CDC/ACIP [to 20 Oct 2018 ]

CDC/ACIP [to 20 Oct 2018 ]

Tuesday, October 16, 2018
Transcript for CDC Update on Acute Flaccid Myelitis (AFM)
NANCY MESSONNIER: Thank you. Good afternoon and thank you for joining us today to talk about acute flaccid myelitis or AFM. Today I want to update you on CDC’s work on AFM including what we know and what we don’t know about the condition and advice for clinicians and parents. AFM is a rare, but serious condition that affects the nervous system. It specifically affects the area of spinal cord called gray matter and causes muscles and reflexes to become weak. We know this can be frightening for parents. I know many parents want to know what the signs and symptoms are that they should be looking for in their child. I encourage parents to seek medical care right away if you or your child develop sudden weakness or loss of muscle tone in the arms or legs.

CDC has been actively investigating AFM, testing specimens and monitoring disease since 2014 when we first saw an increase in cases. The number of cases reported in this time period in 2018 is similar to what was reported in the fall of 2014 and 2016. Since 2014, most of the AFM cases have been among children. In 2018 so far, CDC has received reports of 127 patients under investigation or PUIs; 62 cases have been confirmed as AFM (in 22 states) –edited for clarity. CDC and state and local health departments are still investigating some of these PUIs. Of the confirmed cases, the average age is about 4 years old. More than 90 percent of the cases are in children age 18 years and younger. We plan to post updated PUI and AFM counts on our website this afternoon.

Going forward, we will report updated case counts on our website every Monday afternoon. We expect that the case count may vary from week to week as our experts work with local and state health departments to investigate their PUIs. Based on previous years, most AFM cases occur in the late summer and fall. The data we are reporting today is a substantially larger number than in previous months this year. CDC recently received increased reports for patients suspected to have AFM with an onset of symptoms in August and September. With enhanced efforts working with state and local health departments and hospitals we were able to confirm a number of these cases faster. Also, CDC is now providing a number of patients still under investigation or PUIs, so people can better investigate increases in confirmed cases over the coming months.

We understand that people particularly parents are concerned about AFM. Right now, we know that poliovirus is not the cause of these AFM cases. CDC has tested every stool specimen from the AFM patients, none of the specimens have tested positive for the poliovirus. AFM can be caused by other viruses, such as enterovirus and west nile virus, environmental toxins and a condition where the body’s immune system attacks and destroys body tissue that it mistakes for foreign material. While we know that these can cause AFM, we have not been able to find a cause for the majority of these AFM cases. The reason why we don’t know about AFM — and I am frustrated that despite all of our efforts we haven’t been able to identify the cause of this mystery illness — we continue to investigate to better understand the clinical picture of AFM cases, risk factors and possible causes of the increase in cases.

Despite extensive laboratory testing, we have not determined what pathogen or immune response caused the arm or leg weakness and paralysis in most patients. We don’t know who may be at higher risk for developing AFM or the reasons why they may be at higher risk. We don’t fully understand the long-term consequences of AFM. We know that some patients diagnosed with AFM have recovered quickly and some continue to have paralysis and require ongoing care. And we know of one death in 2017 in a child that had AFM. For health care professionals, we have developed a provider tool kit that contains information on AFM and instructions for reporting PUIs to the health department. CDC’s website has information for families with patients with AFM, links to important resources and a section for health care providers. We will continue to post updates on our website.

As a parent myself, I understand what it is like to be scared for your child. Parents need to know that AFM is very rare, even with the increase in cases that we are seeing now. We recommend seeking medical care right away if you or your child develop sudden weakness of the arms or legs. As we work to better understand what is causing AFM, parents can help protect their children from serious diseases by following prevention steps like washing their hands, staying up to date on recommended immunizations and using insect repellent. While I am concerned about the increase in cases, I want folks to know this work is core to CDC’s mission to protect America from health threats. Thank you and we are happy to take any questions…

ACIP – October 2018 Draft Meeting Agenda

October 24-25, 2018
MMWR News Synopsis for October 18, 2018

West Nile Virus and Other Nationally Notifiable Arboviral Diseases — United States, 2017
Arboviral diseases (viruses spread to people by mosquitoes and ticks) cause severe illness in the United States each year. Public health surveillance is important to identify outbreaks and guide prevention strategies. This article summarizes surveillance data for arboviruses reported to CDC for 2017. West Nile virus is the most common arbovirus in the continental United States. Eastern equine encephalitis virus transmission via organ transplantation was reported for the first time. La Crosse virus was the most common arbovirus among children. More Jamestown Canyon and Powassan virus cases were reported in 2017 than in any previous year. Communities can prevent arboviral diseases by implementing vector control measures and screening blood donations. Individuals can protect themselves by using insect repellent, wearing long-sleeved shirts and long pants, using air conditioning when available, putting screens on windows and doors, and repairing screens to keep mosquitoes outside.

Mumps Outbreak in a Marshallese Community — Denver Metropolitan Area, Colorado, 2016–2017
Mumps is a serious viral infection that can be prevented by routine vaccination. People living or working in tight-knit networks, such as schools and athletic teams, are vulnerable to mumps outbreaks. Protect yourself and your community with the measles-mumps-rubella (MMR) vaccine. An outbreak of mumps occurred in the small Marshallese community in Denver, Colorado in 2017, likely linked to a larger, concurrent mumps outbreak in the Marshallese community in Arkansas. Mumps can be prevented by the MMR vaccine. Most patients in this outbreak did not have documentation of prior MMR vaccination. Rapid public health response to the outbreak included vaccinating 164 people during MMR vaccination clinics for the affected community, which might have limited spread of mumps to other local communities.

HIV Preexposure Prophylaxis, by Race and Ethnicity — United States, 2014–2016
Preexposure prophylaxis (PrEP) use is increasing, but it is still not reaching many of the Americans who could most benefit from it. Use ofPrEP, a daily pill to prevent HIV, is increasing, but not fast enough. A new CDC analysis found that between 2014 and 2016 the number of Americans who filled a prescription for PrEP increased by 470 percent, from nearly 14,000 to over 78,000 people. Still, this represents a small fraction of the estimated 1.1 million Americans who could benefit from PrEP. Uptake among racial and ethnic minorities is particularly low. While African Americans and Latinos represent approximately 44 percent and 26 percent of Americans who could benefit from PrEP, this study found they represent just 11 percent and 13 percent, respectively, of Americans prescribed PrEP in 2016. Addressing gaps in PrEP awareness and use is critical to stopping new HIV infections in the U.S