Tag: handwashing

Is Acute Flaccid Myelitis Contagious?

Many people were surprised by a comment by Dr. Robert Redfield, the director of the Centers for Disease Control and Prevention, in an interview for “CBS This Morning,” during which he said that acute flaccid myelitis:

“doesn’t appear to be transmissible from human to human.”

Wait, then how do kids get it?

Is Acute Flaccid Myelitis Contagious?

Since we don’t actually know what causes AFM, it is certainly possible, although rather unlikely, that it is caused by something that is not communicable.

But remember, the leading theory is that AFM is caused by an enteroviral infection, either EV-D68 and EV-A71, as most kids develop symptoms shortly after they had viral symptoms, and these two viruses are most commonly identified.

And you are typically contagious when you are sick with an enteroviral infection.

So how can the CDC Director say that AFM “doesn’t appear to be transmissible from human to human?”

It is because even if the virus that causes AFM is communicable, you can’t actually catch AFM from someone.

adult child cooperation daylight
Wash your hands to help avoid viral infections. Photo by Andres Chaparro on Pexels.com

Just like polio.

While the polio virus itself is communicable, paralytic polio isn’t. You can’t catch paralytic polio. Instead, you can catch polio, and then you have the small chance that it develops into paralytic polio.

It may not sound like a big difference, but it is.

Just consider what might happen if AFM itself was contagious, and if most of the kids who were exposed to someone with AFM developed AFM themselves…

We would likely see a lot more cases of AFM, especially in clusters in homes, daycare centers, and schools.

Instead, most cases seem to be isolated.

AFM Clusters

But aren’t there reports of clusters of AFM?

“In September 2016, an acute care hospital in Arizona notified the Maricopa County Department of Public Health (MCDPH) of a suspected case of AFM and subsequent cluster of 11 children who were evaluated with similar neurologic deficits; differential diagnoses included transverse myelitis and AFM.”

Notes from the Field: Cluster of Acute Flaccid Myelitis in Five Pediatric Patients — Maricopa County, Arizona, 2016

Yes, kind of.

But they aren’t clusters of epidemiological linked cases.

In Arizona, for example, only four of the 11 children were confirmed to have AFM and “no epidemiologic links were detected among the four patients.”

“In October 2016, Seattle Children’s Hospital notified the Washington State Department of Health (DOH) and CDC of a cluster of acute onset of limb weakness in children aged ≤14 years.”

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

Similarly, at Seattle Children’s Hospital, the ten cases in their “cluster” had nothing in common, except for having prodromal respiratory or gastrointestinal symptoms about seven days before developing AFM symptoms.

It is likely that you see “clusters” at some hospitals simply because they are referral hospitals for a large region.

But even if we don’t know why some kids with these viral infections develop paralysis and other don’t, if they are the cause, then you wouldn’t develop AFM if you never actually had the virus.

“While we don’t know if it is effective in preventing AFM, washing your hands often with soap and water is one of the best ways to avoid getting sick and spreading germs to other people.”

About Acute Flaccid Myelitis

So handwashing and avoiding others who are sick is still the best strategy to try and avoid getting AFM.

And getting vaccinated against polio and using insect repellents can help you avoid other known causes of AFP – polio and West Nile virus.

More on Preventing AFM

What to Know About Hand, Foot, and Mouth Disease

Have your kids ever had a coxsackievirus A16 infection?

Don’t think so?

What about Hand, Foot, and Mouth Disease (HFMD)?

Symptoms of  Hand, Foot, and Mouth Disease

Hand, Foot, and Mouth Disease is a very common childhood disease that most of us end up getting at some point, typically before we are about five years old. At least you hope you do, because you don’t want to get it as an adult…

Would you recognize these symptoms of HFMD?
Would you recognize these symptoms of HFMD? Photo courtesy Medicina Oral S.L.

Most people are familiar with the classic symptoms of HFMD, which can include:

  • a few days of fever, often up to about 102 degrees F
  • red spots that can turn into blisters on the child’s palms (hand) and soles (foot), but often also on their knees, elbows, and buttocks
  • sores or ulcers in a child’s mouth which are often painful, causing mouth pain or a sore throat and excessive drooling
  • a reduced appetite, which can sometimes lead to dehydration

Symptoms which can last up to 7 to 10 days.

Although that’s the end of it for most kids, a few weeks after the other symptoms have gone away, some kids will have peeling of the skin on the child’s fingers and toes. They might even lose their fingernails and toenails (nail shedding). This is only temporary though, and new nails should quickly grow back.

To confuse matters though, like other viral infections, not all kids have classic symptoms when they get HFMD. Some don’t have a fever, while others don’t have the rash on their hands and feet, which can make it easy to confuse with other viral infections that cause mouth ulcers, like herpangina.

Some kids don’t have any symptoms at all, but surprisingly, they can still be contagious.

Facts About Hand, Foot, and Mouth Disease

HFMD is caused by the coxsackievirus A16 virus and a few other enteroviruses, including enterovirus 71 and coxsackievirus A6. Because more than one virus can cause HFMD, it is possible to get it more than once.

Other things to know about HFMD include that:

  • it is very contagious, especially if you have close contact with nose and throat secretions, fluid from blisters, and feces of someone infected with HFMD, especially during their first week of illness
  • the incubation period for HFMD, the time when you were exposed to someone to when you develop symptoms, is about 3 to 7 days
  • people with HFMD disease can continue to be contagious for days or weeks after their symptoms have stopped, although this isn’t a reason to keep them out of school or daycare. In fact, as long as they don’t have fever and feel well, kids with HFMD can likely go to daycare or school.
  • there is no specific treatment for HFMD, except symptomatic care, including pain relief, fever reducers if necessary, and extra fluids
  • unlike other viruses which are common in the winter, HFMD season is during the spring, summer, and fall
  • complications of HFMD disease are rare, but can include viral meningitis, encephalitis, and a polio-like paralysis
  • HFMD is not the same as foot-and-mouth or hoof-and-mouth disease that affects animals
  • there is currently no vaccine to prevent you from getting HFMD, although cross reactivity between polio vaccines and enterovirus 71 might lead to milder symptoms if you are vaccinated and an EV-71 vaccine is approved in China

Most importantly, to avoid getting HFMD, wash your hands after changing your child’s diaper, teach them to cover their coughs and sneezes, and don’t share cups or other personal items.

Although many of us had HFMD when we were kids, remember that there are multiple viruses that can cause it. When outbreaks occur and we see more cases in adults, it is likely because it isn’t being caused not by coxsackievirus A16, but by a less commonly seen enterovirus that we aren’t immune to, like coxsackievirus A6.

More on Hand, Foot, and Mouth Disease

How Long Are You Contagious When You Have the Flu?

Do your kids have the flu?

When their kids have the flu, one of the first questions most parents have, after all of the ones about how they can get them better as quickly as possible, is how long will they be contagious?

How Long Is the Flu Contagious?

Technically, when you have the flu, you are contagious for about a week after becoming sick.

And you become sick about one to four days after being exposed to someone else with the flu – that’s the incubation period.

“Most experts believe that flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby. Less often, a person might also get flu by touching a surface or object that has flu virus on it and then touching their own mouth, eyes or possibly their nose.”

CDC on Information for Schools

That’s why the flu spreads so easily and it is hard to control flu outbreaks and epidemics once they begin.

Most school closures are not to prevent the spread of the flu and clean the school, but simply because so many kids and staff are already out sick.
Most school closures are not to prevent the spread of the flu and clean the school, but simply because so many kids and staff are already out sick.

Another reason it spreads so easily is that most people are contagious the day before they even begin to develop flu symptoms!

And again, they then remain contagious for another five to seven days.

When Can You Return to School with the Flu?

Does that mean kids with the flu have to stay home for at least seven days?

Not usually, unless they have a fever for that long, or severe flu symptoms, which is definitely a possibility for some kids with the flu.

“Those who get flu-like symptoms at school should go home and stay home until at least 24 hours after they no longer have a fever or signs of a fever without the use of fever-reducing medicine.”

CDC on Information for Schools

In general, as with many other childhood illnesses, you can return to school or daycare once your child is feeling better and is fever free for at least 24 hours.

Keep in mind that even if they don’t have a fever, if your child still isn’t feeling well and isn’t going to be able to participate in typical activities, then they should probably still stay home.

But Are They Still Contagious?

Many childhood diseases have contagious periods that are far longer than most folks imagine. That’s because we continue to shed viral particles even as we are getting better, and sometimes, even once we no longer have symptoms.

Teach your kids proper cough etiquette to help keep cold and flu germs from spreading.
Teach your kids proper cough etiquette to help keep cold and flu germs from spreading.

For example, some infants with rotavirus are contagious for up to 10 days and some with RSV are contagious for as long as 4 weeks!

Like the child with flu that doesn’t have a fever, that doesn’t mean that these kids have to stay out of school or daycare for that whole time. But since they are still contagious, it does raise the issue of what to do about non-essential activities.

Should you keep going to playdates after your child had the flu? How about the daycare at church or the gym?

In general, you should probably avoid non-essential activities while your kids are still recovering from an illness, even if they feel better, because they are likely still contagious.

Most parents have the expectation that their own kids won’t be exposed to someone who is sick in these settings.

So you probably don’t want to bring your sick kid to a playdate or birthday party, etc., even if he is already back in school or daycare.

And whether they have a cold or the flu or another illness, teach your kids to decrease their chances of getting sick by washing their hands properly, not sharing drinks (bring a water bottle to school), and properly covering their own coughs and sneezes. They should also learn to avoid putting things in the mouth (fingers or their pencil, etc.) or rubbing their eyes, as that helps germs that could have made their way onto their hands get into their body and make them sick.

What to Know About Staying Home When You Have the Flu

Although your child may be contagious with the flu for up to a week, your child only has to stay home from school or day care until they are feeling better and are fever free for at least 24 hours.

More About Staying Home When You Have the Flu