Doctors hope social distancing will limit a rare polio-like disease in children - STAT

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• Doctors hope social distancing will limit a rare polio-like disease in children - STAT
• Children’s ‘polio-like’ illness may return in August. But a new treatment will cost millions to test. - The Philadelphia Inquirer
• Michigan confirms first 2020 case of rare ‘polio-like’ illness in Macomb County child - WDIV ClickOnDetroit
• Will 2020 see a spike in AFM cases? Social distancing could have an impact, CDC says - CNN
• COVID-19 vaccine researchers draw on knowledge from history's 'huge disasters' and success stories - ABC News

Doctors hope social distancing will limit a rare polio-like disease in children - STAT Posted: 17 Jul 2020 12:00 AM PDT If the pattern from recent history holds, starting next month, doctors in the U.S. will begin seeing a spike in cases of a polio-like condition in children that leaves them with muscle weakness, paralysis, and, in the most severe cases, trouble breathing. But 2020, if you haven't noticed, is not your average year. Now, experts are waiting to see what will happen this go-around with the condition, called acute flaccid myelitis, or AFM. They've witnessed bursts of cases in the late summer and fall of 2014, 2016, and 2018, but they're wondering if AFM, which is thought to be a rare result of a common viral infection, might be influenced by all the distancing measures put in place to slow the coronavirus pandemic. advertisement That is, efforts to cut down on the spread of the coronavirus might have the same effect on the virus believed to lead to AFM. "That's an idea that very well may play out," said Matthew Vogt, a pediatric infectious disease specialist at University of North Carolina at Chapel Hill. "And all of us who pay attention to AFM are watching that." advertisement It's not clear that will happen, and experts are urging clinicians to be on the lookout for children with muscle weakness or slow reflexes. AFM progresses quickly once symptoms start, and getting children to specialists quickly can improve outcomes. And as people have started emerging from shelter-at-home policies in the past few months, it's possible that the virus that thought to lead to AFM, EV-D68, is rebounding, just as circulation of SARS-CoV-2, which causes Covid-19, has resurged. "I'm uncertain what kind of impact social distancing practices are going to have on EV-D68," said Megan Culler Freeman, a pediatric infectious disease specialist at Children's Hospital of Pittsburgh. EV-D68 is a respiratory virus and, as recent research has found, the primary suspect behind the bulk of AFM cases. (Other viruses, including EV-A71, are thought to cause AFM as well.) It's part of the enterovirus family (hence the EV) and, for most people, causes only colds or asthma-like symptoms. But in 2014, doctors noticed a surge of polio-like illnesses in children, a pattern that has repeated every two years since. Since the Centers for Disease Control and Prevention started tracking AFM in 2014, there have been 630 confirmed cases. (Doctors have since looked at earlier years and retrospectively identified AFM cases, and there are a small number of cases in off years as well. The increasing numbers could be a result of both AFM becoming more common for some reason and of better detection and reporting practices.) Scientists have traced the potential cause to EV-D68, finding evidence of an immune response to the virus in patients' spinal fluid. But it's still not clear whether the damage to nerves in the spinal cord that leads to the movement problems is caused by the virus itself, an aberrant immune response to the viral infection, or some combination of the two. Freeman said she leaned toward the immune system as the culprit. Kids who develop AFM typically do so about a week after experiencing cold symptoms, which means it's "probably driven by the person, not a difference in the virus." CDC But researchers are not sure why such a small number of children develop AFM — perhaps fewer than 1% of those infected — given how widely EV-D68 circulates during its season. Researchers are looking into patients' genes and their health histories for clues. "We don't have a strong handle on why the kids who get AFM, why are they the unfortunate ones?" Vogt said. The every-other-year AFM clusters correspond to the levels of circulating EV-D68, which remain low during the off periods and then rise ahead of the spike in AFM cases. It's possible that people infected by the virus one year develop some protection that lasts long enough to prevent a surge the next year — like a short-term form of herd immunity — but not long enough to stave off another surge in two years. It's still too early to know whether EV-D68 levels are going to increase this year as they have in past even-numbered years, and if the physical distancing policies Americans have been embracing to various extents since March will have an effect. Surveillance data indicate that enterovirus levels collapsed in March as shelter-at-home policies went into effect, though not as much as those of other viruses, such as influenza. Enteroviruses also seemed to pick up more quickly than other viruses in June and July as states lifted their lockdown restrictions. AFM shares some similarities to another condition researchers have started seeing in some children with Covid-19. Called multisystem inflammatory syndrome in children, or MIS-C, it involves severe inflammation affecting multiple organ systems and typically appears two to four weeks after a Covid-19 case. (It's also a rare consequence of Covid-19; children generally have mild cases compared to adults, particularly the elderly.) Both AFM and MIS-C could be the result of an overactive immune system persisting after an acute viral infection, and both seem largely limited to children. But there are key differences: While AFM, for example, involves the nervous system, MIS-C largely affects the heart and blood vessels. "The idea that they both could be aberrant immune responses to otherwise common viruses, that's a possibility," Vogt said.

Children’s ‘polio-like’ illness may return in August. But a new treatment will cost millions to test. - The Philadelphia Inquirer Posted: 03 Jul 2020 12:00 AM PDT For AFM, which strikes a small fraction of the number infected with COVID, $10 million to $15 million would be needed to test the antibody in human patients and scale up production for clinical use, said James E. Crowe Jr., director of the Vanderbilt Vaccine Center and senior author of the new study. That is a pittance compared with the spending on COVID, yet the funds remain elusive.

Michigan confirms first 2020 case of rare ‘polio-like’ illness in Macomb County child - WDIV ClickOnDetroit Posted: 27 Jul 2020 09:09 AM PDT DETROIT – Michigan has confirmed its first case of acute flaccid myelitis (AFM) in 2020, a rare condition that attacks the nervous system, specifically in children. The Michigan Department of Health and Human Service (MDHHS) confirmed the first case in a child in Macomb County. Two others possible cases are being monitored. As of June 30, the CDC had confirmed 13 cases of AFM in 10 states for 2020, mostly in children. Despite increases in cases across the country since 2014, the CDC estimates that less than one to two in a million children in the United States will get AFM annually. In 2018, Michigan reported five cases and one case in 2019. "AFM is a rare but serious condition affecting the nervous system and can cause the muscles and reflexes in the body to become weak," said Dr. Joneigh Khaldun, chief medical executive and chief deputy for health. "Most patients report having a mild respiratory illness or fever consistent with a viral infection before developing AFM." The cause or trigger for AFM is not yet known. However, most children had a respiratory illness or fever consistent with a viral infection before they developed AFM. You can decrease risk of getting viral infections by: Washing your hands often with soap and water. Avoiding touching your face with unwashed hands. Avoiding close contact with people who are sick. Healthcare providers are asked to report all patients they suspect of having AFM to their local health department. More on AFM: This information is from the CDC: Acute flaccid myelitis (AFM) is an uncommon but serious neurologic condition. It affects the nervous system, specifically the area of the spinal cord called gray matter, which causes the muscles and reflexes in the body to become weak. We have seen increases in AFM cases in the U.S. every other year starting in 2014. Most AFM cases (more than 90%) have been in young children. You may hear AFM referred to as a "polio-like" condition, but all the stool specimens from AFM patients that we received tested negative for poliovirus. The cases of AFM since 2014 are not caused by poliovirus. Sudden onset of arm or leg weakness, loss of muscle tone, and loss of reflexes are the most common symptoms. Treatment There is no specific treatment for AFM, but a clinician who specializes in treating brain and spinal cord illnesses (neurologist) may recommend certain interventions on a case-by-case basis. For example, neurologists may recommend physical or occupational therapy to help with arm or leg weakness caused by AFM. Physical rehabilitation might improve long-term outcomes if implemented during the initial phase of illness. CDC is working closely with national experts to better understand how to treat AFM and will update our clinical management considerations with new information when available. We are also working to understand the long-term outcomes (prognosis) of people with AFM. How does it spread? AFM affects mainly children and is not believed to be contagious. It may be a rare complication following a viral infection, and environmental and genetic factors may also contribute to its development. 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.

Will 2020 see a spike in AFM cases? Social distancing could have an impact, CDC says - CNN Posted: 21 Jul 2020 04:22 PM PDT [unable to retrieve full-text content]Will 2020 see a spike in AFM cases? Social distancing could have an impact, CDC says  CNN

COVID-19 vaccine researchers draw on knowledge from history's 'huge disasters' and success stories - ABC News Posted: 14 Jul 2020 12:00 AM PDT A post-coronavirus world depends on a vaccine. Without it, there's no returning to "normal life" anytime soon. Fortunately, scientists working on a COVID-19 vaccine have decades of scientific knowledge and technological advancements on their side. While vaccines usually take years or even decades to develop, after early breakthroughs some medical experts believed this one might be available in 12 to 18 months. Now, months later, human trials are even underway. What can the failures and successes of past vaccine research tell us about the challenges ahead? The first vaccines The military has largely driven the past century of vaccine research, says Arthur Allen, the author of Vaccine: The Controversial Story of Medicine's Greatest Lifesaver. "After the last great pandemic … which was the 1918-19 flu pandemic, the US military and other militaries around the world saw infectious disease as a threat to their forces," he tells ABC RN's Rear Vision. The Spanish flu outbreak killed about 50 million people worldwide.(Getty: PhotoQuest) "During World War I, there was an attempt to make a flu vaccine which was a total failure. They didn't know what flu was," Mr Allen says. By World War II researchers were beginning to understand what viruses were and laboratories across the US were enlisted to make vaccines for illnesses like Japanese encephalitis and typhus. But one of the most important breakthroughs was still to come. What can polio research teach us? People in the early 20th century feared polio because of its ability to cause paralysis, especially in children. Vaccines expert Andrew Artenstein says many people who contracted polio either had mild symptoms or no symptoms. Driven by fear more children would become paralysed by polio, the US funded further vaccine research.(Getty: Kirn Vintage Stock) "It was extraordinarily scary. It seemed to be a random event [when it paralysed a child]," he says. "It didn't discriminate socioeconomically, so affluent children could become paralysed, just like poor children." Professor Artenstein says researchers spent decades studying the disease but they were only just learning about how viruses worked. By 1938, a non-government philanthropic foundation called the March of Dimes brought together businesspeople and politicians to sell the public the idea that polio needed to be eradicated using a vaccine. Private and government money sponsored scientists' work. The key event in the fight against polio came in the late 1940s when three Harvard scientists were able to culture the virus in the laboratory. "When they were able to culture the virus … [scientists could] grow enough virus to actually inject it into animals and start to figure out the immune response," Professor Artenstein says. Five years later in 1954, Jonas Salk announced the first positive results of a vaccine. Jonas Salk inoculates a young boy with the polio vaccine.(Getty: Al Fenn/The LIFE Picture Collection) But it wasn't a five-year race for a vaccine, it was decades in the making. "That was two decades of work that underpinned a vaccine before they could even get to the point where they could test it in humans in a broad scale enough to announce and see that it was safe and effective," Professor Artenstein says. Have there been setbacks? Arthur Allen says along with the breakthroughs of the early vaccines came some "huge disasters". During World War II a yellow fever vaccine developed by the US was contaminated with Hepatitis B. Listen to Rear Vision Would you volunteer to be a human guinea pig in a clinical trial for COVID-19 vaccine? Learn more about the history and ethics of human clinical trials. Read more "About 10 per cent of the soldiers who were vaccinated against yellow fever actually got Hepatitis B and were flat on their butts for weeks at a time. There were also some deaths," Mr Allen says. Professor Artenstein says an early polio vaccine was contaminated with live virus — causing 40,000 cases of polio, leaving 200 children with varying degrees of paralysis and 10 dead. What can we take away from HIV research? Not every search for a vaccine has been successful. Medical historian Professor Howard Markel says attempts to create an HIV vaccine have failed because "the HIV virus is so darn crafty". The virus still kills. About 300 to 400 people die of AIDS every hour. Many of the deaths are in developing nations in Africa. "[It's] very difficult to create a vaccine against it," he tells RN's Saturday Extra. While a vaccine is still eluding researchers, they have produced a number of treatments to manage HIV.(Getty: Marco Longari) But he says the pharmaceutical industry has been very successful at coming up with antiretroviral drugs to keep the virus at a negligible level in a patient's blood. Washington University's Michael Kinch agrees, saying researchers have learnt a "tremendous amount" about diagnostics, genetic tests and antiviral drugs through their work on HIV. Which coronavirus vaccine will win the race? The clues are in the vial Hanging out for a coronavirus vaccine? Here's your three best hopes — and why they could be dashed. Read more "HIV was such an overwhelming and widely distributed pandemic itself, and it's still going 40 years after it was first reported in 1981," Dr Kinch says. "It has not been solved, but it's become a chronic illness rather than a death sentence for most people." How the SARS setback gives us a 'jumpstart' for COVID-19 SARS, which first appeared in 2002, is a distant cousin of the new coronavirus. Scientists abandoned their SARS research after a small group of vaccinated animals became sicker when infected with the virus than unvaccinated animals. Professor Artenstein says the setback "kind of stopped enthusiasm" for the SARS vaccine. "We were very fortunate with SARS that the infection died out before we actually needed a vaccine." SARS changed the way of life for millions of people in the early 2000s.(Getty: Christian Keenan) But Dr Kinch says the link between the viruses gives researchers a "jumpstart in some of the vaccine science" and background work. There are more than 200 teams around the world researching the COVID-19 virus. Companies are dusting off old models and ideas and are comparing them against the current genetic sequence of this virus. It also means they have libraries of possible treatments and possible vaccine candidates. Dr Kinch says "if we're lucky" a COVID-19 vaccine won't take seven years because there's a "tremendous amount of focus" in laboratories and researchers have decades of scientific knowledge to build on. Listen to the podcast Rear Vision puts contemporary events in their historical context, answering the question: "How did it come to this?" Read more "We've learned a lot about vaccines. Even though we haven't had success with HIV, there's been a lot of science," Dr Kinch says. He also says technology is on our side. "The other thing you need to remember is it's 2020," he says. "Compared to 1940 when they were working on trying to learn about the polio virus in the laboratory, our technology is much more advanced. "It's been 80 years of advances." But while he's hopeful of a breakthrough, Dr Kinch warns an 18-month goal to produce a safe vaccine and immunise most of the world's population is "very optimistic". Say we find a vaccine — then what? Professor Markel says "it's a matter of time" before a coronavirus vaccine is discovered. "As citizens of the world we will have to roll up our sleeves and get this, probably on an annual basis, just like we have to get our influenza vaccines," he says. More stories from Rear Vision: Professor Artenstein warns a large-scale vaccination effort would be challenging because most countries have a limited capacity to mass produce a new vaccine. "Most of the capacity we have for making vaccines at the moment is being used to make the conventional vaccines that we use all the time," he says. He says production plants and production lines will need to be built. Dr Kinch says other challenges include producing enough vials and other equipment to move the vaccine around. "Even if today we had those seven-and-a-half billion vials full of vaccine and ready to go, it takes a lot of coordination to immunise seven-and-a-half billion people." 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