Posted in children, Health, news

US Braces for New Wave of Polio-Like Illness

As August approaches, the CDC is asking health care professionals to be on the lookout and report any suspected cases of AFM (Acute Flaccid Myelitis), a paralyzing illness resembling polio, as cases may peak during this time.

Last year a total of 233 cases were confirmed in 41 states.  This year 11 have been reported and an additional 57 cases are being investigated.  Cases have been reported in California, Maryland, Nebraska, North Carolina, Pennsylvania, Texas, Utah and West Virginia this year.

 

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Image above from CDC

Last year, California, Colorado and Texas appeared to be the worst hit with 15, 16 and 31  cases respectively.  Experts are urging states to report any cases of suspected AFM as the above map could be an under-representation of true numbers.

On their website, the CDC reports the following:

  • Most of the patients with AFM (more than 90%) had a mild respiratory illness or fever consistent with a viral infection before they developed AFM.
    • Viral infections such as from enteroviruses are common, especially in children, and most people recover. We don’t know why a small number of people develop AFM, while most others recover. We are continuing to investigate this.
  • These AFM cases are not caused by poliovirus; all the stool specimens from AFM patients that we received tested negative for poliovirus.
  • We detected coxsackievirus A16, EV-A71, and EV-D68 in the spinal fluid of four of 570 confirmed cases of AFM since 2014, which points to the cause of those patients’ AFM. For all other patients, no pathogen (germ) has been detected in their spinal fluid to confirm a cause.
  • Most patients had onset of AFM between August and October, with increases in AFM cases every two years since 2014. At this same time of year, many viruses commonly circulate, including enteroviruses, and will be temporally associated with AFM.
  • Most AFM cases are children (over 90%) and have occurred in 48 states and DC.

 

The “48 states” refers to cases since 2014.   90% of the cases occurred in children under the age of 4.

The age range of children affected appear to be 3-14.  A 6-year-old boy in Washington State died in 2016 and was the first death to be linked to this mysterious illness.  His parents reported he had felt ill, became dizzy and within hours suffered swelling in the brain and paralysis.  Despite medical efforts, he passed.

In 2018 parents of two children who died from AFM accused the CDC of hiding their deaths.

Although the exact cause of AFM is unknown, health experts are considering a variety of possibilities. They have actually been investigating this since 2014 when reports of AFM began to surface across the United States.

What is AFM?

AFM stands for Acute Flaccid Myelitis.  It’s a condition that occurs suddenly, causing inflammation of the brain and spinal cord, causing loss of muscle tone and reflexes.  Although limb weakness is the primary symptom, patients could also exhibit slurred speech, facial drooping, and in serious cases inability to breath due to paralysis of the respiratory muscles.  Mild cases appear to resolve but serious cases can cause residual paralysis or death. Children appear to be more affected than adults.

What causes AFM?

Although health officials do not know for certain, due to its rapid onset, a pathogen such as a virus seems highly likely.  With the 2013-2014 outbreak, some of the cases tested positive for enterovirus (EV-D68), but it is not conclusive whether this was the exact cause or just coincidentally found in the patients tested.

Some postulate a combination of viruses may be a factor or an autoimmune disease.  Although Guillain-Barre syndrome causes acute limb weakness and paralysis when the immune system begins attacking the nervous system, the report that many individuals feel feverish or ill prior, seem to point to a pathogen as the primary cause although the latter is not being ruled out.  Virus families such as enterovirus (including polio and nonpolio enterovirus), adenovirus (causing respiratory and GI illness) cocksackieviruses and flaviviruses (including West Nile) have been suspected.

How common is AFM?

Per the CDC, acute flaccid myelitis is rare (less than 1 in a million cases) however currently they report 570 cases have been confirmed since the outbreak began in August 2014.

How is it diagnosed?

Medical professionals look at a variety of factors.

History: how the paralysis/loss of muscle tone began and which limbs did it affect first

Laboratory tests and CSF (cerebrospinal fluid) testing: to look for signs of infection

MRI of the brain: which may show gray matter involvement in a case of AFM.

Is there a treatment?

There is no standard treatment that has been proven effective, however depending on the severity of the symptoms, health professionals can consider a variety of options including steroids, IVIG, interferon, antivirals and supportive measures.  Some physicians are using “nerve transfers”, similar to a transplant, to help children regain control of their limbs.

Is there a vaccine?

No.  Until they can identify the exact cause, or causes, health officials cannot create a vaccine.

How does one avoid getting AFM?

If we assume it’s a pathogen causing the illness, avoiding contact with sick individuals, being up-to-date on one’s vaccines and good hand-washing are imperative.  Although we do not know if AFM is caused by a mosquito-born illness, avoiding mosquitoes would be wise as well.   More therefore needs to be researched to determine why and how those individuals with AFM were infected.

 

spanish book

Learning Medical Spanish is Easy!!!

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in Health, news

Nerve “Transfer” May Help Those Paralyzed by Polio-like Illness, AFM

An 8 year-old boy who was paralyzed when he developed Acute Flaccid Myelitis (AFM) is now able to walk again due to a new surgery that “transfers” healthy nerves to limbs who lost their neurological function.

Brandon Noblitt of Greenville, South Carolina, lost use of his lower extremities in 2016, a week into him having cold like symptoms.

Amy Moore, MD, plastic and reconstructive surgeon Washington University in St. Louis was able to perform a nerve transplant, taken from his arm, and one year later, Brandon can walk again.

 

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He uses a wheelchair to play basketball but can play football and play with his friends.

The surgery has better success if done within 9 months of the illness.

This rare polio-like illness is startling health officials as cases of AFM are popping up throughout the US.

Since August 2014, the CDC has received reports on 404 cases, 72 of which were from this year alone.

Multiple states who have reported cases of children diagnosed with AFM, which may manifest initially with cold type symptoms but then progress to sudden muscle weakness, stiffness, slurred speech and facial droop.

The age range of children affected appear to be 3-14.  A 6-year-old boy in Washington State died in 2016 and was the first death to be linked to this mysterious illness.  His parents reported he had felt ill, became dizzy and within hours suffered swelling in the brain and paralysis.  Despite medical efforts, he passed.  Although the exact cause is unknown, health experts are considering a variety of possibilities. They have actually been investigating this since 2014 when reports of AFM began to surface across the United States.

What is AFM?

AFM stands for Acute Flaccid Myelitis.  It’s a condition that occurs suddenly, causing inflammation of the brain and spinal cord, causing loss of muscle tone and reflexes.  Although limb weakness is the primary symptom, patients could also exhibit slurred speech, facial drooping, and in serious cases inability to breath due to paralysis of the respiratory muscles.  Mild cases appear to resolve but serious cases can cause residual paralysis or death. Children appear to be more affected than adults.

What causes AFM?

Although health officials do not know for certain, due to its rapid onset, a pathogen such as a virus seems highly likely.  With the 2013-2014 outbreak, some of the cases tested positive for enterovirus (EV-D68), but it is not conclusive whether this was the exact cause or just coincidentally found in the patients tested.

Some postulate a combination of viruses may be a factor or an autoimmune disease.  Although Guillain-Barre syndrome causes acute limb weakness and paralysis when the immune system begins attacking the nervous system, the report that many individuals feel feverish or ill prior, seem to point to a pathogen as the primary cause although the latter is not being ruled out.  Virus families such as enterovirus (including polio and nonpolio enterovirus), adenovirus (causing respiratory and GI illness) and flaviviruses (including West Nile) have been suspected.

How common is AFM?

Per the CDC, acute flaccid myelitis is rare (less than 1 in a million cases) however currently they report 362 people affected in currently 16 states (down from 39 states in 2016). CNN reports, however, as of mid October “most” states are affected.

How is it diagnosed?

Medical professionals look at a variety of factors.

History: how the paralysis/loss of muscle tone began and which limbs did it affect first

Laboratory tests and CSF (cerebrospinal fluid) testing: to look for signs of infection

MRI of the brain: which may show gray matter involvement in a case of AFM.

Is there a treatment?

There is no standard treatment that has been proven effective, however depending on the severity of the symptoms, health professionals can consider a variety of options including steroids, IVIG, interferon, antivirals and supportive measures.  Some physicians are using “nerve transfers”, similar to a transplant, to help children regain control of their limbs.

Is there a vaccine?

No.  Until they can identify the exact cause, or causes, health officials cannot create a vaccine.

How does one avoid getting AFM?

If we assume its a pathogen causing the illness, avoiding contact with sick individuals, being up-to-date on one’s vaccines and good hand-washing are imperative.  Although we do not know if AFM is caused by a mosquito-born illness, avoiding mosquitoes would be wise as well.   More therefore needs to be researched to determine why and how those individuals with AFM were infected.

 

dw sketch.jpg

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

Posted in Health, news

Case of PrEP Failure Reported in California Man

A man from San Francisco is apparently the 6th reported case of HIV (Human Immunodeficiency Virus) acquired while taking Truvada, the pre-exposure prophylactic agent.

He’s the third man in the United States who acquired the sexually transmitted virus while taking Truvada as directed.

 

What is PrEP?

PrEP stands for Pre-Exposure Prophylaxis, meaning a treatment taken prior to becoming exposed.  Truvada is PrEP providing protection for those who may become exposed to HIV.

It is composed of two medications:  200 mg emtricitabine and 300 mg tenofovir disoproxil fumarate.

It is taken once daily in pill form.

 

How does PrEP protect against getting HIV?

HIV infects T-cells, or T-Lymphocytes which help fight infection in the human body.

448523-b40db4493269414ce8806eaa4b89bc0e.png

Once it infects a healthy T-cell, the virus hijack’s the host’s “machinery” to produce more HIV infected cells using an enzyme called reverse transcriptase.

Truvada’s two medications interfere with this enzyme, preventing HIV from infecting more cells and using their DNA to expand.

 

How effective is PrEP?

Per the CDC, Truvada can provide at least 90% protection and more if combined with condoms and other prevention methods.

 

How does PrEP fail?

If one does not take their prescription regularly it may not provide its full protection.  Moreover PrEP can fail if a strain of HIV shows resistance to the medication.

Those who take PrEP cannot currently have HIV or severe renal disease.  Moreover we screen for liver disease and active hepatitis prior to starting the medication.

PrEP has been groudbreaking in HIV prevention and “failure” cases such as this are extremely rare.  However it does remind us that HIV can develop resistance, hence no medication is 100% effective all of the time.

For more on this story read here.

For more on PrEP read here.

 

dw sketch.jpg

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

 

 

 

 

 

Posted in Health, news

Close the Toilet Lid When you Flush

Back in microbiology class we learned to “flush and run” after using the toilet.

Sneeze-Effect-300x212

Now its starting to catch on.  Media outlets have reported on studies that have shown how aerosolized microbes can contaminate surfaces nearby. And for those of us who leave our toothbrush on the counter….gross.

Fox News reports pathogens including Shigella, Salmonella, and norovirus can be in high concentrations in feces and vomit, transmitted to users when the “plume” is formed during flushing.  They write:

According to a 2013 review of studies published by the American Journal of Infection Control, it’s clear that flushing your toilet with the lid wide open can pose potential risks. The specific act is called “toilet plume aerosols,” which occurs during flushing. When the toilet contains feces or vomit, the flush can produce potentially infectious aerosols that will live in your bathroom for hours.

Li et al last summer investigated toilet flushing systems and their effect on spewing microbes. They reported:

..in all flushing conditions the emission strength of S. epidermidis was greatest, followed by E. coli and then P. alcaligenes.
This paper also highlights the need for greater concern over the transmission via toilet flushing of aerosols containing pathogenic organisms, which poses particular for the immunocompromised, children and the elderly. Finally, our findings also imply that a cistern tank design is preferable to a flushometer design with respect to aerosol generation.

Pathogens can live on inanimate objects such as surface counters for extended periods of time.  The following is a list of bacteria and viruses and their documented survival time outside of a host.

 

3042980_Table-1-Pathogen-survival-times-on-dry-surfaces

Closing the lid can protect bathroom goers and storing dental utensils in closed cabinets will lessen exposure.

toothbrush

Moreover how many times have we dropped things into the open toilet?  And I wouldn’t trust the 5 second rule on that one if your sandwich gets submerged….

 

dw sketch.jpg

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

 

 

 

 

Posted in Health, Hepatitis, news

Ohio Joins Multiple States in Declaring Hepatitis A Outbreak

Since 2017 multiple states have declared outbreaks of the Hepatitis A Virus and now the Department of Heath in Ohio (ODH) has declared one as well.

Since the start of 2018, cases in Ohio have risen to 79, double the total number recorded for 2017 in the Buckeye state.

hepatitis A

Image from Cleveland.com

 

WTOL reports: Ohio’s hepatitis A outbreak cases appear to be primarily among people who use illegal drugs, those who have been incarcerated, people who have had contact with known cases, those also infected with hepatitis C, men who have sex with men, and people experiencing homelessness.

Per the CDC, the below states have reported the following number of cases:

  • California 704  (as of April 11, 2018)
  • Indiana 148  (as of June 21, 2018)
  • Kentucky 760
  • Michigan 846
  • Missouri 125
  • Utah 109 (2018) and 147 (2017)
  • West Virginia  248
  • Arkansas 40 since February, 2018

Last year Colorado reported a doubling of Hepatitis A cases since the previous year.

What is Hepatitis A?

Hepatitis A is a disease that affects the liver.  Its caused by a virus (Hepatitis A virus) that is most commonly ingested. Poor hand washing and/or contaminated food are likely culprits.  It’s transmitted by the fecal-oral route, where food or drink contaminated by fecal matter enters another person’s GI tract.  Sexual transmission of Hepatitis A has been reported during activities involving oral-anal sex.

Hepatitis A can live outside the body for months, so unclean dining areas can be contaminated and transfer to food.

Those who are immunosuppressed run the risk of dying from the infection.

 

What are the symptoms of Hepatitis A?

Symptoms of Hepatitis A include:

Jaundice – yellowing of the skin and eyes

Fever

Abdominal Pain

Fatigue

Dark Urine

Joint Pain

Clay – looking stools

Diarrhea

Nausea

Vomiting

Loss of appetite

Hepatitis-A.jpg

 

What is the treatment for Hepatitis A?

There is no specific treatment for hepatitis A.  Most hepatitis A infections resolve on their own.

We usually recommend rest, fluids, and offer medications to help with nausea and vomiting.

For liver injury we avoid medications and alcohol that can worsen liver damage. The liver will usually recover within months after hepatitis A infection.

There are vaccines for Hepatitis A included in the childhood vaccination schedule.  Those older who weren’t vaccinated as a child can get the vaccine from their local provider or health department.  Many states require all health care and food workers to be vaccinated.

The best form of prevention however is good hand washing, dining area hygiene, and cooking food thoroughly.

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

Posted in flu, Health, news

Australia Bracing for Flu Season, What it Means for the US

Australia, being in the Southern Hemisphere, faces its flu season months before we do.  Flu cases started to rise in May, peak in August, and then subside as their temperatures warm in November and December.

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Our flu season begins conversely in late fall ends in June.

US manufacturers use Australia’s flu season as a barometer of how our flu season will go in terms of virulence and vaccination efficacy.

A recent poll by finder.com.au found half of Australian’s surveyed (sample of 2,003), will refuse to get the flu shot in fear of it not being effective or believing it will make them sick.  That projects to 9.5 million people not choosing vaccination. Generation X’ers seem to be more wary of the vaccine than Baby Boomers.

Last year’s flu season for both Australia and the US was the most severe since the 2009 H1N1 pandemic.  The most predominant strain was H3N2, which is highly virulent, mutable, and therefore shifty when it comes to trying to tie it down to make an efficacious vaccine.  Numbers of flu-related deaths were much higher and the flu shot appeared to only offer 30% protection at most.

In Australia, the Department of Health has already tallied 12,281 cases of flu (according to http://www.isg.org.au) in 2018 which is 19% higher than this time last year.

So if 1/2 of those at risk fail to get vaccinated what does that mean for the US?

Less virus, less virulence

The flu virus comes in many strains.  The virus needs a host to multiple and propagate.  If fewer people choose vaccination which provides protection against three strains (trivalent vaccine) or four strains (quadrivalent vaccine), the virus has more reservoirs thus allowing easier spread and strength.  One vaccinated, even if with a 30% effective vaccine, still has some protection and may thwart a virus from setting up shop in their body.  So less virus, less virulence.

The more infected, the higher resistance

If more of the population harbors an illness, many will attempt to treat themselves or rush to get antivirals.  Improper use of antivirals, such as Tamiflu, could spurn resistance to the drug. We don’t have many antivirals to choose from during flu season so the less we need to use one the better in terms of salvaging its efficacy.

More myths get spread

Every year I hear “I won’t get the flu shot ever again because it gave me the flu”……Does this really happen??  Can you get the flu from the flu shot?

The answer is “No”, but the topic is definitely worth dissecting.

Firstly, the flu shot is made up of an “inactivated virus”.  A nice way of saying a “killed virus”.  Although the nasal spray version of the flu shot is a watered down, weakened version of the virus, the flu shot does not have active virus in it.  So technically one cannot get the flu.  Rarely someone could have an allergic reaction to the shot and scientists are investigating the incidence of neurological conditions such as Guillain-Barré and narcolepsy. Again these are rare and would not feel like “the flu.”

But, some may insist they “came down with the flu” after receiving the flu shot.  Why?

For one thing, many are getting the flu shot too late.  Influenza starts to circulate in one’s  neck of the woods and many are exposed before the shot gets a chance to prime one’s immune system.

Secondly, the flu shot is not 100% effective.  The average efficacy of the flu shot is approx. 60% but can be better in certain populations.   Moreover the flu shot usually protects against 3 or 4 strains of the flu.  One could be exposed to a strain of the flu that was not in this year’s flu shot, hence coming down with the “flu” after receiving the flu shot.

Finally, what could be occurring is, the flu shot starts to work by inducing one’s immune system to recognize the flu and this activation of the immune system makes one feel some of the symptoms of the flu.

So for those fearful of getting the flu shot, education is needed to quell their fears and stop viral spread of not only the virus but misconceptions that could be deadly.

If Australia is headed for a severe flu season, then so will we….

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

 

 

 

 

 

 

 

Posted in Health, news

Warning of “Disease X” outbreak. What is it?

The World Health Organization (WHO) has issued a list of diseases that could potentially become worldwide deadly epidemics, and “Disease X” is included in this list.

The list includes the following:

  • Zika
  • Ebola
  • Lassa Fever
  • SARS
  • MESS
  • CCHF (Crimean-Congo) hemorrhagic fever
  • Nipah/henipaviral
  • and Disease X.

Disease X represents a pathogen, not yet identified, that could turn and become one of the worst threats yet.

Citing biochemical warfare, gene editing, or Mother Nature’s ability to induce mutations, the WHO believes a benign pathogen that’s currently circulating could jump from animal hosts to humans, or evolve to become a highly virulent, infectious bug.

So the next “Disease X” could be:

  • a deadlier strain of flu
  • multiple drug resistant gonorrhea
  • an avian flu that jump from birds to humans
  • a bio-weapon such as release of anthrax

 

This warning helps remind the globe of the unpredictability and speed at which new epidemics arise.

WHO stated, “Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease.”

Moreover, diseases such as Zika and Ebola were discovered decades ago, but only recently did they cause fast-moving epidemics, despite smaller sporadic outbreaks in the past.  So a currently deadly virus or bacteria that causes isolated cases, if the conditions are right, can ignite a cluster, expand locally in an outbreak, or increase further and become an epidemic.

And humans lack natural immunity to chemical agents and man-made pathogens, hence can be easily overpowered when exposed for the first time.

The formal designation of Disease X will hopefully incite researchers to prepare for what could be a surprise ambush by something that’s been either under our radar for some time or about to be created.

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network and Board Certified Family Physician