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A dispatch from the front lines of acute flaccid myelitis

T o parents and the press, the "new" disease that is paralyzing kids is a mystery. Media coverage of acute…

T o parents and the press, the “new” disease that is paralyzing kids is a mystery. Media coverage of acute flaccid myelitis (AFM), which causes sudden limb weakness and paralysis in children, has given families the impression that healthcare providers and public health officials are sitting quietly and helplessly, flummoxed in the face of a disease that threatens children’s health .

That just is not so.

Parents have a right to be concerned about this illness. But they should also know that AFM is weird, a one-in-a-million event. It does not spread within families, hospitals, or towns. Selv om en virus kaldet enterovirus D68, sammen med andre virus som forårsager respiratorisk og diarré sygdom, har været forbundet med sygdommen, en enkelt definitive årsag er endnu ikke blevet identificeret.

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Progress has been made on multiple fronts since 201

4 when acute flaccid Myelitis first emerged in news headlines and the public awareness. In the clinical arena, multidisciplinary and multicenter collaborations have been tapping the collective wisdom of experts in infectious disease, neurology, neuroradiology, and rehabilitation, leading to the development of best practices for clinical care. Epidemiologic and research data on the disease are being shared across centers to optimize and standardize the approach to how children affected by this condition are cared for at any center across the country.

At Children’s National Health System in Washington, DC, where we Work, specialized programs have long been in place to fight emerging infections and neuroinflammatory disorders. Bowel of these are relevant to acute flaccid myelitis due to its association with viruses and the nerve inflammation it causes. Takket være vårt program og lignende programmer på stedet hos andre pædiatriske medicinske centre, beviser-baserede, standardiserede kliniske baner nu vejledende evalueringen og behandlingen af ​​hvert barn som er antaget at have akut flaccid myelitis.

As with other types of brain and spinal cord skader, de bedste resultaterne kommer ofte med tidlig mobilisering, så rehabilitering begynder tidligt, selv om et barn med AFM er i intensivvæsenet. Pediatric physical therapists are trained to make children with weak limbs feel like they are champions, whether they are infants, toddlers, or older children.

On the epidemiological and public health fronts, the Centers for Disease Control and Prevention has standardized and publicized case definitions so children with AFM can be identified. And the CDC recently announced a new task force on acute flaccid myelitis.

Multiple medical centers and surveillance networks have begun more intense and broad efforts to look at patterns of specific respiratory and diarrhea virus circulation in communities and have initiated targeted viral surveillance to detect spikes in frequency that may be associated with a subsequent spike in AFM cases.

On the scientific front, investigators have applied advanced molecular techniques, including whole exome genetic sequencing, to better understand enterovirus D68, as well as to exclude other agents that may contribute to AFM.

Investigators have also successfully developed laboratory and animal models of acute flaccid myelitis that closely mimic the human disease. These preclinical models provide a deeper understanding of how AFM injures the spinal cord and has helped identify potential treatment targets. Researchers are also screening off-the-shelf drugs and compounds that may work for these targets, and have already tested and reported on the safety and effectiveness of promising treatments.

Our health system has established a research biobank for blood and spinal fluid samples from children with neuroinflammatory diseases. Studying these specimens could lead to discoveries about AFM and new insights into how it affects individuals. Via een uniek onderzoeks partnership tussen Children’s National and the National Institute of Allergy and Infectious Diseases, we are engineering antiviral treatments tailored to the individual patient that target the exact virus he or she has been infected with. That approach can be lifesaving in potentially fatal viral infections among patients with defects in their immune systems. In de toekomst kan deze gerichte celtherapie technologie mogelijk worden toegepast op virussen die het nerveuze systeem, inclusief enterovirussen, targeten en deactiveren.

De eerste polio-epidemie in de U.S. began in 1894; Franklin Delano Roosevelt got polio in 1921; Dr. Jonas Salk gave his vaccine to his family in 1953; and the vaccine developed by Dr. Albert Sabin was licensed in 1960. That’s a span of 66 years. Sabin’s highly effective and routinely used polio vaccine is often underappreciated for its essential role in safeguarding health and preventing a disease that paralyzed up to 20,000 children a year in the pre-vaccination era.

With modern techniques and multi-center collaborations, we Håper at tiden for at løse akut flaccid myelitt vil være mye kortere enn det var for polio. But it will not happen overnight. Physicians and scientists need public and governmental support to speed progress. To effectively contend with AFM – and the next emerging infectious disease – the nation needs to enhance and intensify existing surveillance networks for viral diseases, expand laboratory investigation models to determine how disease occurs and how to treat it, and help major pediatric hospital networks share data , conduct clinical trials, and optimize care.

Even when all of that is happening, clinicians in our program and similar ones at other pediatric centers throughout the country apply continually updated information to guide a standardized approach to evaluate and treat children with acute flaccid myelitis and help them achieve the best chance of full recovery.

Roberta L. DeBiasi MD, Chief of the Division of Pediatric Infectious Diseases, Elizabeth M. Wells, MD, is medical director of the neurosciences unit , and Jessica Carpenter, MD, is associate professor of pediatrics and neurology, all at Children’s National Health System in Wa shington, D.C.

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