Tag: infections

What Does Polio-Like Mean?

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.”

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.

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 230 children in 34 states 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.”

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

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What to Know About Fifth Disease

Fifth disease, also called erythema infectiosum, is a very common viral infection that most kids get in early childhood.

It got its name because it was the fifth disease that was known to cause a fever and rash.

Measles was the first.

Symptoms of Fifth Disease

Fifth disease can cause a child to look like they have slapped cheeks.
Fifth disease can cause a child to look like they have slapped cheeks. Photo by Dr. Philip S. Brachman

It is caused by parvovirus B19.

Symptoms start with a red rash on your child’s cheek, giving them the appearance that they have been slapped. And that’s where fifth disease’s other name comes from – slapped cheek disease.

This slapped cheek rash is often subtle, so that many parents might think that the rash is from the sun or wind. They often don’t even consider that their child might be ‘sick’ until a few days later, when they get a pink, lacy rash on their arms and legs. Even then, they might mistake the rash for hives, poison ivy, or any number of other common childhood rashes.

Diagnosis of Fifth Disease

Unless you understand that the fifth rash can come and go, being more obvious when your child is overheated, it can be easy to see why it isn’t quickly recognized by some people. It can also be confusing because the rash could also appear on a child’s back, chest, and leg – it doesn’t have to be limited to the cheeks and arms.

And the rash, which can be itchy, can linger for weeks or even months.

While a blood test can be done, it is this pattern of symptoms that makes the diagnosis.

Most importantly, understand that fifth disease eventually does goes away without treatment. While not usually necessary, anti-itch treatments may be tried.

Can your kids go to school with fifth disease?

Fortunately, kids are not contagious while they have this rash, so they can go to school and participate in other activities. You might need a note from your pediatrician to convince folks though. They were contagious during the week before they developed the rash though, so it can be a good idea to tell people, so they can look for symptoms too.

Facts About Fifth Disease

Other things to know about fifth disease include that:

  • Fifth disease is caused by the parvovirus B19 virus and is most common during the spring and school outbreaks are no uncommon.
  • The incubation period for fifth disease is very long – up to 4 to 21 days. That means you can get this virus about 4 to 21 days after being exposed to someone else that had it, especially if you were exposed to their respiratory secretions (coughing and sneezing) just before they developed their rash.
  • Prodromal symptoms of fifth disease, which can start 7 to 10 days before the rash, might include a few days of mild fever, muscle aches, headache and decreased activity.
  • In addition to a rash, adults with fifth disease can also have joint pain and arthritis.

It is also important to know that like roseola, fifth disease can be more serious for those with immune system problems. It can also be serious for pregnant women who aren’t immune and for those with hemolytic anemia and sickle cell disease.

What to Know About Fifth Disease

Fifth disease is a very common viral infection that causes a characteristic rash on a child’s cheeks, arms, and legs that can linger for weeks.

More Information About Fifth Disease

Rotavirus Vaccines and Infections

Rotavirus is a now vaccine-preventable disease that can cause vomiting and diarrhea in young children.

While rotavirus isn’t the only cause of diarrhea in children, it was once the most common cause of severe diarrhea in young children.

Norovirus, several bacteria (Salmonella and Shigella), parasites, and other organisms still cause gastroenteritis (stomach flu) in children, but we don’t see rotavirus as much anymore. The National Respiratory and Enteric Virus Surveillance System (NREVSS) now reports low levels of rotavirus infection each year, with only about 5% of rotavirus tests now being positive during the peak of rotavirus season vs over 25% in the pre-vaccine era.

Rotavirus Infections

Children can develop symptoms of rotavirus symptoms about 1 to 3 days after being exposed to someone else who is sick with a rotavirus infections (the incubation period). These symptoms could include vomiting, watery diarrhea (without blood or mucus), fever, and abdominal pain. Although the fever and vomiting typically only last a few days, the diarrhea can often last at least 3 to 8 days or longer.

A rapid antigen stool test is available to test for rotavirus, but the diagnosis a typically made clinically, which means without testing and based on your child’s symptoms, especially if rotavirus infections are going around in your community.

Of course getting diagnosed with rotavirus is much less likely these days, now that we have a safe and effective vaccine.

While rotavirus was once the most common cause of severe diarrhea in children, leading to about 3 million cases of diarrhea, 55,000 hospitalizations, and 20 to 40 deaths in the United States each year, that has been greatly reduced in the post-vaccine era.

During the 2007-2008 rotavirus season, rotavirus activity decreased by more than 50% as compared to the 15 previous rotavirus seasons from 1991 to 2006. And during the 2010 to 2012 seasons, “the number of positive rotavirus tests declined 74%-90% compared with the pre-vaccine baseline and the total number of tests performed annually declined 28%-36%.”

Rotavirus Vaccines

The first rotavirus vaccine, Rotashield was quickly taken off the market in 1999 after it was found to be associated with an increased risk of intussusception, a type of bowel obstruction.

Newer rotavirus vaccines include:

  • RotaTeq – approved in 2006 and given to infants as a 3 dose vaccine series, it provides protection against five common strains of rotavirus, including serotypes G1, G2, G3, G4 and P1
  • Rotarix – approved in 2008 and given to infants as a 2 dose vaccine series, it provides protection against the most strain of rotavirus that most commonly gets kids sick

Both are live vaccines that are given orally and are thought to provide protection for at least two to three rotavirus seasons.

How good is that protection?

Completing either series of vaccines has been found to provide up to 98% protection against severe rotavirus gastroenteritis and up to 87% against any rotavirus gastroenteritis.

Infants should not get a rotavirus vaccine if they have had a severe allergic to a previous dose of the vaccine, to latex, if they have a history of intussusception, or if they have severe combined immunodeficiency (SCID).

They can usually get the rotavirus vaccine if they simply have some chronic stomach issues, like acid reflux or a milk intolerance, or if someone in the house has a problem with their immune system (just wash your hands after diaper changes). An immune system problem that is not SCID, an episode of acute, moderate or severe gastroenteritis, or other acute illness would be considered precautions to getting the rotavirus vaccine.

What To Know About Rotavirus

Rotavirus is a life-threatening disease that was once very common in childhood but can now be easily prevented with either the RotaTeq or Rotarix vaccines.

 

Sources:

American Academy of Pediatrics. Rotavirus infections. In:Pickering LK, Baker CJ, Long SS, eds. RedBook: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2015

Gershon: Krugman’s Infectious Diseases of Children, 11th ed.

Live attenuated human rotavirus vaccine, Rotarix. Bernstein DI – Semin Pediatr Infect Dis – 01-OCT-2006; 17(4): 188-94.

Outbreaks of Acute Gastroenteritis Transmitted by Person-to-Person Contact, Environmental Contamination, and Unknown Modes of Transmission — United States, 2009–2013. MMWR. December 11, 2015 / 64(SS12);1-16

Tate JE et al. Trends in national rotavirus activity before and after introduction of rotavirus vaccine into the national immunization program in the United States, 2000 to 2012. Pediatr Infect Dis J. 2013;32(7):741-744.