Increase in suspected cases of Acute Flaccid Myelitis in Washington state since September 2016

As of November 4, 2016 no cases of Acute Flaccid Myelitis have been reported in Grays Harbor County.

Current Situation in Washington

• A cluster of suspected acute flaccid myelitis (AFM) has been reported among Washington residents.

• As of November 3rd, 2016, two cases have been confirmed and seven others are being evaluated by CDC.

• All cases are among children between 3 and 14 years of age who presented with acute paralysis of one or more limbs. All had a febrile prodrome 1 to 2 weeks prior to presentation with symptoms of AFM.

• The earliest onset of limb weakness was on September 14th and the most recent on October 27th.

• The cases are residents of King County (3), Pierce County (1), Franklin County (2), Snohomish County (1) and Whatcom County (2).

Actions Requested

• Report suspected cases of AFM promptly (see case definition below) to Grays Harbor County Public Health and Social Services at 360-532-8631, or the 24 hour emergency number: 360-581-1401.

• Complete the AFM patient summary form when reporting patients to Grays Harbor County Public Health and Social Services.

• Collect specimens from patients suspected of having AFM as early as possible in the course of illness (see details below)*.

• Notify Grays Harbor County Public Health and Social Services if you are aware of patients of any age that presented to your facility or practice in 2016 and fit the case definition (must have CSF results or MRI report available).

• Contact Grays Harbor County Public Health and Social Services for guidance.

Background Information

From January 1st to September 30th, 2016, a total of 89 people in 33 states across the country have been confirmed to have AFM. This represents an increase over the previous 2 years (reporting only started in 2014). Most of these have been in children. No etiology for the infections has been established although a potential association with enterovirus D68 has been reported. AFM is also known to be associated with other neurotropic enteroviruses, adenovirus, herpes viruses, arboviruses including West Nile virus, and other etiologies. Non-infectious causes have not been ruled out.

Resources

CSTE case definition: Clinicians should be vigilant and consider AFM in patients presenting with:

• Onset of acute limb weakness

• AND a magnetic resonance image (MRI) showing spinal cord lesion largely restricted to gray matter and spanning one or more spinal segments

• OR cerebrospinal fluid (CSF) showing pleocytosis (white blood cell count >5 cells/mm3)

Specimen collection guidance

Collect specimens from patients suspected of having AFM as early as possible in the course of illness including:

• Cerebrospinal fluid,

• Serum (acute and convalescent) and whole blood*,

• Two stool specimens separated by 24 hours (whole stool preferred over rectal swab),

• Upper respiratory tract sample (in order of preference: nasopharyngeal swap > nasal swab > nasal wash/aspirate > oropharyngeal swab,

• Oropharyngeal swab should always be collected in addition to the nasopharyngeal specimen on any patient suspected to have polio.

*Whole blood should be sent refrigerated to CDC and arrive within 24 hours of collection.

WA Department of Health – AFM Investigation

Centers for Disease Control and Prevention – Acute Flaccid Myelitis website

 For questions or further information, contact Lisa Leitz, RN, Communicable Disease Program Coordinator, at 532-8631 x4044.

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West Nile virus: Tests confirm first death in WA from disease

The Washington State Department of Health (DOH) confirmed the first death due to West Nile virus this year in Washington. The decedent was a female in her 70s, was a resident of Benton County and was most likely exposed to infected mosquitoes in Benton County. A second reported case, a man in his 80s from Benton County, is currently hospitalized with West Nile virus disease. He was also most likely exposed to infected mosquitoes in Benton County. Currently, there are no cases of West Nile virus disease in Grays Harbor County.

As of August 18th, 2016, West Nile virus activity has been found in seven counties in eastern Washington: Benton, Yakima, Spokane, Adams, Franklin, Grant, and Stevens counties. Although eastern Washington is where most West Nile virus is detected, the mosquito species that carry West Nile virus are found throughout the state.

Action requested: Remind all patients about the precautions they can take to avoid being bitten by mosquitoes.

• Use an EPA-registered mosquito repellent when outdoors or in the woods.

• Stay indoors around dawn and dusk when mosquitoes are most active, if possible.

• If outdoors during dusk and dawn, wear long sleeves and pants to avoid bites.

  Prevention Tips for the Home:

• Make sure your door and window screens are in good condition, and mosquitoes cannot get indoors.

• Reduce mosquito habitat around the home by dumping standing water from buckets, tires, cans, flower pots, etc. Frequently change the water in kids’ wading pools, bird baths, pet dishes, and water troughs.

Symptoms: Most people bitten by a mosquito carrying West Nile virus will not get sick. Some people will develop mild symptoms (including headache, fever, body aches that go away without treatment). In rare instances, however, West Nile virus can be very serious and/or fatal. Severe disease can include meningitis or encephalitis. The risk for serious illness is highest among people over 60 years of age, and those with certain medical conditions (such as cancer, diabetes, hypertension, kidney disease, and people who have received organ transplants).

 Resources

• Washington State Department of Health, West Nile virus information line: 1-866-788-4787

• Washington State Department of Health, West Nile virus webpage

• Centers for Disease Control and Prevention

For questions or further information, contact Lisa Leitz, RN, Communicable Disease Program Coordinator, at 532-8631 x4044. 

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Lead exposure concern: Status update

Recent detections of lead in drinking water systems in Flint, Michigan and Tacoma, Washington have raised public awareness of the importance of safe drinking water and prevention of lead exposure. As of May 5, 2016, no current cases of lead poisoning (≥ 45µg/dL) or detections of lead in public drinking water have been reported in Grays Harbor.

At this time standard lead screening and assessment is requested. We will continue to monitor recommendations from the Washington State Department of Health and will share guidance for providers if any change in action is requested or exposure concerns arise.

Grays Harbor Environmental Health Department is responding to inquiries about public water safety, and questions can be directed to Environmental Health at 249-4222.

Standard action is requested – no new action at this time

• Assess all children for risk of lead poisoning at 12 and 24 months of age.

• WA Department of Health recommends performing a blood lead test on children with the following risk factors:

  • Lives in or regularly visits any house built before 1950.

  • Lives in or regularly visits any house built before 1978 with recent or ongoing renovations or remodeling.

  • From a low income family (income <130% poverty level, and Federal law mandates screening for all children covered by Medicaid).

  • Known to have siblings or frequent playmate with an elevated blood lead level.

  • Is a recent immigrant, refugee, foreign adoptee, or child in foster care.

  • Has a parent or principal caregiver who works professionally or recreationally with lead (examples: remodeling, painting, mining, makes lead fishing weights, works in or visits gun ranges, hobbies involving stained glass, pottery, soldering or welding, etc.).

  • Uses traditional, folk, or ethnic remedies or cosmetics (examples: Greta, Azarcon, Ghasard, Ba-baw-san, Sindoor, and Kohl).

• Healthcare providers should consider testing additional children per clinical judgment, including, but not limited to:

  • Children whose parents have concerns or request testing.

  • Children living within a kilometer of an airport or lead emitting industry, or on former orchard land.

  • Children with pica behavior.

  • Children with neurodevelopmental disabilities or conditions such as autism, ADHD, and learning delays.

• An elevated blood lead level ≥ 5µg/dL is a notifiable condition.

   Background information

• In Washington, the most common source of lead poisoning is lead-based paint. Paint containing lead was not banned until 1978.

• Other common sources of lead exposure are: contaminated soil, children’s toys and jewelry, drinking water, workplace and hobby hazards, home remedies and cosmetics, lead glazed ceramic ware, imported candy and mini blinds.

  Resources

• Washington Department of Health, Blood Lead Testing and Reporting: Information for Health Care Providers website.

• Washington Department of Health, Lead information website.

  For questions or further information, contact Lisa Leitz, RN, Communicable Disease Program Coordinator, at 532-8631 x4044  

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 EPI NEWS is faxed to healthcare offices during events of public health significance.  Please share or post so that others may see this.  Sign up for Epi News by email at:  lleitz@co.grays-harbor.wa.us.