-old New York City girl came down with brucellosis in 2012 after exposure to an infected puppy recently purchased from a pet store.
  • Several people with HIV have developed brucellosis in recent years, all linked to intact dogs they owned that were later diagnosed with B. canis infection.

“An average, healthy adult would probably not contract this disease unless they were exposed to a really high concentration of bacteria,” Hensel said.

Brucellosis primarily causes symptoms similar to the flu — fever, sweats, fatigue, headache and muscle pain, according to the U.S. Centers for Disease Control and Prevention.

The disease also can cause long-term or recurring symptoms, such as arthritis, swelling of the testicles, swelling of the heart, neurologic symptoms and chronic fatigue, the agency noted.

Brucellosis can also mean trouble for a pregnancy, said Dr. Amesh Adalja, a senior scholar with the Johns Hopkins Center for Health Security.

“Though brucellosis is a common cause of animal [miscarriages], it is also linked to fetal problems in women who are pregnant when they contract it — though at a lesser degree than with other animal species,” Adalja explained. “The diminished role is due to the lack of a specific compound produced in human placenta [erythritol] as well as anti-brucella activity in human amniotic fluid.”

The CDC recommends that pregnant women talk with their doctor if they’ve been exposed to brucellosis, saying that a short course of antibiotics could be “lifesaving for the fetus.”

Hensel and her colleagues suggested that better diagnostic tools should be developed to help determine the prevalence of B. canis in both dogs and humans.

“At this point, we don’t know what the incidence in the United States is, and how many dogs are carrying this bacteria,” Hensel said. “We would like to put that out there for clinicians to think about, in terms of the risk of transmission from dogs to people.”

The new study was published online July 11 in the journal Emerging Infectious Diseases.

More information

The U.S. Centers for Disease Control and Prevention has more about brucellosis.

© 2018 HealthDay. All rights reserved.

Posted: July 2018

Drugs.com – Daily MedNews

July Is Peak Time for Illness From Feces in Pools

By E.J. Mundell

HealthDay Reporter

THURSDAY, June 28, 2018 (HealthDay News) — Is it safe to go in the water this summer? Not if microscopic germs like E. coli or cryptosporidium are swimming in the pool with you, U.S. health officials warn.

“These germs make people sick when they swallow water contaminated with poop,” the U.S. Centers for Disease Control and Prevention stated frankly in a news release on Thursday.

The statement accompanied a new report on 140 outbreaks of “untreated recreational water” that sickened nearly 5,000 people and killed two between 2000 and 2014 in the United States.

Many of these cases were traced to fecal matter released into pools by children or adults who weren’t following proper hygiene precautions, said a team led by preventive medicine researcher Michele Hlavsa, of Emory University in Atlanta.

About one-third of the cases occurred in public parks, and another third at public beaches, the report found. And July was the peak month — 58 percent began in that month.

The way a pool or local beach usually gets contaminated isn’t pretty.

“Swimmers can be a source of fecal contamination if they have a fecal incident in the water or fecal material washes off their bodies,” the researchers explained.

Dr. Robert Glatter is an emergency physician at Lenox Hill Hospital in New York City who’s seen the effects of severe gastrointestinal illnesses firsthand.

“If you develop fever, diarrhea, abdominal pain or vomiting after swimming in a lake or untreated water, it’s important to see your doctor or be treated in the emergency department,” he said. In the new report, 87 percent of illnesses were traced to bugs such as E. coli, cryptosporidium, norovirus and Shigella — all of which can be present in feces.

“Water that enters the nose while swimming in warm freshwater can place you at risk for not only diarrhea and enteritis, but parasitic and fungal infections that can spread to the brain and sinuses,” Glatter warned.

In fact, the two deaths noted in the report were linked to Naegleria fowleri, the so-called “brain-eating amoeba” that can grow in warm freshwater. Cases are very rare, but the disease is often quickly fatal.

Continued

“Wearing a nose clip or simply keeping your head above water may be helpful if you swim in lakes, rivers or areas of untreated water,” Glatter said. “Try to avoid swallowing water, since this may lead to bacterial, viral and parasitic infections. The only sure way to prevent an infection from Naegleria fowleri due to swimming is to avoid water-related activities in warm freshwater lakes or rivers.”

A small fraction of the outbreaks noted in the new report were spurred by “toxins or chemicals” — usually toxins emitted by harmful “algae blooms.” Would-be swimmers can often get a heads-up about those issues, however.

“It’s vital to obey any posted advisories in which beaches are closed for swimming,” Glatter said. Also stay away from any water that looks discolored, foamy or has a foul smell.

Of course, the best way everyone can keep water-safe this summer is to pitch in for prevention.

“If you are sick with diarrhea, stay out of the water, since swallowed water may contain enteric pathogens that can result in nausea, vomiting and diarrhea,” Glatter said.

According to the study team, parents must be especially vigilant.

That’s because outbreaks were most likely at pools or beaches “frequented by children under 5 years with no or limited toileting skills [and] without adequate, easily accessible and well-stocked hygienic facilities,” such as toilets or diaper-changing stations.

Dr. Nicole Berwald is interim chair of emergency medicine at Staten Island University Hospital in New York City. She stressed that for the millions of Americans who flock to beaches and pools this summer, the water is fine.

“These recreational activities are usually performed without hazardous outcomes,” she said. “With that said, swimmers should be aware of potential health risks so they can enjoy the summer months while protecting themselves.”

The new report was published June 29 in the CDC’s Morbidity and Mortality Weekly Report.

WebMD News from HealthDay

Sources

SOURCES: Robert Glatter, M.D., emergency physician, Lenox Hill Hospital, New York City; Nicole Berwald, M.D., interim chair, emergency medicine, Staten Island University Hospital, New York City; June 29, 2018,Morbidity and Mortality Weekly Report

Copyright © 2013-2018 HealthDay. All rights reserved.

WebMD Health