Category: Pediatric News

Does Zantac Cause Cancer?

Breaking News – In Canada, companies marketing ranitidine products have stopped any further distribution until evidence is provided to demonstrate that they do not contain NDMA above acceptable levels.

Have you heard the news that taking ranitidine (Zantac) could cause cancer?

I’d be surprised if you haven’t…

Does Zantac Cause Cancer?

So does Zantac really cause cancer or is this just media hype?

“The U.S. Food and Drug Administration has learned that some ranitidine medicines, including some products commonly known as the brand-name drug Zantac, contain a nitrosamine impurity called N-nitrosodimethylamine (NDMA) at low levels. NDMA is classified as a probable human carcinogen (a substance that could cause cancer) based on results from laboratory tests. NDMA is a known environmental contaminant and found in water and foods, including meats, dairy products, and vegetables.”

FDA Statement alerting patients and health care professionals of NDMA found in samples of ranitidine

Ok, so Zantac might contain NDMA and NDMA could cause cancer.

But NDMA is found in many things, so how concerned should we be about it being in Zantac?

“Although NDMA may cause harm in large amounts, the levels the FDA is finding in ranitidine from preliminary tests barely exceed amounts you might expect to find in common foods.”

FDA Statement alerting patients and health care professionals of NDMA found in samples of ranitidine

Although the FDA is still “evaluating whether the low levels of NDMA in ranitidine pose a risk to patients,” so far, it doesn’t sound like a very big concern.

While Novartis AG’s Sandoz division, which makes ranitidine, has stopped distributing their generic version of Zantac, Sanofi will continue to distribute brand name Zantac. And many other companies make ranitidine, so it will likely continue to be available.

How do medications become contaminated with NDMA?

In the case of blood pressure medications (sartans), regulators began looking for NDMA last year.

“It is now known that these impurities can form during the production of sartans that contain a specific ring structure known as a tetrazole ring under certain conditions and when certain solvents, reagents, and other raw materials are used. In addition, it is possible that impurities were present in some sartans because manufacturers had inadvertently used contaminated equipment or reagents in the manufacturing process.”

Sartan medicines: companies to review manufacturing processes to avoid presence of nitrosamine impurities

Ranitidine doesn’t contain a tetrazole ring, but as with the sartans, it is possible that the NDMA formed during production or that contaminated equipment or reagents were used in the manufacturing process.

“Valisure’s research, along with that of Stanford University and others, found that NDMA was the result of the “inherent instability” of the ranitidine molecule.”

Valisure Detects NDMA in Ranitidine

And food?

“The typical diet in most countries contains nitrates, nitrites, and nitrosamines. Nitrates and nitrites occur naturally in fruit and vegetables, which are regarded as an important part of a healthy diet due to the powerful evidence of beneficial health effects against cancer. In the same time, nitrates and nitrites are often used as food additives in processed meats such as ham, bacon, sausages, and hot dogs, to retard microbial spoilage, and preserve meat products recognizable appearance and flavor as well. A high consumption of processed meats is linked to an increased gastric cancer risk, and many people consider nitrates/nitrites as the main reason for that. Nitrosamines are produced by chemical reactions of nitrates, nitrites and other proteins.”

Song et al on Dietary Nitrates, Nitrites, and Nitrosamines Intake and the Risk of Gastric Cancer: A Meta-Analysis

NDMA is not in food because of contamination.

“…excess lifetime cancer risk was calculated separately for each of the five nitrosamines and then summed to arrive at a total excess lifetime cancer risk of 1.46 × 10-6 (or about 1 in 683,000) due to average population exposure to nitrosamines through pork bacon.”

Cancer Risk from Nitrosamines in Pork Bacon

And the cancer risk from NDMA in food is considered to be small.

“Nitrosamines are ubiquitous in the human environment and have been detected in food items, including cured meat, bacon, fish, and beer, in cosmetics, drugs, and in the front passenger areas of new cars.”

Exposure to high concentrations of nitrosamines and cancer mortality among a cohort of rubber workers

The bigger risk is likely from nitrosamines in cigarette smoke and occupational exposures.

What should you do if your child takes ranitidine?

Still, do you want to give your kids a medicine that might contain a substance that could cause cancer?

“The FDA is not calling for individuals to stop taking ranitidine at this time; however, patients taking prescription ranitidine who wish to discontinue use should talk to their health care professional about other treatment options. People taking OTC ranitidine could consider using other OTC medicines approved for their condition. There are multiple drugs on the market that are approved for the same or similar uses as ranitidine.”

FDA Statement alerting patients and health care professionals of NDMA found in samples of ranitidine

Since the risk seems so small, whether or not you continue giving your child Zantac or you switch to something else might depend on how easy it would be to switch.

Over the counter Zantac is approved for adults and children 12 years and over. There are many options to treat reflux for these folks, including Pepcid, Prevacid, Nexium, and Prilosec, etc.

On the other hand, prescription ranitidine syrup is approved for infants as young as one-month-old. Not many medicines are approved at this age.

There is one though.

Although not an H2-receptor antagonists like ranitidine, Nexium is another reflux medicine that is approved for infants. It is a proton pump inhibitor (also decreases the production of acid in the stomach) that is available in delayed release oral suspension packets.

Should you stop taking Zantac?

So what should you do?

Although doing nothing or switching seem like your two options, if your child’s reflux has been well controlled on Zantac for awhile, this might be a good idea to ask your pediatrician if a trial off medications might be appropriate.

Most infants and children eventually outgrow having reflux and are able to wean off their reflux medicine. Is your child ready?

Of course, you shouldn’t stop your child’s medicine without talking to your doctor first. And instead of stopping their Zantac, it might be better to switch to another reflux medicine.

“Carcinogens do not cause cancer at all times, under all circumstances.”

American Cancer Society on Known and Probable Human Carcinogens

Could you keep taking Zantac? That’s also an option for now, especially if you only expect that your child will be on it for a short time, but as more manufactures declare that they will stop shipping ranitidine, you might have to switch anyway.

Whatever you do, don’t panic over this news. Your kids are almost certainly not at any real increased risk to develop cancer just because they have been taking Zantac.

More on NDMA in Zantac

The New Vaccine Surveillance Network Report on Enterovirus D68 Infections

Anyone who has been following the outbreaks of Acute Flaccid Myelitis the last few years will likely think the following report is long overdue.

The report, Enterovirus D68–Associated Acute Respiratory Illness — New Vaccine Surveillance Network, United States, July–October,2017 and 2018, is especially welcome by those folks who are already convinced that AFM is associated with EV D68.

The New Vaccine Surveillance Network Report on Enterovirus D68 Infections

But wait, why was surveillance done through the New Vaccine Surveillance Network?

And for that matter, what is the New Vaccine Surveillance Network?

“The New Vaccine Surveillance Network (NVSN) includes study sites that focus on population-based surveillance and data collection on the use and impact of vaccines and the impact of vaccine policies. Since 2006, NVSN sites have conducted active, population-based surveillance for hospitalizations and outpatient visits associated with acute gastroenteritis (AGE) in children (2006-present). NVSN sites have conducted surveillance for acute respiratory illness (ARI) from 2000 to 2009, and again beginning in 2015.”

New Vaccine Surveillance Network (NVSN)

Before you start thinking that this means a new Enterovirus D68 vaccine is coming out soon, many NVSN studies have nothing to do with vaccines…

“NVSN supports broad-based surveillance and research projects for acute gastroenteritis and acute respiratory infections in areas with a population base of at least 500,000.”

New Vaccine Surveillance Network (NVSN) Overview

In addition to studies on the flu and pneumococcal disease, they have done studies on norovirus, coronavirus, human metapneumovirus, HPIV, RSV, and rhinovirus infections.

So what did they find out about Enterovirus D68 infections?

“Based on preliminary data, test results were positive for EV-D68 for two (0.08%) of 2,433 patients with ARI who were tested during 2017 and 358 (13.9%) of 2,579 tested during 2018. “

Enterovirus D68–Associated Acute Respiratory Illness — New Vaccine Surveillance Network, United States, July–October, 2017 and 2018

There were a lot more EV D68 infecions in 2018 than there were in 2017

And what does that mean?

Considering that we had “only” 33 confirmed cases of AFM in 16 states in 2017 and at least 223 confirmed cases of AFM in 41 states in 2018, the rise in EV-D68 cases seems to correlate with the rise in AFM.

“Although AFM is rare in the United States, these AFM surveillance data, along with the EV-D68 activity documented through NVSN, provide additional supporting evidence for a temporal association between EV-D68 respiratory illness and AFM. “

Enterovirus D68–Associated Acute Respiratory Illness — New Vaccine Surveillance Network, United States, July–October, 2017 and 2018

Again, few people are going to be surprised by this news…

So, what’s next?

You mean besides the 2019 AFM season?

More on Acute Flaccid Myelitis News


Infants’ Ibuprofen Concentrated Oral Suspension Recall

Three lots of  Infants' Ibuprofen Concentrated Oral Suspension that were made by Tris Pharma, Inc. and sold under the Equate, CVS Health, and Family Wellness brands and sold at Wal-Mart, CVS, and Family Dollar stores have been recalled.

If you have little kids who sometimes take pain or fever medications, you will want to check your medicine cabinet for this recall.

Three lots of Infants’ Ibuprofen Concentrated Oral Suspension have been recalled because the concentration in the bottle might be higher than they it is supposed to be.

What does that mean?

Although they are supposed to be at a 50mg per 1.25ml concentration, if it is indeed higher, then if you gave your child 1.25ml, they might get more than just 50mg.

“To date, Tris Pharma, Inc. has not received any reports of adverse events related to the lots of product that are the subject of this recall.”

How much more? We don’t know, since we don’t know what the “potentially” higher concentration might be.

Infants’ Ibuprofen Concentrated Oral Suspension Recall

Fortunately, the recall is limited to just 3 lots of  Infants’ Ibuprofen Concentrated Oral Suspension that were made by Tris Pharma, Inc. and sold under the Equate, CVS Health, and Family Wellness brands and sold at Wal-Mart, CVS, and Family Dollar stores.

Do you have any recalled Ibuprofen?
Do you have any recalled Ibuprofen? Check your lot numbers!

If you have the recalled Ibuprofen, don’t use it. Contact Tris Pharma for a refund.

And seek medical attention if you think your child got too much Ibuprofen and is having any symptoms, especially nausea, vomiting, epigastric pain, or more rarely, diarrhea.

Fortunately, getting extra Ibuprofen is not usually as dangerous as getting extra Acetaminophen.

Although, of course, neither is good! Be careful when dosing your kids and be sure they need it first.

Oh, and yes, at least in this case, store brand Ibuprofen at Family Dollar and Wal-Mart is the same as store brand Ibuprofen at CVS…

More on Infants’ Ibuprofen Concentrated Oral Suspension Recall

Acute Flaccid Myelitis Update

Breaking News – The CDC has updated the Acute Flaccid Myelitis (AFM) case counts. (see below).

These 223 confirmed cases are among the total of 374 reports that CDC received of patients under investigation.

We continue to get regular updates from the CDC about AFM.

CDC Telebriefing: Update on Acute Flaccid Myelitis (AFM) in the U.S.

Unfortunately, we aren’t getting the real answer we were looking for – how to stop the outbreak.

Acute Flaccid Myelitis Update

Since the last update, we have learned that:

  • the case count is up to 223 confirmed cases among 374 reports, with most cases being confirmed at this point (2018)
  • cases have been reported in 41 states (2018)
  • there have been 2 confirmed cases (NC and UT) among 15 reported cases so far this year (2019)

That means that we have clearly exceeded the last record of 149 cases in 2016.

There are also 49 confirmed cases and 28 cases under investigation in Canada since January 2018.

In other news:

  • the CSTE will be issuing issued a new statement on AFM reporting reaffirming that they “are confident state and local health departments are working closely with doctors to ensure suspected cases are reported.”
  • the CDC has posted updated treatment guidelines
  • an MMWR early release, Increase in Acute Flaccid Myelitis — United States, 2018,  will provide details on the first 80 cases of 2018 – but sound similar to what we have learned from outbreaks in 2014 and 2016…
  • the CDC is working with local and state health departments on better long term tracking of cases – something parents have been pushing for!
  • an AFM Task Force has been established to “bring together experts from a variety of scientific, medical, and public health disciplines to help solve this critical public health issue.”

Most importantly though, we again learned that the CDC still doesn’t feel that they have enough evidence to say that any one thing is causing AFM.

AFM Cases in the United States

In addition to this year’s cases, there were:

  • 33 confirmed cases in 16 states in 2017
  • 149 confirmed cases in 39 states in 2016
  • 22 confirmed cases in 17 states in 2015
  • 120 confirmed cases in 34 states in 2014 – with most of the cases being reported in California (24), Colorado (10), Utah (6), Massachusetts (9), Virginia (5), Indiana (5), and Illinois (4)

What’s next?

More on Acute Flaccid Myelitis News

Updated on March 27, 2019

What to Know About the Acute Flaccid Myelitis Investigations

Although you may just now be hearing about acute flaccid myelitis, it is important to understand that it isn’t new.

The rise in AFM cases began in 2014 and seem to occur every other year.
The rise in AFM cases began in 2014 and seem to occur every other year.

It wasn’t even new when we started to see an increased number of cases a few years ago.

What is new, is that we are seeing an increased number of cases.

Acute Flaccid Myelitis Timeline

AFM refers to acute (sudden onset) flaccid (droopy or loose muscles) myelitis (inflammation of the spinal cord) and it is a subtype of acute flaccid paralysis.

If that explanation doesn’t really help you, it might help to understand that paralytic polio, like AFM, is another subtype of acute flaccid paralysis.

“In August 2012, the California Department of Public Health (CDPH) was contacted by a San Francisco Bay area clinician who requested poliovirus testing for an unvaccinated man aged 29 years with acute flaccid paralysis (AFP) associated with anterior myelitis (i.e., evidence of inflammation of the spinal cord involving the grey matter including anterior horn cell bodies) and no history of international travel during the month before symptom onset. Within 2 weeks, CDPH had received reports of two additional cases of AFP with anterior myelitis of unknown etiology.”

Acute Flaccid Paralysis with Anterior Myelitis — California, June 2012–June 2014

That seems to be about when this started, in 2012.

Unfortunately, they didn’t figure out what was causing the paralysis in these three patients, despite extensive testing and more cases followed.

“To identify other cases of AFP with anterior myelitis and elucidate possible common etiologies, CDPH posted alerts in official communications for California local health departments during December 2012, July 2013, and February 2014.”

Among 23 cases, California health officials found that the median age of the patients was 10 years old, only two tested positive for EV-D68, although most did have a recent “an upper respiratory or gastrointestinal prodrome.”

“Acute flaccid paralysis (AFP) with anterior myelitis is not a reportable condition, and baseline rates of disease are unknown but are likely quite low. Data from 1992–1998 on children aged <15 years in California indicated an incidence of 1.4 AFP cases per 100,000 children per year and did not identify a single case of AFP with anterior myelitis.”

California wasn’t the only state with cases.

In 2014, there were at least 12 cases in Colorado and 11 in Utah.

“In response to the CDPH and CHCO reports, the CDC established a case definition for enhanced nationwide surveillance of AFM, which included individuals less than 21 years of age with acute flaccid limb weakness and MRI involvement of predominantly the gray matter of the spinal cord without identified etiology presenting after August 1, 2014.”

Messacar et al on Acute Flaccid Myelitis: A Clinical Review of US Cases 2012–2015

All together though, in 2014, once  the CDC began actively investigating cases, at least 120 cases were discovered in 34 states. The cases were associated with a large outbreak of EV-D68-associated respiratory illness, although they weren’t able to conclusively link those respiratory illnesses to the AFM cases.

Is there any evidence that there were a lot of cases before 2012?

Or that the CDC has dropped the ball and hasn’t been doing enough to investigate cases?

Not if you look at the timeline.

The CDC was involved very early, called for all cases to be reported, and is actively investigating those cases.

CDC activities include… using multiple research methods to further explore the potential association of AFM with possible causes as well as risk factors for AFM. This includes collaborating with experts to review MRI scans of people from the past 10 years to determine how many AFM cases occurred before 2014, updating treatment and management protocols, and engaging with several academic centers to conduct active surveillance simultaneously for both AFM and respiratory viruses.

CDC on the AFM Investigation

And if the first cases in California and Colorado triggered so much attention, isn’t it likely that any cases anywhere else would have done the same thing?

That makes it very unlikely that many cases were missed in earlier years.

  • EV-D68 first identified as a cause of respiratory tract infections – 1962
  • the first reports that EV-D68 could cause severe, even fatal respiratory disease – 2008
  • first AFM cases are discovered in California – August 2012
  • the Colorado Department of Public Health and Environment notifies the CDC about a cluster of AFM cases at Children’s Hospital Colorado and a joint investigation begins between the CDPH, CDC, and the physicians caring for the patients  – September 2014
  • the CDC issues a health advisory on Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children and calls on local and state health departments to report patients to the CDC – September 2014
  • the CDC conducts a conference call on Neurologic Illness with Limb Weakness in Children, so that clinicians could learn about the latest situation, surveillance, and CDC clinical guidance for AFM testing, patient evaluation and case reporting – October 2014
  • the CDC posts Interim Considerations for Clinical Management – November 2014
  • 120 AFM cases in 34 states – 2014
  • Council of State and Territorial Epidemiologists AFM case definition adopted – June 2015
  • 22 AFM cases in 17 states – 2015
  • 149 AFM cases in 39 states – 2016
  • Council of State and Territorial Epidemiologists AFM case definition updated, which once again, recommends against adding AFM to the Nationally Notifiable Disease List – June 2017
  • 33 AFM cases in 16 states, including one death – 2017
  • CDC Telebriefing on Acute Flaccid Myelitis in the US with Dr. Nancy Messonnier, director of CDC’s National Center for Immunization and Respiratory Diseases – August 2018
  • 158 AFM cases confirmed in 36 states among 311 reported cases that are being investigated – 2018

The other issue that concerns many parents is why a definitive cause hasn’t yet been identified. And why don’t we have treatments or a cure yet?

“To date, no pathogen (germ) has been consistently detected in the patients’ spinal fluid; a pathogen detected in the spinal fluid would be good evidence to indicate the cause of AFM since this condition affects the spinal cord.”

CDC on AFM Investigation

Although enteroviruses can be difficult to detect in spinal fluid, it is important to keep in mind that isn’t the only thing that is keeping experts from declaring the investigation over and naming a cause, such as EV-D68.

“Among 41 patients whose upper respiratory tract samples were available for enterovirus/rhinovirus testing at CDC, 17 (41%) tested positive: eight (20%) for EV-D68 and nine (22%) for eight other enterovirus/rhinovirus types.”

Eyal Leshem on Notes from the Field: Acute Flaccid Myelitis Among Persons Aged ≤21 Years — United States, August 1–November 13, 2014

Another big issue is that EV-D68 has not been detected in every, or even most AMF patients, and many others have been found to have other enteroviral infections, including EV-A71.

Could it be a coincidence that investigators are finding these enteroviruses simply because it is the season for them to appear? That would mean something else is causing these kids to have AFM.

“During September–November 2016, 10 confirmed cases of AFM were reported in Washington. No common etiology or source of exposure was identified. Enterovirus-A71 was detected in one patient and EV-D68 in two patients, one of whom also tested positive for adenovirus.”

Acute Flaccid Myelitis Among Children — Washington, September–November 2016

While the focus is on EV-D68 as a cause and everyone wants an answer, no one wants the CDC or other investigators to be wrong.

That doesn’t mean that they should be overly cautious and waste time or resources once an answer is evident, but just that they should follow sound epidemiological principles, get the right answer, and help stop kids from getting AFM.

What’s Next for AFM?

There are still a lot of unknowns about AFM, but this is likely what we can expect in the coming months:

  • the CDC will continue to investigate all unconfirmed cases that have occurred this year, which can take about four weeks after a case is reported and all necessary information is sent in. Keep in mind that since we don’t know if the CDC has already received all of the information on the cases they are investigating, we don’t know when they will finish investigating any pending cases.
  • local or state health departments will likely reach out to treating physicians to get followup about AFM patients about two months after they developed limb weakness and then report this short-term follow-up data to the CDC. In general, the CDC does not seem to contact patients directly.

From the current investigation, information from outbreaks and cases over the previous years, and cases in other countries, we will hopefully get the answers we need soon to prevent and treat AFM.

During the COCA Call, the AFM Surveillance Team will discuss the activities CDC is conducting as part of its AFM investigation.
The AFM Surveillance Team will participate in a COCA Call in mid-November.

Maybe some of those answers will come during a Clinician Outreach and Communication Activity (COCA) Call on November 13, when members from the CDC Acute Flaccid Myelitis Surveillance Team discuss the “activities the CDC is conducting as part of its investigation into AFM.”

The fact that the CDC has an Acute Flaccid Myelitis Surveillance Team will be news and is hopefully reassuring to some folks…

This is also probably a good time to remind folks that funding for public health has been declining in recent years, even as we expect our public health officials to respond to more things and react more quickly to keep us all safe and healthy. Let’s make sure we fund our public health programs, including the CDC and NIH, so that they have all of the resources they need to address all of today’s public health challenges.

More on the Acute Flaccid Myelitis Timeline

Updated on December 10, 2018

Tom Price as HHS Secretary – Good for Kids?

Many are describing President-elect’s choice of Representative Tom Price as the secretary of health and human services as “scary” and a “radical choice.”

To understand why, you should both understand what he believes and what his job will be.

The HHS Secretary

HHS Secretary Sebelius at a meeting of the Interagency Autism Coordinating Committee.
HHS Secretary Sebelius, NIH Director Dr. Francis Collins, and others, listen to a speech at the a meeting of the Interagency Autism Coordinating Committee, July 10, 2012. (HHS photo by Chris Smith)

Surprisingly, few people probably know the name of the current HHS secretary – Sylvia Mathews Burwell.

She succeeded Kathleen Sebelius, who resigned in 2014, mostly over problems with the healthcare.gov website and roll-out of the Affordable Care Act.

What does the HHS Secretary do?

As head of the United States Department of Health and Human Services, the HHS Secretary is a member of the President’s Cabinet and overseas the:

  • Administration for Children and Families (ACF)
  • Administration for Community Living (ACL)
  • Agency for Healthcare Research and Quality (AHRQ)
  • Agency for Toxic Substances and Disease Registry (ATSDR)
  • Centers for Disease Control and Prevention (CDC)
  • Centers for Medicare & Medicaid Services (CMS)
  • Food and Drug Administration (FDA)
  • Health Resources and Services Administration (HRSA)
  • Indian Health Service (IHS)
  • National Institutes of Health (NIH)
  • Substance Abuse and Mental Health Services Administration (SAMHSA)

As you probably recognize at least a few of those names, like the FDA, CDC, and NIH, you likely know that these agencies “administer a wide variety of health and human services and conduct life-saving research for the nation, protecting and serving all Americans.”

That work can be seen in the current strategic plan of the HHS:

  1. To Strengthen Health Care
  2. To Advance Scientific Knowledge and Innovation
  3. To Advance the Health, Safety, and Well-Being of the American People
  4. To Ensure Efficiency, Transparency, Accountability, and Effectiveness of HHS Programs

And it can be seen in many of the current problems they are tackling, such as combating the opioid epidemic, lead poisoning hazards, the Zika virus, and continuing to get more people insurance coverage, etc.

Problems with Tom Price as HHS Secretary

So what might be the problem with Rep. Tom Price as HHS Secretary, after all, he is a doctor and has been endorsed by the AMA?

“The Association of American Physicians and Surgeons recommends a policy of Non-Participation to all physicians as the only legal, moral, and ethical means of concretely expressing their complete disapproval of the spirit and philosophy behind these amendments.”

THE PRINCIPLES OF MEDICAL ETHICS OF THE ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS

Tom Price is a member of the Association of American Physicians and Surgeons (AAPS), an organization of doctors that was opposed to the establishment of Medicare and Medicaid and which tells its members that it is “legal, moral, and ethical” to not treat patients on Medicare and Medicaid.

The AAPS is also against birth control and pushes a lot of anti-vaccine misinformation that can scare parents away from getting their kids vaccinated and protected against vaccine-preventable diseases!

A Radical Choice

In describing Tom Price as a “radical choice” for HHS Secretary, the New York Times stated that he is “a man intent on systematically weakening, if not demolishing, the nation’s health care safety net.”

In addition to supporting the repeal of Obamacare, Tom Price is a climate change denier, and has been in favor of:

  • block granting Medicaid
  • turning Medicare into a voucher program, which many think is a step towards privatization
  • barring all federal funds for Planned Parenthood, even though the very great majority of their activities have nothing to do with abortion
  • limiting participation in Children’s Health Insurance Program (CHIP) and voting against expanding CHIP several times
  • cutting billions of dollars from the Supplemental Nutrition Assistance Program (SNAP or food stamps) as it was converted to a State Flexibility Fund in the 2015 GOP proposed budget
  • continuing to ban research on gun violence at the CDC as he did not sign a letter with a bipartisan group of 146 other members of Congress, led by Congressman David Price, calling for a lift of the de-facto ban on federal gun violence research

And although his nomination was supported by the AMA, the American Academy of Family Physicians (AAFP), and the Association of American Medical Colleges (AAMC), there are many doctors and medical students who think that “Price’s stances are incompatible with the values of the medical profession and with the stated missions of the above organizations.”

The AAP on the Nomination of Tom Price

What has the American Academy of Pediatrics said about Tom Price’s nomination?

“Above all, HHS should strive to implement an agenda with children at the core and ensure that all children have access to high-quality, affordable health care so they can thrive throughout their lifetimes. All children, regardless of their immigration status, should have affordable health care coverage, insurance with pediatric-appropriate benefits, access to timely and affordable primary and subspecialty pediatric care and mental health services, and receive comprehensive, family-centered care in a medical home.”

AAP’s Blueprint for Children

As is their style, they have not issued a statement, but reviewing the AAP’s Blueprint for Children, it isn’t too hard to figure out what they would say.

Members of the American Academy of Pediatrics routinely volunteer to lobby members of Congress to support pediatric issues, like CHIP re-authorization.
Although they are not always successful, members of the American Academy of Pediatrics routinely volunteer to lobby members of Congress to support pediatric issues, like CHIP re-authorization.

The Blueprint, which “presents specific policy recommendations for the federal government to align its activities to promote healthy children, support secure families, build strong communities, and ensure that the United States is a leading nation for children,” states that they:

  • oppose block grants for Medicaid and other entitlement programs
  • support renewing and strengthening CHIP
  • support maternal and reproductive health programs
  • want to improve access to Medicaid services
  • support protecting and strengthening federal nutrition programs for children and families, including SNAP and WIC
  • support federally funded research to build the evidence base for a public health response to violence, including research on gun violence coordinated by the Centers for Disease Control and Prevention (CDC)
  • want the administration to aggressively addresses climate change
  • support the enactment of comprehensive immigration reform that prioritizes the health, well-being, and safety of children
  • want the administration to address factors that make some children more vulnerable than others, such as race, ethnicity, religion, sexual orientation or gender identity, and disability

And perhaps the thing that is most apparently in conflict with Tom Price’s nomination, the AAP states that they want the HHS secretary and Congress to:

Support and improve the ACA. The ACA has made important progress for children. Congress should improve upon this progress and enhance pediatric benefits in the marketplaces, allow families that are not eligible for CHIP to purchase CHIP plans in the health insurance marketplaces, improve affordability of plans for families (especially those with children with special health care needs), and strengthen rules to ensure that adequate pediatric networks exist in marketplace plans.”

Tom Price is not going to support and improve the ACA (Obamacare), strengthen CHIP, or improve access to Medicaid services. He is basically against just about everything the American Academy of Pediatrics supports and has been working for.

We don’t need a statement from the AAP to know what that means.

 

What Does Polio-Like Mean?

Breaking News – 90 cases of AFM in 27 states have been confirmed so far this year, and are among 252 cases that are under investigation.

afmPolio has been in the news a lot lately.

Well, not exactly polio.

The term “polio-like” has been in the news.

This follows a large outbreak of enterovirus D68 (EV-D68) respiratory infections in 2014, some of which seemed to be associated with the development of acute flaccid myelitis (AFM).

While there were no reports of EV-D68 infections in 2015, there have been “limited sporadic EV-D68 detections in the U.S. in 2016.”

And 2017.

And 2018.

But after we saw 149 cases in 39 states in 2016, there were only 33 cases in 16 states in 2017.

And there have been about 38 cases in 16 states in 2018, coming out of the peak season for AFM cases – August to October.

Polio-Like Syndromes

Similar to coxsackievirus, which causes hand, foot, and mouth disease, EV-D68 is a non-polio enterovirus. On the other hand, the virus that actually causes polio is just a different type of enterovirus.

Because they are all enteroviruses, some get differentiated as being non-polio.

To make it even more confusing, some non-polio enteroviruses can cause a polio-like syndrome.

And both polio and non-polio enteroviruses can cause acute flaccid myelitis.

It is important to note that only some, but not all, of the kids with AFM have been positive for enterovirus D68. In Colorado this year, 9 of 14 cases were linked to EV-A71 infections.

Acute Flaccid Myelitis

What is acute flaccid myelitis?

AFM is a syndrome characterized by sudden onset of limb weakness, sometimes accompanied by cranial nerve dysfunction (such as facial drooping or difficulty speaking). In many cases, distinctive lesions in the gray matter (nerve cells) of the spinal cord may be seen on neuroimaging.

CDC definition

Acute flaccid myelitis caused by the polio virus can usually be recognized because it is associated with an unvaccinated person who traveled to an area that still has cases of polio and who has “one or more limbs with decreased or absent tendon reflexes in the affected limbs, without other apparent cause, and without sensory or cognitive loss. Paralysis usually begins in the arm or leg on one side of the body (asymmetric) and then moves towards the end of the arm or leg (progresses to involve distal muscle groups).”

Since 2014, at least 350 children have developed acute flaccid myelitis. Most had some improvement in function and a small number had a complete recovery, just as a small number had no improvement.

And of course, none of them had polio. In fact, the last polio outbreak in the United States was in 1979.

So maybe we should stop saying “polio-like,” as it likely just confuses people, few people likely know what “polio-like” symptoms actually are, and these cases have nothing to do with the polio virus.

Unfortunately, “despite extensive testing, CDC does not yet know the cause of the AFM cases.”

AFM isn’t caused by vaccines though…

Still, the CDC recommends standard precautions to try and avoid AFM, including handwashing, avoiding other people who are sick, getting vaccinated (to avoid polio), and protecting your kids from mosquitoes (West Nile virus can cause AFM too).

For More Information on Polio-Like Syndromes

Updated November 13, 2018

Save