Neurological complications of flu in children may rise this year

Today's Med Page story.

Public health officials are considering reporting a slight potential increase in neurological complications of influenza in children – particularly a rapidly progressive and dangerous condition called acute necrotizing encephalopathy (ANE).

Adrienne Randolph, MD, MSc, from Boston Children's Hospital, said he has reported about 12 potential cases of fluid-related ANE to the CDC's Center for Vaccination and Respiratory Diseases (NCIRD) in the past few weeks. Ta.

Randolph's position as leader Pediatric intensive care influenza network It gives her special insight into what's going on with flu complications for children across the country.

“No studies say that all of these cases are truly acute necrotizing encephalopathy,” Randolph said. Today's Med Pagecaution about making preliminary conclusions. “That's why I let the CDC know about potential cases across the US that I know. They can investigate.”

She noted that ANE could be a complex diagnosis that requires the discovery of specific clinical features and imaging. So, “Whatever is done needs to be done in a systematic way, and cases are carefully viewed by experts,” she said.

Nevertheless, Randolph said he couldn't remember investigators from a site that was observing flu-related ANE cases last year.

A CDC spokesman said Today's Med Page The agency is “aware of anecdotal reports” of influenza A-related ANEs in children. “We have no active monitoring of ANE, but we are considering the situation and will provide updates.”

Randolph said her NCIRD contact “suggested me a clever question and I sent them more information, but that's pretty much it.”

A doctor at one US center said Today's Med Page Their facility had a baby died from an influenza-related ANE this year. “It really progressed quickly and she [went into a coma] The sources whose name and location were withheld to protect the privacy of patients. The baby used to be healthy.

Andrew Silverman, MHS, MHS, MHS, and Keith Van Harlen, MD, of Stanford Medicine, California, have recognized at least 10 cases of flu-related ANE in their state alone, over the flu season last year and this year. He said there was.

“ANE is not specifically reportable, but this appears to be a true increase in the number of cases,” Silverman said. Today's Med Page. Last year, they treated and presented flu-related ANE children at Lucile Packard Children's Hospital Stanford Case report for Neurology.

Following that case, “we have a rare cluster of additional cases in the coming weeks, which has encouraged interest in a larger case series,” Van Harlen said. Today's Med Page.

Silverman and Van Harlen have collected cases of ANE related to the flu and recently issued a request for the International Association of Infectious Diseases' promised mailing list serv. Silverman said with the help of the California Department of Public Health, they are also calling for a stronger surveillance recommendation for the condition.

Symptoms of ANE may include seizures and changes in mental state, and patients may become coma, says Sue Hong Rootson, a pediatric neurocoagulant patient at Johns Hopkin Children's Center in Baltimore. said M.D.

“This is a dramatic brain edema of this type, and the brain expands rapidly within a really short time frame,” Rootson said. Today's Med Page. “Your child can go to the hospital, and after a day or two, your brain is so swollen that it loses all its brain function. It's pretty scary in that you feel Dominoes start falling. Then come back.”

Classic imaging findings of ANE include bilateral thalamus involvement, deep gray matter involvement, and sometimes brainstem involvement, she said.

Routson said her facility had one case of ANE this year, along with four other cases of neurological complications of influenza that do not have classic ANE findings about MRI or clinical progression. He said he was there.

Usually, she said she might see one case of influenza with neurological complications each year.

She said it was “a very active flu season.” [intensive care unit] Admission is happening now.

In fact, CDC data has influenza It's the best evereven during the 2009-2010 H1N1 pandemic season, reported CDC sources that requested anonymity Today's Med Page. “As of the week ending February 1st, including the 2009 H1N1 pandemic, the percentage of outpatient visits with flu-like illnesses is the highest ever,” the source said. Masu.

It is not clear whether the overall surge in flu is increasing the number of rare complications, experts said. It is also possible that children are vaccinated or perhaps less immunized as they are not exposed to the flu during the Covid-19 pandemic.

However, last year, Italian researchers reported an outbreak of influenza with ANE at Meyer Children's Hospital in Florence, Italy. Seven children developed conditions ranging from milder encephalopathy to ANE with coma and multi-intestinal disorders. They explain in detail in the European CDC Journal EuroSurveIllance.

One of the children died, the other was left in minimal consciousness, while the rest had a good or full recovery.

The authors reported that all children tested positive for the 2009 H1N1 pandemic strain, but the cause of the cluster of cases was not precisely clear.

Clinicians are wary as H5N1 avian influenza spreads across the United States to a total of 68 human cases, with H5N1 avian influenza reaching dairy cows and poultry herds. According to the latest CDC data.

However, Randolph noted that the potential increase in influenza neurological complications this year does not appear to be linked to H5N1. Although some of the 12 cases she reported to the CDC had subtyping, they turned out to be a 2009 H1N1 pandemic strain, she said.

Nevertheless, CDC sources said they feel they are in the dark about flu surveillance as they are not permitted to communicate with key partners such as medical institutions.

“We would normally have been in great communication with our clinical and other partners now, but we're not able to talk to them because we've been ordered to stand up to the new administrative manager,” the source said. I did.

Especially with regard to H5N1, the source said the CDC was not getting enough information about testing and subtyping. “Therefore, they don't really understand the situation.”

Randolph and Rootson said treatment for ANE includes steroids, intravenous immunoglobulins and other immune modulators such as Anakinra (Kinelet) and tocilizumab (Actemra) as it is thought to be an overreaction of the immune system .

They said they may reveal words about the potential increase in cases. Community physicians may help them better identify and treat their condition.