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October 10, 2018

Rare, polio-like illness affects 6 children in Minnesota

Daily Briefing

    Since mid-September, six children in Minnesota have been hospitalized with acute flaccid myelitis (AFM) —a polio-like disease that's so rare, the state typically sees less than one case a year, Minnesota health officials said Monday.

    The case for improving coordination between behavioral health and pediatrics

    What is AFM?

    According to the CDC, AFM mainly affects children. The disease targets the spinal cord and can lead to muscle weakness and paralysis. Other symptoms of the disease include difficulty swallowing and slurred speech. In some rare cases, the disease can lead to extremity pain, respiratory failure, and sometimes death.

    CDC began tracking cases of AFM in 2014, and since then, 362 cases have been reported, 38 of which have been reported this year.

    Disease investigators have attributed the nationwide uptick in AFM cases to an outbreak of Enterovirus D 68. The virus is related to the rhinovirus, which is responsible for the common cold, and causes symptoms similar to a cold, including runny nose and coughing. But those symptoms can rapidly escalate into more serious symptoms, such as wheezing, low blood oxygen, and difficulty breathing.

    Marc Patterson, a pediatric neurologist at the Mayo Clinic said the Enterovirus also can invade the nervous system of some patients—possibly due to genetic predispositions—and result in conditions such as AFM.

    Janette Nesheiwat, a family physician, said the disease "starts off with a cold, cough, runny nose, congestion, and then before you know it, you have weakness and paralysis of your arms and your legs."

    Patterson said there is no vaccine against enteroviruses and treatment options are limited. Doctors may prescribe physical therapy or surgery to help repair nerves, Patterson said. Some patients fully recover from the disease while others can suffer lasting neurological damage.

    6 cases in Minnesota

    The Minnesota Department of Health (MDH) last week issued a statement to inform the public about the six recent cases of AFM as well as precautions to take to prevent the illness that can lead to AFM.

    According to MDH, all six cases reported in the past few weeks involved children ages 10 and younger in the Twin Cities, central Minnesota, and northeastern Minnesota. All of the children were hospitalized.

    To prevent viral infections that can lead to AFM, MDH recommends washing hands, covering coughs and sneezes, staying home when sick, staying current with vaccinations, and protecting against mosquitos when spending time outside.

    Kris Ehresmann, director of the infectious disease division at MDH, said the six cases of AFM within the past month "is really a striking departure from the norm." She added that it's unclear how many more cases of the disease the state will see. "Since we don't know, really, how it's transmitted, it's really hard to say if we'll see more cases," she said. "But because there's been so much attention to this, I think there's going to be a greater awareness" (Bever, "To Your Health," Washington Post, 10/8; Gill et. al., ABC News, 10/8; Croft, CNN, 10/9; Ducharme, TIME, 10/8).

    The case for improving coordination between behavioral health and pediatrics


    The CDC estimates that nearly $247 billion is spent annually on the treatment and management of childhood mental disorders. Further, pediatric patients and caregivers often struggle to access high-quality behavioral health expertise due to a limited number of specialists and fragmented approaches to behavioral health services.

    In this presentation, we review the case for improving coordination between behavioral health and pediatrics, and describe four successful models that increase access to behavioral health care.

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