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Enterovirus may be linked to paralysis in 12 Colorado children, study findsnew study by researchers from Children's Hospital Colorado suggests a potential link between a rare respiratory virus and a form of paralysis that has so far affected more than 100 children in the US. Since early August last year, 107 children over 34 US states have developed acute flaccid paralysis (AFP) - a sudden form of muscle weakness or paralysis. The condition is characterized by limb weakness, difficulty swallowing and/or facial weakness.AFP is normally associated with poliovirus, and global vaccinations for the virus has meant incidence of AFP has become uncommon. But the number of recent cases identified is three times higher than normal.While the cause remains unclear, the Centers for Disease Control and Prevention (CDC) have flagged enterovirus D68 (EV-D68) - a non-polio virus that causes mild to severe respiratory illness - as a culprit, particularly since 2014 saw an outbreak of the virus around the same time as cases of AFP rose.Starting in Missouri and Illinois in August 2014, outbreaks of EV-D68 soon started to spread to other parts of the US, including Colorado - where from then until October, several children were admitted to Children's Hospital Colorado with AFP.Study leader Dr. Kevin Messacar, a pediatric infectious disease physician and researcher at Children's Hospital Colorado, and colleagues set out to review these cases in an attempt to gain a better understanding of the cause.According to the researchers, between August 1st and September 30th, 2014, there was a 36% rise in the number of respiratory-related visits to Children's Hospital Colorado emergency department and a 77% increase in respiratory-related admission rates, compared with the same months in 2013 and 2014.During the same period last year, the team notes, there was also a significant rise in the number of nasal samples testing positive for rhinovirus and enterovirus."In a sample of 25 specimens from children admitted to the intensive care unit with severe respiratory illness who tested positive for rhinovirus or enterovirus in the nasopharynx, we identified EV-D68 in 19 (76%) specimens," say the researchers.'S everal factors suggest a link between EV-D68 neurological disease'Between August 1st and October 31st, 2014, the researchers identified 12 children who presented at the hospital with varying severities of muscle weakness in their limbs, facial weakness and problems swallowing. Around a week before these symptoms started, all of the children had a fever and respiratory illness.Magnetic resonance imaging (MRI) revealed that 10 of the children had lesions in the spinal cord, while nine of the children had brain stem lesions. The researchers identified the presence of enteroviruses or rhinoviruses among eight of the children - and five of these tested positive for EV-D68.Though the 12 children have received treatment, 10 of the children with limb paralysis continue to have problems and the researchers say it is unclear as to whether this will be permanent. They add that three of the children have shown improvements in swallowing and facial weakness, however.Based on their findings, published in The Lancet, the researchers believe it is possible EV-D68 may be associated with neurological disease. They say:"We report the first geographical and temporal cluster of acute flaccid paralysis and cranial nerve dysfunction associated with a community-wide outbreak of enterovirus-D68 respiratory disease.Although our findings do not prove that enterovirus D68 is the cause of the neurological presentations described, several epidemiological, virological and clinical factors suggest an association between the D68 virus and neurological disease."They add that if EV-D68 outbreaks continue, effective treatments and vaccines against the virus need to be a major scientific priority."If further investigation confirms the link between EV-D68 and AFP and cranial nerve dysfunction, EV-D68 will be added to the list of non-poliovirus enteroviruses capable of causing severe, potentially irreversible neurologic damage, and finding effective antiviral therapies and vaccines will be a priority," says senior author Dr. Samuel Dominguez, microbial epidemiologist at the Children's Hospital Colorado.In June 2013, Medical News Today reported on a study that found a number of children with Crohn's disease also had enterovirus, indicating a link between the two conditions.Written by Honor WhitemanReferencesA cluster of acute flaccid paralysis and cranial nerve dysfunction temporally associated with an outbreak of enterovirus D68 in children in Colorado, USA, Kevin Messacar, et al., The Lancet, published online 29 January 2015, abstract.The Lancet news release, accessed 30 January 2015.Additional source: CDC, Summary of findings: investigation of acute flaccid myelitis in US Children, 2014, accessed 30 January 2015.Organ transplants in the US 'have saved almost 2.3 million years of life'Little more than 50 years ago, the world's first successful kidney transplant took place. Now, more than 16,000 kidney transplants take place each year in the US alone, indicative of just how far organ transplantation has come. Now, researchers have analyzed 25 years of transplant data to determine how many years of life have been saved by the procedure.The research team, including Dr. Abbas Rana of the Baylor College of Medicine in Houston, TX, publishes their findings in JAMA Surgery.In the US, around 79 people each day receive an organ transplant. Every 10 seconds, a person is added to the waiting list to receive one. Organ transplantation is normally the only effective treatment for end-stage organ failure, meaning people's lives literally depend on the procedure.Statistics up to the beginning of December 2012 reveal that of patients who received a heart transplant, almost 70% were alive 5 years later. For patients who received a kidney transplant from a living donor, 92% were alive 5 years after the procedure. With figures like these, it is no wonder Dr. Rana and colleagues hail organ transplantation as the "marvel of modern medicine."For their study, however, the team wanted to delve deeper into the survival benefits of organ transplantation in the US. They set out to determine how many years of life the procedure has saved between 1987 and 2012.The number of life-years saved is a 'stellar accomplishment'In 1987, the United Network for Organ Sharing (UNOS) began keeping records of all solid organ transplants that take place in the US, as well as records of patients who were waiting for a transplant.Using the UNOS database, Dr. Rana and colleagues reviewed the records of 1,112,835 patients with end-stage organ failure. Of these, 533,329 received a transplant and 579,506 were on the waiting list but did not have the procedure.The researchers calculated the number of life-years saved by organ transplantation between September 1st, 1987 and December 31st, 2012 by comparing the survival outcomes of patients who underwent the procedure with those who did not.The results of the analysis revealed that over the 25-year period, organ transplantation saved 2,270,859 years of life in the US. Each organ transplant was estimated to have saved around 4.3 years of life.The researchers also estimated the years of life saved by each type of organ transplantation, which were:Kidney transplant - 1.3 million years of life savedLiver transplant - 465,296 years of life savedHeart transplant - 269,715 years of life savedPancreas-kidney transplant - 79,198 years of life savedLung transplant - 64,575 years of life savedPancreas transplant - 14,903 years of life savedIntestine transplant - 4,402 years of life saved.The researchers hail the almost 2.3 million life-years saved by organ transplantation in the US as a "stellar accomplishment." They add:"Although most of the findings in this analysis are not novel, this analysis concisely reports on the collective experience of solid-organ transplant in the United States, making it, to our knowledge, the largest study in the field of transplantation yet conducted.These results refute any lingering perception of transplantation as a niche field with limited practical benefit. Furthermore, focusing exclusively on the survival benefit does not capture the vast improvements in quality of life and the drastically lowered morbidity rates after a transplant."Donor shortages hamper progress of organ transplantationThe researchers point out, however, that there is a "critical shortage" of donor organs, which hinders progress in the field of organ transplantation.They note that of the patients on the waiting list for an organ transplant during the 25-year period studied, only 47.9% had the procedure.According to the US Government Information on Organ and Tissue Donation and Transplantation, 123,258 people in the US are currently waiting for an organ transplant, but only 30,000 organ transplants were carried out in 2013. Around 18 people die each day waiting for an organ transplant."The need is increasing; therefore, organ donation must increase," say the researchers. "We call for deepened support of solid-organ transplant and donation - worthy endeavors with a remarkable record of achievement and a tremendous potential to do even more good for humankind in the future."In September 2014, Medical News Today reported on a study published in BMC Medicine, in which researchers from the UK assessed whether an opt-in or opt-out system is best for organ donations.Written by Honor WhitemanReferencesSurvival benefit of solid-organ transplant in the United States, Abbas Rana, et al., JAMA Surgery, doi:10.1001/jamasurg.2014.2038, published online 28 January 2015, abstract. JAMA news release, accessed 28 January 2015.Additional source: US Government Information on Organ and Tissue Donation and Transplantation, organ donation data, accessed 28 January 2015.。