Eight of the nine children admitted to Seattle Children’s Hospital in recent weeks with sudden weakness in an arm, a leg or both limbs, have a rare condition known as acute flaccid myelitis, or AFM, the Washington state Department of Health confirmed Friday.
The health department and the Centers for Disease Control and Prevention have been investigating the cases of the children who went to the hospital within six weeks of each other with acute neurologic illnesses.
They ranged in age from 3 to 14 years, and came from five counties.
Two of the nine children admitted with symptoms were from Whatcom County.
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One of them, 6-year-old Daniel Ramirez of Bellingham, died this week but state health officials said Friday that Ramirez didn’t have AFM, adding the investigation into the cause of his death was still occurring.
Three of the eight children with AFM remain hospitalized and five have been released.
“None of the children have a life-threatening condition at this point,” said Jim Owens, pediatric neurologist at Children’s Hospital.
Health officials provided no additional information about specific cases, citing privacy concerns.
In addition to Whatcom, the ill children were from Franklin, King, Pierce and Snohomish counties.
So far, there’s been no link among the cases.
“There’s been no obvious commonality amongst these eight,” said Scott Lindquist, state infectious disease epidemiologist at the Department of Health. “At this point there isn’t evidence that would point to a single source of illness among these cases.”
Health investigators will dig deeper as they continue to seek answers.
“Now that we know we have eight confirmed cases we are going to do an in-depth interview with each of these children and their families, looking at all potential causes,” Lindquist said. “We’re talking about what they ate, whether they received any medications, what their illness was, any exposures to anything that any of these eight would have in common.”
The CDC has been using lab tests and magnetic resonance imaging to search for distinctive lesions in certain areas of the spinal cord in order to confirm the presence of AFM.
In addition to weakness of the limbs, the condition also could weaken the muscles of the face and the eyes. In severe cases, breathing could become difficult.
Health officials said AFM was rare, with fewer than one in a million people afflicted by it.
There had been just one confirmed case in Washington state this year.
Now, there are nine.
Health officials on Friday sought to allay parents’ fears by reminding the public that the disease was rare, even as they said the number of recent cases in Washington state was worrying.
“That’s what’s alarming for us now. In a disease that really has not been seen – so two cases in 2014, none in 2015 – and to see eight cases that meet the case definition clustered this close together still remains a concern,” Lindquist said.
A number of germs and viruses are linked to AFM.
They include enteroviruses, which usually cause milder illness in children such as respiratory infections, unless they get into the central nervous system. That’s when they can cause more serious problems, such as inflammation of the brain.
Other links include germs that cause colds and sore throats as well as mosquito-borne West Nile virus, autoimmune disease or environmental toxins.
While the condition has been described as polio-like, health officials said polio wasn’t the cause for the Washington state illnesses.
Still, the exact cause for AFM remains unknown.
The children were admitted to the hospital with a range of symptoms that also differed in severity. But all lost strength or movement in one or more of their arms or legs, officials have said.
Owens said the sudden weakness occurs within hours to a couple of days, and then plateaus. It doesn’t worsen over time.
Recovery varies. Some do completely, and others don’t.
“Time will tell for these children,” Owens said.
The increase in cases here reflects an overall increase this year in AFM nationally.
There have been 89 cases in 33 states as of September.
That’s more than 21 confirmed cases in 16 states in 2015.
In 2014, there were 120 cases in 34 states in 2014, according to the CDC.
On Friday, Seattle Children’s also addressed concerns about patient safety, saying the children came to the hospital with symptoms for which they were seeking care.
“Patient safety is our top priority at Seattle Children’s, and parents should know that it is safe to bring their children to the hospital,” said Mark Del Beccaro, chief medical officer at the hospital, in a news release. “We are using appropriate standard infection control, including putting patients with symptoms of active respiratory infections in isolation so they do not have contact with any other patients.”
Protect yourself and your children
Health officials said acute flaccid myelitis, or AFM, isn’t contagious in and of itself.
But many of the germs that cause AFM are contagious, such as enteroviruses.
You can protect against some causes by:
▪ washing your hands often with soap and water,
▪ covering your cough,
▪ avoiding close contact with sick people,
▪ cleaning surfaces with disinfectant, especially when touched by someone who has been sick,
▪ vaccinating your children,
▪ and protecting against mosquito bites.