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Senator Klobuchar presses for answers on mysterious paralyzing disease

U.S. Senator Amy Klobuchar
U.S. Senator Amy Klobuchar

Health officials still can't say what is causing it.

Posted: Nov 13, 2018 2:25 PM
Updated: Nov 13, 2018 2:28 PM

NEW YORK (AP) — More children have been diagnosed with a mysterious paralyzing illness in recent weeks, and U.S. health officials said Tuesday that they still aren't sure what's causing it.

This year's count could surpass the tallies seen in similar outbreaks in 2014 and 2016, officials said. Fortunately, the disease remains rare: This year, there have been 90 cases spread among 27 states, the Centers for Disease Control and Prevention said.

It's not clear what's causing some children to lose the ability to move their face, neck, back, arms or legs. The symptoms tend to occur about a week after the children had a fever and respiratory illness.

Health officials call the condition acute flaccid myelitis. No one has died from it this year, but CDC officials say at least half the patients do not recover from the paralysis and some have serious complications.

Polio and West Nile virus have been ruled out. Doctors have suspected the cause might be some kind of enterovirus, which in most people causes cold symptoms. But CDC officials say that's not clear.

The first mysterious wave of paralysis cases in 2014 coincided with a wider spike in illnesses connected to an enterovirus called EV-D68, CDC officials said. But there was no such spike during the waves in 2016 or this year.

There's also a lack of clinical evidence: CDC officials have checked the spinal fluid of about three-quarters of the 90 patients, and found EV-68 in only one. Another type of enterovirus called EV-A71 was found in only one other patient.

But there are questions about that, too. If a virus is the cause, it's possible the test is not good enough, or the germ left the spinal fluid by the time the tests were taken, said the CDC's Dr. Nancy Messonnier. It's also possible the culprit is hiding elsewhere in the body.

Or perhaps the paralyzing illnesses are caused by some new germ for which no lab test has been developed. Or maybe there's some predisposing factor in some patients that cause their immune systems to react so severely to a germ or other trigger that the immune response causes paralysis, CDC officials said.

On Tuesday, Minnesota Senator Amy Klobuchar released the following letter she sent to CDC Director Robert Redfield:

“Dear Director Redfield:”

“I write to express my ongoing concern about the continuing rise in the number of children suffering from acute flaccid myelitis (AFM), and to request an update on the Centers for Disease Control and Prevention's (CDC) progress in working to identify the etiology of AFM and issuing updated clinical guidelines for treatment.”

“While I appreciate your response to my previous letters and willingness to provide staff briefings, important questions remain regarding the CDC's efforts to address the 80 cases of AFM that have now been confirmed in 25 states. Accordingly, I respectfully request answers to the following additional questions:”

“1. The CDC has identified many possible causes of AFM. Is there an update as to whether the CDC has identified a common etiology for the confirmed cases of AFM?”

“2. Which states have reported cases of AFM, and what is the breakdown of cases for each state? Do you have any other information as to the geographic areas that have been more affected by AFM? Which states mandate reporting of potential AFM cases to the CDC? Do these or other states only require AFM reporting if an illness is first identified as an outbreak by state and local health departments or other state authorities?”

“3. Concerns have been raised that AFM may be under-reported. Does the CDC have a view as to whether incidences of AFM are currently being under-reported? If so, what factors contribute to the potential incidence of under-reporting?”

“4. Is the CDC working with scientific experts to consolidate the existing research on AFM from various universities and other research institutions in an effort to provide both the families of those affected by AFM and clinicians the most updated information?”

“a. When will the CDC issue updated clinical guidance on the treatment of AFM?”

“b. I understand that you recently expressed support for the establishment of a task force to assess and respond to the recent increase in AFM cases. What would be the benefits of a task force like the one you described, and has the CDC taken action to establish such a task force? If not, would the CDC need additional authority, funding, or resources to convene a task force?”

“5. A child who became paralyzed from AFM recently underwent an innovative surgery that established connections between newly transferred nerves and the affected muscles, ultimately enabling the child to walk again. Has the CDC studied the safety and efficacy of the procedure for potential use in treating other former AFM cases? What diagnostics and other tools are the CDC and other agencies exploring to enable the earlier detection of AFM and potentially minimize the impact of the condition once it is discovered?”

“6. Does the CDC have an estimate of the overall financial burden of AFM to a family with a child who develops the condition and requires long-term health care services?”

“Thank you for your continued work to ensure that vulnerable young patients battling AFM and their families have hope for the future. I look forward to your response.”

Klobuchar previously sent a letter on this subject to the CDC in October and was joined days later by fellow Minnesota Senator Tina Smith and Iowa Senators Chuck Grassley and Joni Ernst in pressing for more information.

About 120 cases of AFM were confirmed in 2014, the first time such a wave occurred. Another 149 were reported in 2016. In 2015 and 2017, the counts were far lower, and it's not clear why.

The illnesses have spiked in September each year there's been a wave and tailed off significantly by November. But it can take weeks to determine which cases should be counted in the outbreak. More than 160 cases are still being investigated, and some of those may join the count, CDC officials said.

Minnesota Coronavirus Cases

Data is updated nightly.

Cases: 450762

Reported Deaths: 6079
CountyCasesDeaths
Hennepin935111486
Ramsey40220742
Dakota33243348
Anoka31118366
Washington20282231
Stearns17957188
St. Louis13777244
Scott1203597
Wright11688106
Olmsted1062075
Sherburne823966
Carver698338
Clay654681
Rice613969
Kandiyohi555772
Blue Earth544833
Crow Wing486877
Otter Tail459367
Chisago455036
Benton421587
Winona391948
Douglas376666
Nobles372446
Mower369429
Goodhue351259
Polk330059
McLeod326546
Beltrami313248
Morrison312945
Lyon303338
Becker286939
Itasca285943
Isanti283241
Carlton282243
Steele275810
Pine267814
Freeborn249523
Todd232530
Nicollet226437
Brown215834
Mille Lacs214745
Le Sueur211716
Cass208424
Meeker200633
Waseca190716
Wabasha17293
Martin171326
Roseau166117
Hubbard149938
Redwood140627
Houston139014
Renville137840
Dodge13624
Chippewa131732
Cottonwood127818
Fillmore12535
Wadena120417
Rock110612
Sibley10897
Aitkin108533
Faribault107416
Watonwan10678
Pennington100315
Kanabec98018
Pipestone95523
Yellow Medicine93916
Murray8995
Jackson86310
Swift83818
Pope7425
Marshall70315
Stevens7038
Clearwater68614
Lac qui Parle65716
Lake65615
Wilkin6299
Koochiching59910
Lincoln4892
Big Stone4663
Unassigned43968
Grant4298
Norman4248
Mahnomen4137
Kittson37220
Red Lake3184
Traverse2553
Lake of the Woods1951
Cook1150

Iowa Coronavirus Cases

Data is updated nightly.

Cases: 308737

Reported Deaths: 4391
CountyCasesDeaths
Polk46313460
Linn17916278
Scott15694167
Black Hawk13964242
Woodbury13064179
Johnson1220051
Dubuque11504157
Pottawattamie9086114
Dallas901872
Story875536
Webster470677
Cerro Gordo469972
Sioux458757
Clinton455065
Warren452039
Marshall429262
Buena Vista395230
Muscatine393078
Des Moines389243
Plymouth352269
Wapello347598
Jasper328559
Lee321132
Marion307252
Jones272949
Henry265831
Carroll257434
Bremer248048
Crawford233124
Washington221333
Boone221017
Benton210950
Mahaska196337
Jackson193931
Tama189559
Dickinson188129
Kossuth177744
Delaware174736
Clay170721
Wright166024
Fayette164123
Buchanan161023
Hamilton161030
Winneshiek159120
Harrison157362
Hardin156130
Cedar154419
Clayton153049
Butler149824
Page145415
Floyd140536
Cherokee139527
Mills138016
Lyon137033
Poweshiek134124
Hancock130824
Allamakee130029
Iowa126722
Calhoun12309
Grundy121927
Jefferson121625
Madison12169
Winnebago120829
Mitchell116436
Louisa115530
Cass114743
Chickasaw113312
Appanoose111540
Emmet111232
Sac111215
Union110223
Humboldt105819
Shelby104027
Guthrie103624
Franklin103118
Unassigned10000
Palo Alto91411
Montgomery87224
Keokuk85826
Howard84819
Monroe81419
Clarke8017
Pocahontas77811
Ida75430
Davis69721
Greene6977
Adair69320
Lucas6619
Monona65017
Osceola64510
Worth6154
Taylor5969
Fremont5206
Van Buren49914
Decatur4944
Ringgold44611
Audubon4188
Wayne41721
Adams2983
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