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.

Nasal Coronavirus Vaccines May Work Better Than Injected Ones, Researchers Say - The New York Times

Posted: 14 Jul 2020 12:00 AM PDT

Of the 150-plus coronavirus vaccines in development around the world, the lion's share will rely on a needle prick to make their way into the body.

Most vaccines throughout history have been jabbed into the upper arm, often to great success. But when protecting people against pathogens that invade the airway — like the coronavirus — an intramuscular shot isn't necessarily the best strategy, some experts say.

"When we take apart and present pathogens in a way that the immune system doesn't naturally see them, it's not as ideal," said Avery August, an immunologist at Cornell University. "You run the risk of not generating the right immune response."

Many microbes, including the coronavirus, enter the body through the mucosa — wet, squishy tissues that line the nose, mouth, lungs and digestive tract — triggering a unique immune response from cells and molecules there. Intramuscular vaccines generally do a poor job of eliciting this mucosal response, and must instead rely on immune cells mobilized from elsewhere in the body flocking to the site of infection.

Given the potency and rapid spread of the coronavirus, some say it makes sense to develop vaccines for the airway as well as the more standard jabs. "Knowing how potent mucosal responses can be against a viral pathogen, it would be ideal to be thinking about mucosal vaccines," said Akiko Iwasaki, an immunologist at Yale University.

Several research groups, including teams in the United States, Canada and the Netherlands, are working on nasal coronavirus vaccines. And a few companies, including the American biotech Vaxart, are starting to cook up oral formulations, which deliver their contents to another mucus-rich surface: the spongy lining of the gut.

Updated 2020-07-28T16:28:36.182Z

The hope is that mucosal vaccines will do all that their intramuscular competitors can and more, mounting a multipronged attack on the coronavirus from the moment it tries to breach the body's barriers, said Deepta Bhattacharya, an immunologist at the University of Arizona.

Under ideal circumstances, both types of vaccines would marshal a response in the blood. B cells, for example, would churn out antibodies — including a particularly potent disease-fighter called IgG — to roam the body in search of invaders to dispatch. Other cells, called T cells, would either help B cells produce antibodies or seek out and destroy infected cells.

But vaccines spritzed through the nose or mouth would also tap into another set of immune cells that hang around mucosal tissues. The B cells that reside here can make another type of antibody, called IgA, that plays a large role in bringing gut and airway pathogens to heel. And T cells in this neighborhood can memorize the features of specific pathogens, then spend the rest of their lives patrolling the places they first encountered them.

These mucosal immune responses seem to underlie the success of the oral polio vaccine, which contains a weakened form of polio virus and has helped most of the world eradicate polio. When it debuted in the 1960s, the vaccine was considered, in many ways, an enormous improvement over its injected predecessor because it targeted the body's immune response in the gut, where the virus thrives. Many people who took the oral vaccine seemed to quash infections even before they felt symptoms — or passed the germ on to others.

"It was a fabulous vaccine to stop the transmission of polio," said Dr. Anna Durbin, a vaccine expert at Johns Hopkins University. "It helped induce herd immunity," she said, referring to the threshold of the population that needs to be immune to a pathogen to keep it from spreading.

Vaccines given through muscle are great for prompting the body to churn out antibodies in the bloodstream, like IgG. If a pathogen shows up, hordes of these on-call molecules will rush to meet it.

For many respiratory infections, that's good enough.

"The majority of respiratory vaccines, like the measles vaccine, are given intramuscularly, and it works," Dr. Iwasaki said. "If enough antibodies reach the right mucosal surface, it doesn't really matter how they were induced."

Still, relying on that strategy alone can be risky — a bit like shoring up a bank's security at every entrance except for the one a thief would most likely hit. Sentinels roving throughout the building could subdue the interloper after they trip the alarm. But by that point, some damage has probably already been done.

"It's mainly a timing issue," Dr. Bhattacharya said. "If you have circulating cells and molecules, they'll eventually find the infection. But you'd rather have a more immediate response."

Without a strong mucosal response, injected vaccines may be less likely to produce so-called sterilizing immunity, a phenomenon in which a pathogen is purged from the body before it's able to infect cells, Dr. Durbin said. Vaccinated people might be protected from severe disease, but could still be infected, experience mild symptoms and occasionally pass small quantities of the germ onto others.

Reliably rousing mucosal immunity isn't easy, however — and vaccines that specifically target them come with their own drawbacks. Although FluMist, a nasal spray vaccine containing weakened flu viruses, has been shown to be more effective than flu shots in young children, its performance is more lackluster in adults. And the oral polio vaccine has been linked to a very small number of cases of polio after the weakened virus in the product mutated.

Designing a mucosal vaccine with less risky ingredients, such as inactivated viruses or genetic material, could circumvent that issue. But these more innocuous formulations could be too weak to stimulate a long-lasting immune response.

"You want the vaccine to be strong enough to get in and do what it needs to do, but it can't cause a lot of symptoms," Dr. Durbin said. "It's a really difficult balance."

Much of mucosal immunity also remains mysterious to researchers. "A lot of what we know about the rest of the immune system kind of goes out the window when we're talking about a mucosal site," said Dr. Frances Eun-Hyung Lee, a physician and immunologist at the Emory Vaccine Center. There are also fewer tried-and-true technologies for developing nasal and oral vaccines, compared with injectables.

All these factors can introduce speed bumps in the vaccine-development timeline, as researchers work to ensure both safety and effectiveness, Dr. August said. That means mucosal recipes might not be among the first generation of coronavirus vaccines. But perhaps that's all the more reason to invest in them earlier, he said.

[Like the Science Times page on Facebook. | Sign up for the Science Times newsletter.]