Jan Dyer

Many patients with spinal cord injury (SCI) need mechanical ventilatory support. One type of support is diaphragm pacing, which stimulates the diaphragm, helping the person breathe. A minimally invasive form of diaphragm pacing via laparoscopically placed intramuscular diaphragm electrodes has “liberated thousands of patients from mechanical ventilation,” says Anthony DiMarco, MD. He and VA colleague Krzysztof Kowalski, PhD, have found a way to completely restore respiratory muscle function in patients with SCI safely and effectively.

In mid-thoracic and higher level SCIs, the expiratory muscles are paralyzed, putting patients at risk for respiratory tract infections and atelectasis, a major cause of morbidity and mortality in that population. The research team, led by DiMarco and Kowalski, combined diaphragm pacing with a minimally invasive system that allows the patient—simply with the press of a button—to cough effectively, reducing the risk of aspiration and infections. It is the first method in the world, says Dr. Kowalski, that activates abdominal and lower rib cage muscles to produce an effective cough.

An interventional clinical trial in 3 patients demonstrated that using the 2 systems in tandem was safe. The new system was implanted surgically, with disc electrodes placed on the dorsal surface of the spinal cord via laminectomy. Participants in the study used a stimulator to produce several different cough efforts from light to strong.

Mean peak expiratory airflow and airway pressure generation during spontaneous efforts were 1.7 ± 0.2 L/s and 31 ± 7 cmH₂O, respectively. After the spinal cord stimulation was applied, peak expiratory airflow was 9.0 ± 1.9 L/s and airway pressure generation was 90 ± 6 cmH₂O. In other words, results “characteristic of a normal cough,” the researchers concluded. Moreover, each patient raised secretions much more easily.

The research is being done at the Cleveland Functional Electrical Stimulation Center, a consortium of MetroHealth Medical Center, Case Western Reserve University, and Louis Stokes Cleveland VA Medical Center.

Army veteran David Powers, one of the study participants, in an interview with the VAntage Point blog, says, “Being a part of this research trial has made me feel great. For not only my own health but helping to improve the lives of others as well.”

Many patients with spinal cord injury (SCI) need mechanical ventilatory support. One type of support is diaphragm pacing, which stimulates the diaphragm, helping the person breathe. A minimally invasive form of diaphragm pacing via laparoscopically placed intramuscular diaphragm electrodes has “liberated thousands of patients from mechanical ventilation,” says Anthony DiMarco, MD. He and VA colleague Krzysztof Kowalski, PhD, have found a way to completely restore respiratory muscle function in patients with SCI safely and effectively.

In mid-thoracic and higher level SCIs, the expiratory muscles are paralyzed, putting patients at risk for respiratory tract infections and atelectasis, a major cause of morbidity and mortality in that population. The research team, led by DiMarco and Kowalski, combined diaphragm pacing with a minimally invasive system that allows the patient—simply with the press of a button—to cough effectively, reducing the risk of aspiration and infections. It is the first method in the world, says Dr. Kowalski, that activates abdominal and lower rib cage muscles to produce an effective cough.

An interventional clinical trial in 3 patients demonstrated that using the 2 systems in tandem was safe. The new system was implanted surgically, with disc electrodes placed on the dorsal surface of the spinal cord via laminectomy. Participants in the study used a stimulator to produce several different cough efforts from light to strong.

Mean peak expiratory airflow and airway pressure generation during spontaneous efforts were 1.7 ± 0.2 L/s and 31 ± 7 cmH₂O, respectively. After the spinal cord stimulation was applied, peak expiratory airflow was 9.0 ± 1.9 L/s and airway pressure generation was 90 ± 6 cmH₂O. In other words, results “characteristic of a normal cough,” the researchers concluded. Moreover, each patient raised secretions much more easily.

The research is being done at the Cleveland Functional Electrical Stimulation Center, a consortium of MetroHealth Medical Center, Case Western Reserve University, and Louis Stokes Cleveland VA Medical Center.

Army veteran David Powers, one of the study participants, in an interview with the VAntage Point blog, says, “Being a part of this research trial has made me feel great. For not only my own health but helping to improve the lives of others as well.”

Many patients with spinal cord injury (SCI) need mechanical ventilatory support. One type of support is diaphragm pacing, which stimulates the diaphragm, helping the person breathe. A minimally invasive form of diaphragm pacing via laparoscopically placed intramuscular diaphragm electrodes has “liberated thousands of patients from mechanical ventilation,” says Anthony DiMarco, MD. He and VA colleague Krzysztof Kowalski, PhD, have found a way to completely restore respiratory muscle function in patients with SCI safely and effectively.

In mid-thoracic and higher level SCIs, the expiratory muscles are paralyzed, putting patients at risk for respiratory tract infections and atelectasis, a major cause of morbidity and mortality in that population. The research team, led by DiMarco and Kowalski, combined diaphragm pacing with a minimally invasive system that allows the patient—simply with the press of a button—to cough effectively, reducing the risk of aspiration and infections. It is the first method in the world, says Dr. Kowalski, that activates abdominal and lower rib cage muscles to produce an effective cough.

An interventional clinical trial in 3 patients demonstrated that using the 2 systems in tandem was safe. The new system was implanted surgically, with disc electrodes placed on the dorsal surface of the spinal cord via laminectomy. Participants in the study used a stimulator to produce several different cough efforts from light to strong.

Mean peak expiratory airflow and airway pressure generation during spontaneous efforts were 1.7 ± 0.2 L/s and 31 ± 7 cmH₂O, respectively. After the spinal cord stimulation was applied, peak expiratory airflow was 9.0 ± 1.9 L/s and airway pressure generation was 90 ± 6 cmH₂O. In other words, results “characteristic of a normal cough,” the researchers concluded. Moreover, each patient raised secretions much more easily.

The research is being done at the Cleveland Functional Electrical Stimulation Center, a consortium of MetroHealth Medical Center, Case Western Reserve University, and Louis Stokes Cleveland VA Medical Center.

Army veteran David Powers, one of the study participants, in an interview with the VAntage Point blog, says, “Being a part of this research trial has made me feel great. For not only my own health but helping to improve the lives of others as well.”

Psoriasis is associated with systemic inflammation, which heightens the risk of blood vessel disease and diabetes. Therefore, the finding, while notable, may not have been entirely unexpected. Biologic therapy (BT) for psoriasis was already found to be favorably associated with luminal coronary plaque, the researchers say, but it was not clear whether those associations were attributable to direct anti-inflammatory effects on the coronary arteries. They wanted to find out whether the perivascular fat attenuation index (FAI) would offer clues. FAI is a new method of analyzing CT scans by assessing whether the fat tissue surrounding arteries becomes attenuated, or less fatty.

The researchers investigated their premise in 134 participants from an ongoing NIH study, the Psoriasis Atherosclerosis Cardiometabolic Initiative cohort. Of the participants, 82 had been receiving anti-tumor necrosis factor α, anti-interleukin (IL) 12/23, or anti-IL-17 for 1 year. The remaining 52 had not received any BT, and given topical or light therapy. The patients underwent CT scans at the start of the study and 1 year later. All of the patients had low cardiovascular risk. At baseline, 27 in the treated group and 19 in the untreated group had a focal coronary atherosclerotic plaque.

The study found that an abnormal perivascular FAI was linked to a 6- to 9-fold increased risk of major adverse cardiovascular events, study coauthor Charalambos Antoniades, MD, says. Patients on BT had a significant decrease in FAI at 1 year, as well as improved psoriasis symptoms. Even patients with preexisting coronary artery plaque had a reduction in coronary inflammation after BT. No change was seen in the untreated patients. The associations with FAI were independent of the presence of coronary plaque and were consistent among patients receiving different biologic agents.

The researchers say their findings have implications for other chronic inflammatory diseases, such as lupus and rheumatoid arthritis, which are known to raise the risk for heart attacks and stroke.

Psoriasis is associated with systemic inflammation, which heightens the risk of blood vessel disease and diabetes. Therefore, the finding, while notable, may not have been entirely unexpected. Biologic therapy (BT) for psoriasis was already found to be favorably associated with luminal coronary plaque, the researchers say, but it was not clear whether those associations were attributable to direct anti-inflammatory effects on the coronary arteries. They wanted to find out whether the perivascular fat attenuation index (FAI) would offer clues. FAI is a new method of analyzing CT scans by assessing whether the fat tissue surrounding arteries becomes attenuated, or less fatty.

The researchers investigated their premise in 134 participants from an ongoing NIH study, the Psoriasis Atherosclerosis Cardiometabolic Initiative cohort. Of the participants, 82 had been receiving anti-tumor necrosis factor α, anti-interleukin (IL) 12/23, or anti-IL-17 for 1 year. The remaining 52 had not received any BT, and given topical or light therapy. The patients underwent CT scans at the start of the study and 1 year later. All of the patients had low cardiovascular risk. At baseline, 27 in the treated group and 19 in the untreated group had a focal coronary atherosclerotic plaque.

The study found that an abnormal perivascular FAI was linked to a 6- to 9-fold increased risk of major adverse cardiovascular events, study coauthor Charalambos Antoniades, MD, says. Patients on BT had a significant decrease in FAI at 1 year, as well as improved psoriasis symptoms. Even patients with preexisting coronary artery plaque had a reduction in coronary inflammation after BT. No change was seen in the untreated patients. The associations with FAI were independent of the presence of coronary plaque and were consistent among patients receiving different biologic agents.

The researchers say their findings have implications for other chronic inflammatory diseases, such as lupus and rheumatoid arthritis, which are known to raise the risk for heart attacks and stroke.

Psoriasis is associated with systemic inflammation, which heightens the risk of blood vessel disease and diabetes. Therefore, the finding, while notable, may not have been entirely unexpected. Biologic therapy (BT) for psoriasis was already found to be favorably associated with luminal coronary plaque, the researchers say, but it was not clear whether those associations were attributable to direct anti-inflammatory effects on the coronary arteries. They wanted to find out whether the perivascular fat attenuation index (FAI) would offer clues. FAI is a new method of analyzing CT scans by assessing whether the fat tissue surrounding arteries becomes attenuated, or less fatty.

The researchers investigated their premise in 134 participants from an ongoing NIH study, the Psoriasis Atherosclerosis Cardiometabolic Initiative cohort. Of the participants, 82 had been receiving anti-tumor necrosis factor α, anti-interleukin (IL) 12/23, or anti-IL-17 for 1 year. The remaining 52 had not received any BT, and given topical or light therapy. The patients underwent CT scans at the start of the study and 1 year later. All of the patients had low cardiovascular risk. At baseline, 27 in the treated group and 19 in the untreated group had a focal coronary atherosclerotic plaque.

The study found that an abnormal perivascular FAI was linked to a 6- to 9-fold increased risk of major adverse cardiovascular events, study coauthor Charalambos Antoniades, MD, says. Patients on BT had a significant decrease in FAI at 1 year, as well as improved psoriasis symptoms. Even patients with preexisting coronary artery plaque had a reduction in coronary inflammation after BT. No change was seen in the untreated patients. The associations with FAI were independent of the presence of coronary plaque and were consistent among patients receiving different biologic agents.

The researchers say their findings have implications for other chronic inflammatory diseases, such as lupus and rheumatoid arthritis, which are known to raise the risk for heart attacks and stroke.

The VA currently stipulates a 3-month maximum dispensing limit for all medications, including oral contraceptive pills (OCPs). But a 12-month cycle for OCPs improves adherence, reduces coverage gaps, and reduces unintended pregnancy, say researchers from University of Pittsburgh and the VA Pittsburgh Health Care System, both in Pennsylvania. Not only that, they add, the VA could save > $2 million a year.

OCPs are among the most commonly used methods of contraception among women veterans. VA data indicate that 43% of women dispensed 3-month supplies experience ≤ 1 gap of ≤ 7 days between refills during a year of use. Citing research that has found women on 12-month dispensing cycles have fewer gaps, which leads to fewer unintended pregnancies and abortions. US guidelines now recommend routine initial dispensing of up to 1-year supplies of hormonal contraception.

However, the financial consequences for such a switch in the VA were unclear, the researchers say. To find out, they developed a decision analysis model from the VA perspective to compare incremental costs of a 12-month supply vs a 3-month supply dispensed quarterly. Basing their model on a cohort of 24,309 women, the researchers looked at the effects of each strategy on resulting coverage gaps, discontinuation of OCPs, pregnancy, birth, miscarriage, and abortion.  

The model projected that the 12-month system would reduce unintended pregnancies by 14%, or 583 unintended pregnancies averted annually—a conservative estimate, the researchers say.

Overall, the model estimated total savings of > $2 million annually.

Their results suggest obvious financial benefits for the VA—for example, less money spent on intrapartum care, the researchers say. But they add, “it is vital that contraceptive policies serve first and foremost to augment women’s reproductive outcomes and autonomy.” They highlight the potential financial gains as a “secondary benefit to the more important and evidence-based goal of improving contraceptive access.”

The VA currently stipulates a 3-month maximum dispensing limit for all medications, including oral contraceptive pills (OCPs). But a 12-month cycle for OCPs improves adherence, reduces coverage gaps, and reduces unintended pregnancy, say researchers from University of Pittsburgh and the VA Pittsburgh Health Care System, both in Pennsylvania. Not only that, they add, the VA could save > $2 million a year.

OCPs are among the most commonly used methods of contraception among women veterans. VA data indicate that 43% of women dispensed 3-month supplies experience ≤ 1 gap of ≤ 7 days between refills during a year of use. Citing research that has found women on 12-month dispensing cycles have fewer gaps, which leads to fewer unintended pregnancies and abortions. US guidelines now recommend routine initial dispensing of up to 1-year supplies of hormonal contraception.

However, the financial consequences for such a switch in the VA were unclear, the researchers say. To find out, they developed a decision analysis model from the VA perspective to compare incremental costs of a 12-month supply vs a 3-month supply dispensed quarterly. Basing their model on a cohort of 24,309 women, the researchers looked at the effects of each strategy on resulting coverage gaps, discontinuation of OCPs, pregnancy, birth, miscarriage, and abortion.  

The model projected that the 12-month system would reduce unintended pregnancies by 14%, or 583 unintended pregnancies averted annually—a conservative estimate, the researchers say.

Overall, the model estimated total savings of > $2 million annually.

Their results suggest obvious financial benefits for the VA—for example, less money spent on intrapartum care, the researchers say. But they add, “it is vital that contraceptive policies serve first and foremost to augment women’s reproductive outcomes and autonomy.” They highlight the potential financial gains as a “secondary benefit to the more important and evidence-based goal of improving contraceptive access.”

The VA currently stipulates a 3-month maximum dispensing limit for all medications, including oral contraceptive pills (OCPs). But a 12-month cycle for OCPs improves adherence, reduces coverage gaps, and reduces unintended pregnancy, say researchers from University of Pittsburgh and the VA Pittsburgh Health Care System, both in Pennsylvania. Not only that, they add, the VA could save > $2 million a year.

OCPs are among the most commonly used methods of contraception among women veterans. VA data indicate that 43% of women dispensed 3-month supplies experience ≤ 1 gap of ≤ 7 days between refills during a year of use. Citing research that has found women on 12-month dispensing cycles have fewer gaps, which leads to fewer unintended pregnancies and abortions. US guidelines now recommend routine initial dispensing of up to 1-year supplies of hormonal contraception.

However, the financial consequences for such a switch in the VA were unclear, the researchers say. To find out, they developed a decision analysis model from the VA perspective to compare incremental costs of a 12-month supply vs a 3-month supply dispensed quarterly. Basing their model on a cohort of 24,309 women, the researchers looked at the effects of each strategy on resulting coverage gaps, discontinuation of OCPs, pregnancy, birth, miscarriage, and abortion.  

The model projected that the 12-month system would reduce unintended pregnancies by 14%, or 583 unintended pregnancies averted annually—a conservative estimate, the researchers say.

Overall, the model estimated total savings of > $2 million annually.

Their results suggest obvious financial benefits for the VA—for example, less money spent on intrapartum care, the researchers say. But they add, “it is vital that contraceptive policies serve first and foremost to augment women’s reproductive outcomes and autonomy.” They highlight the potential financial gains as a “secondary benefit to the more important and evidence-based goal of improving contraceptive access.”

Even when a standard HIV RNA test is negative, some patients may still have viral DNA in their cerebrospinal fluid (CSF)—and that could be a predictor of later memory and concentration problems, say researchers who conducted a National Institute of Health (NIH)-funded study of patients on long-term antiretroviral therapy (ART).

The 69 participants, enrolled in the AIDS Clinical Trials Group HIV Reservoirs Cohort Study, had infections controlled with ART for a median of 9 years. Calling it a “striking observation,” the researchers found nearly half of the patients had viral DNA in CSF cells, although the standard viral load tests of the cell-free CSF fluid were positive in only 4% of the patients.

Of the 30 patients with persistent HIV, 9 (30%) experienced neurocognitive difficulties in a 7-domain neuropsychological test battery. Among 35 participants with no detectable HIV DNA in CSF, 4 (11%) were clinically impaired.

The low rates of detectable HIV RNA in the cell-free CSF fraction and within CSF cell pellets suggest low levels of HIV transcription within cells and infrequent release into the extracellular space during systemically suppressive ART, the researchers say.

The brain is one of the first targets of the virus, and CNS manifestations are common. Neurocognitive impairment in HIV-positive patients is probably related to multiple factors, including HIV infection, age, neuroinflammation, and comorbid conditions, including substance abuse, the researchers say. There also may be a “legacy effect,” in which processes associated with long-term exposure to HIV before ART leads to irreversible neurologic injury and more extensive infection of CSF cells. Lack of an association with inflammatory biomarkers in this study suggested that current inflammation does not lead to present neurocognitive dysfunction, the researchers say, but does not rule out prior inflammation as the underlying cause of neuronal injury.

Still, given that brain tissue in living individuals is “inaccessible” (as the researchers put it), CSF offers a window into neuropathogenesis of HIV. Studies have found a range between 15% and 55% of participants develop an HIV-associated neurocognitive disorder (HAND). The new findings may support a role of persistent HIV-infected cells, but the researchers emphasize that the association does not confirm that HIV DNA causes HAND. However, they add, persistent HIV in “sanctuary sites” despite ART presents a barrier to curing the infection. Their study, they say, indicates that examination of CSF cells is important in assessing residual HIV in compartments during ART.

Even when a standard HIV RNA test is negative, some patients may still have viral DNA in their cerebrospinal fluid (CSF)—and that could be a predictor of later memory and concentration problems, say researchers who conducted a National Institute of Health (NIH)-funded study of patients on long-term antiretroviral therapy (ART).

The 69 participants, enrolled in the AIDS Clinical Trials Group HIV Reservoirs Cohort Study, had infections controlled with ART for a median of 9 years. Calling it a “striking observation,” the researchers found nearly half of the patients had viral DNA in CSF cells, although the standard viral load tests of the cell-free CSF fluid were positive in only 4% of the patients.

Of the 30 patients with persistent HIV, 9 (30%) experienced neurocognitive difficulties in a 7-domain neuropsychological test battery. Among 35 participants with no detectable HIV DNA in CSF, 4 (11%) were clinically impaired.

The low rates of detectable HIV RNA in the cell-free CSF fraction and within CSF cell pellets suggest low levels of HIV transcription within cells and infrequent release into the extracellular space during systemically suppressive ART, the researchers say.

The brain is one of the first targets of the virus, and CNS manifestations are common. Neurocognitive impairment in HIV-positive patients is probably related to multiple factors, including HIV infection, age, neuroinflammation, and comorbid conditions, including substance abuse, the researchers say. There also may be a “legacy effect,” in which processes associated with long-term exposure to HIV before ART leads to irreversible neurologic injury and more extensive infection of CSF cells. Lack of an association with inflammatory biomarkers in this study suggested that current inflammation does not lead to present neurocognitive dysfunction, the researchers say, but does not rule out prior inflammation as the underlying cause of neuronal injury.

Still, given that brain tissue in living individuals is “inaccessible” (as the researchers put it), CSF offers a window into neuropathogenesis of HIV. Studies have found a range between 15% and 55% of participants develop an HIV-associated neurocognitive disorder (HAND). The new findings may support a role of persistent HIV-infected cells, but the researchers emphasize that the association does not confirm that HIV DNA causes HAND. However, they add, persistent HIV in “sanctuary sites” despite ART presents a barrier to curing the infection. Their study, they say, indicates that examination of CSF cells is important in assessing residual HIV in compartments during ART.

Even when a standard HIV RNA test is negative, some patients may still have viral DNA in their cerebrospinal fluid (CSF)—and that could be a predictor of later memory and concentration problems, say researchers who conducted a National Institute of Health (NIH)-funded study of patients on long-term antiretroviral therapy (ART).

The 69 participants, enrolled in the AIDS Clinical Trials Group HIV Reservoirs Cohort Study, had infections controlled with ART for a median of 9 years. Calling it a “striking observation,” the researchers found nearly half of the patients had viral DNA in CSF cells, although the standard viral load tests of the cell-free CSF fluid were positive in only 4% of the patients.

Of the 30 patients with persistent HIV, 9 (30%) experienced neurocognitive difficulties in a 7-domain neuropsychological test battery. Among 35 participants with no detectable HIV DNA in CSF, 4 (11%) were clinically impaired.

The low rates of detectable HIV RNA in the cell-free CSF fraction and within CSF cell pellets suggest low levels of HIV transcription within cells and infrequent release into the extracellular space during systemically suppressive ART, the researchers say.

The brain is one of the first targets of the virus, and CNS manifestations are common. Neurocognitive impairment in HIV-positive patients is probably related to multiple factors, including HIV infection, age, neuroinflammation, and comorbid conditions, including substance abuse, the researchers say. There also may be a “legacy effect,” in which processes associated with long-term exposure to HIV before ART leads to irreversible neurologic injury and more extensive infection of CSF cells. Lack of an association with inflammatory biomarkers in this study suggested that current inflammation does not lead to present neurocognitive dysfunction, the researchers say, but does not rule out prior inflammation as the underlying cause of neuronal injury.

Still, given that brain tissue in living individuals is “inaccessible” (as the researchers put it), CSF offers a window into neuropathogenesis of HIV. Studies have found a range between 15% and 55% of participants develop an HIV-associated neurocognitive disorder (HAND). The new findings may support a role of persistent HIV-infected cells, but the researchers emphasize that the association does not confirm that HIV DNA causes HAND. However, they add, persistent HIV in “sanctuary sites” despite ART presents a barrier to curing the infection. Their study, they say, indicates that examination of CSF cells is important in assessing residual HIV in compartments during ART.

During Operations Iraqi and Enduring Freedom, everything from old uniforms to plastic, aerosol cans, electronic equipment, human waste, tires, and batteries were thrown into open pits, often doused with jet fuel, and set on fire.

Many deployed soldiers were exposed to smoke from these open-air burn pits, putting them at risk for cancer, neurologic effects, reproductive effects, respiratory toxicity, and cardiovascular toxicity. Veterans who were close to burn pits have reported eye irritation, itching, rashes, and respiratory problems, such as bronchitis, asthma, and emphysema.

In May 2019, the VA redesignated the Airborne Hazards Center of Excellence (AHCE), established in 2013, as the Airborne Hazards and Burn Pits Center of Excellence (AHBPCE). The redesignation was a consequence of the Helping Veterans Exposed to Burn Pits Act, which stemmed from an 18-month bipartisan effort to prevent burn pits from becoming “the Agent Orange of this generation of soldiers.” Senator Amy Klobuchar (D-MN), who cosponsored the legislation with Thom Tillis (R-NC) said, “After the Vietnam War, it took the US government years to recognize that there was a link between Agent Orange and its devastating health effects on our soldiers. … [W]e can’t make that same tragic mistake again by failing to identify the devastating health effects associated with burn pits.”

The AHCE was responsible for assessing veterans’ cardiopulmonary function, military/ nonmilitary exposures, and health-related symptoms for those with airborne hazard concerns. The AHBPCE will specialize in clinical and transitional research, focusing on expanding understanding of health outcomes and treatments for burn pit–related issues.

VA providers can consult with the AHBPCE about assessment and treatment. When appropriate, veterans may be invited for a comprehensive, multiday health evaluation from a specialized team. The examination includes state-of-the-art assessments of lung function and exercise capacity. The findings are used to develop recommendations, which are shared with the veteran and referring provider for follow-up care. The findings also are used by researchers at the center and throughout the VA to develop research questions to investigate and potentially improve clinical practice.

Veterans (including those who receive VA-authorized care in the community) with complex clinical presentations who are unable to be diagnosed locally may be referred for consultation or examination.

AHBPCE, which is located at the New Jersey War Related Illness and Injury Study Center (WRIISC), also provides the AHBPCE-WRIISC Airborne hazards Registry (AWARE) program, designed for veterans who complete the Airborne Hazards and Open Burn Pit Registry online questionnaire, report chronic respiratory symptoms, and meet other eligibility criteria. AHBPCE’s mandate also includes analyzing registry data to monitor the VA’s overall clinical response to exposure concerns.

During Operations Iraqi and Enduring Freedom, everything from old uniforms to plastic, aerosol cans, electronic equipment, human waste, tires, and batteries were thrown into open pits, often doused with jet fuel, and set on fire.

Many deployed soldiers were exposed to smoke from these open-air burn pits, putting them at risk for cancer, neurologic effects, reproductive effects, respiratory toxicity, and cardiovascular toxicity. Veterans who were close to burn pits have reported eye irritation, itching, rashes, and respiratory problems, such as bronchitis, asthma, and emphysema.

In May 2019, the VA redesignated the Airborne Hazards Center of Excellence (AHCE), established in 2013, as the Airborne Hazards and Burn Pits Center of Excellence (AHBPCE). The redesignation was a consequence of the Helping Veterans Exposed to Burn Pits Act, which stemmed from an 18-month bipartisan effort to prevent burn pits from becoming “the Agent Orange of this generation of soldiers.” Senator Amy Klobuchar (D-MN), who cosponsored the legislation with Thom Tillis (R-NC) said, “After the Vietnam War, it took the US government years to recognize that there was a link between Agent Orange and its devastating health effects on our soldiers. … [W]e can’t make that same tragic mistake again by failing to identify the devastating health effects associated with burn pits.”

The AHCE was responsible for assessing veterans’ cardiopulmonary function, military/ nonmilitary exposures, and health-related symptoms for those with airborne hazard concerns. The AHBPCE will specialize in clinical and transitional research, focusing on expanding understanding of health outcomes and treatments for burn pit–related issues.

VA providers can consult with the AHBPCE about assessment and treatment. When appropriate, veterans may be invited for a comprehensive, multiday health evaluation from a specialized team. The examination includes state-of-the-art assessments of lung function and exercise capacity. The findings are used to develop recommendations, which are shared with the veteran and referring provider for follow-up care. The findings also are used by researchers at the center and throughout the VA to develop research questions to investigate and potentially improve clinical practice.

Veterans (including those who receive VA-authorized care in the community) with complex clinical presentations who are unable to be diagnosed locally may be referred for consultation or examination.

AHBPCE, which is located at the New Jersey War Related Illness and Injury Study Center (WRIISC), also provides the AHBPCE-WRIISC Airborne hazards Registry (AWARE) program, designed for veterans who complete the Airborne Hazards and Open Burn Pit Registry online questionnaire, report chronic respiratory symptoms, and meet other eligibility criteria. AHBPCE’s mandate also includes analyzing registry data to monitor the VA’s overall clinical response to exposure concerns.

During Operations Iraqi and Enduring Freedom, everything from old uniforms to plastic, aerosol cans, electronic equipment, human waste, tires, and batteries were thrown into open pits, often doused with jet fuel, and set on fire.

Many deployed soldiers were exposed to smoke from these open-air burn pits, putting them at risk for cancer, neurologic effects, reproductive effects, respiratory toxicity, and cardiovascular toxicity. Veterans who were close to burn pits have reported eye irritation, itching, rashes, and respiratory problems, such as bronchitis, asthma, and emphysema.

In May 2019, the VA redesignated the Airborne Hazards Center of Excellence (AHCE), established in 2013, as the Airborne Hazards and Burn Pits Center of Excellence (AHBPCE). The redesignation was a consequence of the Helping Veterans Exposed to Burn Pits Act, which stemmed from an 18-month bipartisan effort to prevent burn pits from becoming “the Agent Orange of this generation of soldiers.” Senator Amy Klobuchar (D-MN), who cosponsored the legislation with Thom Tillis (R-NC) said, “After the Vietnam War, it took the US government years to recognize that there was a link between Agent Orange and its devastating health effects on our soldiers. … [W]e can’t make that same tragic mistake again by failing to identify the devastating health effects associated with burn pits.”

The AHCE was responsible for assessing veterans’ cardiopulmonary function, military/ nonmilitary exposures, and health-related symptoms for those with airborne hazard concerns. The AHBPCE will specialize in clinical and transitional research, focusing on expanding understanding of health outcomes and treatments for burn pit–related issues.

VA providers can consult with the AHBPCE about assessment and treatment. When appropriate, veterans may be invited for a comprehensive, multiday health evaluation from a specialized team. The examination includes state-of-the-art assessments of lung function and exercise capacity. The findings are used to develop recommendations, which are shared with the veteran and referring provider for follow-up care. The findings also are used by researchers at the center and throughout the VA to develop research questions to investigate and potentially improve clinical practice.

Veterans (including those who receive VA-authorized care in the community) with complex clinical presentations who are unable to be diagnosed locally may be referred for consultation or examination.

AHBPCE, which is located at the New Jersey War Related Illness and Injury Study Center (WRIISC), also provides the AHBPCE-WRIISC Airborne hazards Registry (AWARE) program, designed for veterans who complete the Airborne Hazards and Open Burn Pit Registry online questionnaire, report chronic respiratory symptoms, and meet other eligibility criteria. AHBPCE’s mandate also includes analyzing registry data to monitor the VA’s overall clinical response to exposure concerns.

When influenza season arrives, conventional morbidity and mortality statistics, health care encounters, and laboratory data might not “fully reflect the disruption caused to the social and economic life of the community,” say CDC researchers. That is the reason that the National Institute for Occupational Safety and Health (NIOSH) monitors health-related workplace absenteeism every month, and why the World Health Organization (WHO) uses those data to help determine the impact of influenza season worldwide.

The workplace is a prime area for transmission—people share workspace and equipment and interact with one another closely. Estimates of influenza attack rates for working-aged adults can be as high as 14.3% in a given influenza season, the CDC says.

According to NIOSH, absenteeism rose sharply in the 2017-2018 season, to a level significantly higher than that of the average during the previous 5 seasons. In October, 1.7% of workers were absent due to health issues. That figure began climbing in November, peaking in January at 3.0%, significantly exceeding the epidemic threshold. Absenteeism declined steadily after that to a low of 1.4%, then began rising again in August and September.

Male workers, people aged 45 to 64 years, and those working in certain occupations (including management, business, and repair services) were more likely to be out.

Regional absenteeism peaks corresponded to concurrent peaks in influenza-like illness (ILI) activity in those regions. The researchers say this is in line with a longtime recognition that health-related workplace absenteeism correlates well with the presence of ILI, which is why absenteeism data are used as a nonspecific indicator of ILI in the community. During the 2009-2010 influenza A (H1N1) pandemic, for instance, peak workplace absenteeism correlated with the highest occurrence of both ILI and influenza-positive laboratory tests, according to NIOSH.

The associations between ILI, absenteeism, and demographic characteristics are complex, the researchers say, and mediated by factors such as vaccination coverage and access to paid sick leave.

The usual recommendations—vaccination, covering coughs and sneezes, handwashing, and routinely cleaning frequently touched surfaces—are the most effective ways to prevent transmission, the researchers note. During a pandemic, other measures may be needed, such as “social distancing” in workplaces.

NIOSH makes absenteeism surveillance results available (https://www.cdc.gov/niosh/topics/absences/default.html). The researchers suggest that employers might wish to consult them when developing prevention messages.

When influenza season arrives, conventional morbidity and mortality statistics, health care encounters, and laboratory data might not “fully reflect the disruption caused to the social and economic life of the community,” say CDC researchers. That is the reason that the National Institute for Occupational Safety and Health (NIOSH) monitors health-related workplace absenteeism every month, and why the World Health Organization (WHO) uses those data to help determine the impact of influenza season worldwide.

The workplace is a prime area for transmission—people share workspace and equipment and interact with one another closely. Estimates of influenza attack rates for working-aged adults can be as high as 14.3% in a given influenza season, the CDC says.

According to NIOSH, absenteeism rose sharply in the 2017-2018 season, to a level significantly higher than that of the average during the previous 5 seasons. In October, 1.7% of workers were absent due to health issues. That figure began climbing in November, peaking in January at 3.0%, significantly exceeding the epidemic threshold. Absenteeism declined steadily after that to a low of 1.4%, then began rising again in August and September.

Male workers, people aged 45 to 64 years, and those working in certain occupations (including management, business, and repair services) were more likely to be out.

Regional absenteeism peaks corresponded to concurrent peaks in influenza-like illness (ILI) activity in those regions. The researchers say this is in line with a longtime recognition that health-related workplace absenteeism correlates well with the presence of ILI, which is why absenteeism data are used as a nonspecific indicator of ILI in the community. During the 2009-2010 influenza A (H1N1) pandemic, for instance, peak workplace absenteeism correlated with the highest occurrence of both ILI and influenza-positive laboratory tests, according to NIOSH.

The associations between ILI, absenteeism, and demographic characteristics are complex, the researchers say, and mediated by factors such as vaccination coverage and access to paid sick leave.

The usual recommendations—vaccination, covering coughs and sneezes, handwashing, and routinely cleaning frequently touched surfaces—are the most effective ways to prevent transmission, the researchers note. During a pandemic, other measures may be needed, such as “social distancing” in workplaces.

NIOSH makes absenteeism surveillance results available (https://www.cdc.gov/niosh/topics/absences/default.html). The researchers suggest that employers might wish to consult them when developing prevention messages.

When influenza season arrives, conventional morbidity and mortality statistics, health care encounters, and laboratory data might not “fully reflect the disruption caused to the social and economic life of the community,” say CDC researchers. That is the reason that the National Institute for Occupational Safety and Health (NIOSH) monitors health-related workplace absenteeism every month, and why the World Health Organization (WHO) uses those data to help determine the impact of influenza season worldwide.

The workplace is a prime area for transmission—people share workspace and equipment and interact with one another closely. Estimates of influenza attack rates for working-aged adults can be as high as 14.3% in a given influenza season, the CDC says.

According to NIOSH, absenteeism rose sharply in the 2017-2018 season, to a level significantly higher than that of the average during the previous 5 seasons. In October, 1.7% of workers were absent due to health issues. That figure began climbing in November, peaking in January at 3.0%, significantly exceeding the epidemic threshold. Absenteeism declined steadily after that to a low of 1.4%, then began rising again in August and September.

Male workers, people aged 45 to 64 years, and those working in certain occupations (including management, business, and repair services) were more likely to be out.

Regional absenteeism peaks corresponded to concurrent peaks in influenza-like illness (ILI) activity in those regions. The researchers say this is in line with a longtime recognition that health-related workplace absenteeism correlates well with the presence of ILI, which is why absenteeism data are used as a nonspecific indicator of ILI in the community. During the 2009-2010 influenza A (H1N1) pandemic, for instance, peak workplace absenteeism correlated with the highest occurrence of both ILI and influenza-positive laboratory tests, according to NIOSH.

The associations between ILI, absenteeism, and demographic characteristics are complex, the researchers say, and mediated by factors such as vaccination coverage and access to paid sick leave.

The usual recommendations—vaccination, covering coughs and sneezes, handwashing, and routinely cleaning frequently touched surfaces—are the most effective ways to prevent transmission, the researchers note. During a pandemic, other measures may be needed, such as “social distancing” in workplaces.

NIOSH makes absenteeism surveillance results available (https://www.cdc.gov/niosh/topics/absences/default.html). The researchers suggest that employers might wish to consult them when developing prevention messages.

Health care providers who do not have the time or tools to screen patients for HIV risk also may not be prescribing preexposure prophylaxis (PrEP). But help is on the way: NIH-funded researchers have come up with novel computerized methods to identify the patients PrEP could benefit.

In 2 separate studies, the researchers developed and validated algorithms that analyze electronic health records (EHR). In the first study, Harvard researchers used machine learning to create an HIV prediction algorithm using 2007 to 2015 data from > 1 million patients in Massachusetts. The model included variables such as diagnosis codes for HIV counseling or sexually transmitted infections (STIs), laboratory tests for HIV or STIs, and prescriptions for medications related to treating STIs.

The model was validated using data from nearly 600,000 other patients treated between 2011 and 2016. The prediction algorithm successfully distinguished with high precision between patients who did or did not acquire HIV and between those who did or did not receive a PrEP prescription.

The researchers found hundreds of potential missed opportunities. They point to > 9,500 people in the 2016 dataset with particularly high-risk scores who were not prescribed PrEP. A “striking outcome,” the researchers say, is that their analysis suggests that nearly 40% of new HIV cases might have been averted had clinicians received alerts to discuss and offer PrEP to patients with the highest 2% of risk scores.

In the second study, researchers used the EHRs of > 3.7 million patients who entered the Kaiser Permanente System Northern California between 2007 and 2014 to develop a model to predict HIV incidence, then validated the model with data from between 2015 and 2017. Of the original patient group, 784 developed HIV within 3 years of baseline. The study found that the model identified nearly half of the incident HIV cases among males by flagging only 2% of the general patient population.

Embedding the algorithm into the EHR, the lead investigator says, “could prompt providers to discuss PrEP with patients who are most likely to benefit.”

Health care providers who do not have the time or tools to screen patients for HIV risk also may not be prescribing preexposure prophylaxis (PrEP). But help is on the way: NIH-funded researchers have come up with novel computerized methods to identify the patients PrEP could benefit.

In 2 separate studies, the researchers developed and validated algorithms that analyze electronic health records (EHR). In the first study, Harvard researchers used machine learning to create an HIV prediction algorithm using 2007 to 2015 data from > 1 million patients in Massachusetts. The model included variables such as diagnosis codes for HIV counseling or sexually transmitted infections (STIs), laboratory tests for HIV or STIs, and prescriptions for medications related to treating STIs.

The model was validated using data from nearly 600,000 other patients treated between 2011 and 2016. The prediction algorithm successfully distinguished with high precision between patients who did or did not acquire HIV and between those who did or did not receive a PrEP prescription.

The researchers found hundreds of potential missed opportunities. They point to > 9,500 people in the 2016 dataset with particularly high-risk scores who were not prescribed PrEP. A “striking outcome,” the researchers say, is that their analysis suggests that nearly 40% of new HIV cases might have been averted had clinicians received alerts to discuss and offer PrEP to patients with the highest 2% of risk scores.

In the second study, researchers used the EHRs of > 3.7 million patients who entered the Kaiser Permanente System Northern California between 2007 and 2014 to develop a model to predict HIV incidence, then validated the model with data from between 2015 and 2017. Of the original patient group, 784 developed HIV within 3 years of baseline. The study found that the model identified nearly half of the incident HIV cases among males by flagging only 2% of the general patient population.

Embedding the algorithm into the EHR, the lead investigator says, “could prompt providers to discuss PrEP with patients who are most likely to benefit.”

Health care providers who do not have the time or tools to screen patients for HIV risk also may not be prescribing preexposure prophylaxis (PrEP). But help is on the way: NIH-funded researchers have come up with novel computerized methods to identify the patients PrEP could benefit.

In 2 separate studies, the researchers developed and validated algorithms that analyze electronic health records (EHR). In the first study, Harvard researchers used machine learning to create an HIV prediction algorithm using 2007 to 2015 data from > 1 million patients in Massachusetts. The model included variables such as diagnosis codes for HIV counseling or sexually transmitted infections (STIs), laboratory tests for HIV or STIs, and prescriptions for medications related to treating STIs.

The model was validated using data from nearly 600,000 other patients treated between 2011 and 2016. The prediction algorithm successfully distinguished with high precision between patients who did or did not acquire HIV and between those who did or did not receive a PrEP prescription.

The researchers found hundreds of potential missed opportunities. They point to > 9,500 people in the 2016 dataset with particularly high-risk scores who were not prescribed PrEP. A “striking outcome,” the researchers say, is that their analysis suggests that nearly 40% of new HIV cases might have been averted had clinicians received alerts to discuss and offer PrEP to patients with the highest 2% of risk scores.

In the second study, researchers used the EHRs of > 3.7 million patients who entered the Kaiser Permanente System Northern California between 2007 and 2014 to develop a model to predict HIV incidence, then validated the model with data from between 2015 and 2017. Of the original patient group, 784 developed HIV within 3 years of baseline. The study found that the model identified nearly half of the incident HIV cases among males by flagging only 2% of the general patient population.

Embedding the algorithm into the EHR, the lead investigator says, “could prompt providers to discuss PrEP with patients who are most likely to benefit.”

The US Department of Veterans Affairs (VA) has a well-established National HIV Program, says Dr. Richard Stone, executive in charge of the VHA. In fact, he notes, the VA is the single largest provider of HIV care in America and has treated 31,000 veterans for HIV.

Thus, the VA plays a critical role in the effort to establish tools and resources to eradicate HIV in the US, Stone says, “one veteran at a time.” To realize this “ambitious but achievable target,” the VA is:

• Offering HIV testing at least once to every veteran and more often to those at risk;
• Rapidly linking those who are diagnosed to effective treatment;
• Deploying an HIV health force to hard-hit areas of the country, expanding timely access to high-quality HIV care and prevention across the VA’s integrated network, with both face-to-face encounters and telehealth; and
• Offering pre-exposure prophylaxis (PrEP) when clinically appropriate.

The primary goal, Stone says, is for veterans with HIV or at risk for HIV to be able to access the best care “safely and free from stigma and discrimination.”

Resources and educational tools are available at www.hiv.va.gov, including recently updated fact sheets and videos for patients about PrEP

The US Department of Veterans Affairs (VA) has a well-established National HIV Program, says Dr. Richard Stone, executive in charge of the VHA. In fact, he notes, the VA is the single largest provider of HIV care in America and has treated 31,000 veterans for HIV.

Thus, the VA plays a critical role in the effort to establish tools and resources to eradicate HIV in the US, Stone says, “one veteran at a time.” To realize this “ambitious but achievable target,” the VA is:

• Offering HIV testing at least once to every veteran and more often to those at risk;
• Rapidly linking those who are diagnosed to effective treatment;
• Deploying an HIV health force to hard-hit areas of the country, expanding timely access to high-quality HIV care and prevention across the VA’s integrated network, with both face-to-face encounters and telehealth; and
• Offering pre-exposure prophylaxis (PrEP) when clinically appropriate.

The primary goal, Stone says, is for veterans with HIV or at risk for HIV to be able to access the best care “safely and free from stigma and discrimination.”

Resources and educational tools are available at www.hiv.va.gov, including recently updated fact sheets and videos for patients about PrEP

The US Department of Veterans Affairs (VA) has a well-established National HIV Program, says Dr. Richard Stone, executive in charge of the VHA. In fact, he notes, the VA is the single largest provider of HIV care in America and has treated 31,000 veterans for HIV.

Thus, the VA plays a critical role in the effort to establish tools and resources to eradicate HIV in the US, Stone says, “one veteran at a time.” To realize this “ambitious but achievable target,” the VA is:

• Offering HIV testing at least once to every veteran and more often to those at risk;
• Rapidly linking those who are diagnosed to effective treatment;
• Deploying an HIV health force to hard-hit areas of the country, expanding timely access to high-quality HIV care and prevention across the VA’s integrated network, with both face-to-face encounters and telehealth; and
• Offering pre-exposure prophylaxis (PrEP) when clinically appropriate.

The primary goal, Stone says, is for veterans with HIV or at risk for HIV to be able to access the best care “safely and free from stigma and discrimination.”

Resources and educational tools are available at www.hiv.va.gov, including recently updated fact sheets and videos for patients about PrEP

Late summer is the season to be especially alert for possible cases of acute flaccid myelitis (AFM), the CDC says.  

Since 2014, when the CDC began tracking AFM, 570 cases, mostly in children, have been reported. Outbreaks have followed a pattern: every 2 years, spiking between August and October. Nearly all states and DC have reported cases. The largest outbreak, 233 cases, was in 2018. Theoretically, 2019 would be an off year, but too little is known about AFM to say outbreaks are unlikely.

AFM starts with symptoms similar to those of a viral infection but can progress rapidly to limb weakness, then respiratory failure. Most patients are previously healthy children, average age 5 years old, who had respiratory symptoms or fever consistent with a viral infection less than a week before they experienced sudden weakness in their arms or legs. On average, the CDC receives reports of suspected AFM cases 18 days after the patient develops limb weakness.  

The CDC believes viruses play a role, but which ones is still unclear. Symptoms have been found to develop after poliovirus, West Nile virus, and adenovirus infections. In an analysis of confirmed cases from 2018, CDC researchers detected enteroviruses and rhinoviruses in nearly half of stool and respiratory specimens. However, of 74 cases with a cerebral spinal fluid specimen, only 2 were positive for enteroviruses. All specimens tested negative for poliovirus.

But even when it is associated with a viral infection, it is not known how the infection triggered the AFM, or why it triggers AFM in some people and not others. AFM is rare—affecting ≤ 2 children per million in the US every year. Viral infections from enteroviruses are common, especially in children—and especially in the late summer/early autumn months. It is not known why a small number of people develop AFM while most others recover.

AFM can be difficult to diagnose because the symptoms are similar to those of neurologic diseases, such as Guillain-Barré syndrome. As of yet, no laboratory test is available; diagnosis is done through physical examination and magnetic resonance imaging (MRI) scans of the spinal cord.

There also are no proven ways to treat or prevent AFM. That is why timing is so key. The CDC says as soon as AFM is suspected, collect cerebral spinal fluid, serum, stool, and nasopharyngeal swabs. If an MRI shows a spinal lesion with some gray matter involvement, alert the health department and send specimens and medical records. Refer to specialists, monitor the patient for worsening symptoms, hospitalize if indicated, and begin treatment and rehabilitation.

In short: no specific etiology, no specific way to diagnose, and no specific treatment exist for AFM. Treatments, including immunoglobulin, corticosteroids, and antivirals have been tried, but no clear evidence exists that any have affected recovery. Other treatment is supportive, with physical and occupational therapy.

The length of recovery time varies. Some people make a full recovery, most have continued muscle weakness even after a year.

The CDC is researching possible risk factors, conducting advanced laboratory testing and research to determine how viral infections may lead to AFM, and tracking long-term patient outcomes.

Clinicians can contact neurologists who specialize in AFM through the AFM Physician Consult and Support Portal: https://myelitis.org/living-with-myelitis/resources/afm-physician-support-portal/.

Late summer is the season to be especially alert for possible cases of acute flaccid myelitis (AFM), the CDC says.  

Since 2014, when the CDC began tracking AFM, 570 cases, mostly in children, have been reported. Outbreaks have followed a pattern: every 2 years, spiking between August and October. Nearly all states and DC have reported cases. The largest outbreak, 233 cases, was in 2018. Theoretically, 2019 would be an off year, but too little is known about AFM to say outbreaks are unlikely.

AFM starts with symptoms similar to those of a viral infection but can progress rapidly to limb weakness, then respiratory failure. Most patients are previously healthy children, average age 5 years old, who had respiratory symptoms or fever consistent with a viral infection less than a week before they experienced sudden weakness in their arms or legs. On average, the CDC receives reports of suspected AFM cases 18 days after the patient develops limb weakness.  

The CDC believes viruses play a role, but which ones is still unclear. Symptoms have been found to develop after poliovirus, West Nile virus, and adenovirus infections. In an analysis of confirmed cases from 2018, CDC researchers detected enteroviruses and rhinoviruses in nearly half of stool and respiratory specimens. However, of 74 cases with a cerebral spinal fluid specimen, only 2 were positive for enteroviruses. All specimens tested negative for poliovirus.

But even when it is associated with a viral infection, it is not known how the infection triggered the AFM, or why it triggers AFM in some people and not others. AFM is rare—affecting ≤ 2 children per million in the US every year. Viral infections from enteroviruses are common, especially in children—and especially in the late summer/early autumn months. It is not known why a small number of people develop AFM while most others recover.

AFM can be difficult to diagnose because the symptoms are similar to those of neurologic diseases, such as Guillain-Barré syndrome. As of yet, no laboratory test is available; diagnosis is done through physical examination and magnetic resonance imaging (MRI) scans of the spinal cord.

There also are no proven ways to treat or prevent AFM. That is why timing is so key. The CDC says as soon as AFM is suspected, collect cerebral spinal fluid, serum, stool, and nasopharyngeal swabs. If an MRI shows a spinal lesion with some gray matter involvement, alert the health department and send specimens and medical records. Refer to specialists, monitor the patient for worsening symptoms, hospitalize if indicated, and begin treatment and rehabilitation.

In short: no specific etiology, no specific way to diagnose, and no specific treatment exist for AFM. Treatments, including immunoglobulin, corticosteroids, and antivirals have been tried, but no clear evidence exists that any have affected recovery. Other treatment is supportive, with physical and occupational therapy.

The length of recovery time varies. Some people make a full recovery, most have continued muscle weakness even after a year.

The CDC is researching possible risk factors, conducting advanced laboratory testing and research to determine how viral infections may lead to AFM, and tracking long-term patient outcomes.

Clinicians can contact neurologists who specialize in AFM through the AFM Physician Consult and Support Portal: https://myelitis.org/living-with-myelitis/resources/afm-physician-support-portal/.

Late summer is the season to be especially alert for possible cases of acute flaccid myelitis (AFM), the CDC says.  

Since 2014, when the CDC began tracking AFM, 570 cases, mostly in children, have been reported. Outbreaks have followed a pattern: every 2 years, spiking between August and October. Nearly all states and DC have reported cases. The largest outbreak, 233 cases, was in 2018. Theoretically, 2019 would be an off year, but too little is known about AFM to say outbreaks are unlikely.

AFM starts with symptoms similar to those of a viral infection but can progress rapidly to limb weakness, then respiratory failure. Most patients are previously healthy children, average age 5 years old, who had respiratory symptoms or fever consistent with a viral infection less than a week before they experienced sudden weakness in their arms or legs. On average, the CDC receives reports of suspected AFM cases 18 days after the patient develops limb weakness.  

The CDC believes viruses play a role, but which ones is still unclear. Symptoms have been found to develop after poliovirus, West Nile virus, and adenovirus infections. In an analysis of confirmed cases from 2018, CDC researchers detected enteroviruses and rhinoviruses in nearly half of stool and respiratory specimens. However, of 74 cases with a cerebral spinal fluid specimen, only 2 were positive for enteroviruses. All specimens tested negative for poliovirus.

But even when it is associated with a viral infection, it is not known how the infection triggered the AFM, or why it triggers AFM in some people and not others. AFM is rare—affecting ≤ 2 children per million in the US every year. Viral infections from enteroviruses are common, especially in children—and especially in the late summer/early autumn months. It is not known why a small number of people develop AFM while most others recover.

AFM can be difficult to diagnose because the symptoms are similar to those of neurologic diseases, such as Guillain-Barré syndrome. As of yet, no laboratory test is available; diagnosis is done through physical examination and magnetic resonance imaging (MRI) scans of the spinal cord.

There also are no proven ways to treat or prevent AFM. That is why timing is so key. The CDC says as soon as AFM is suspected, collect cerebral spinal fluid, serum, stool, and nasopharyngeal swabs. If an MRI shows a spinal lesion with some gray matter involvement, alert the health department and send specimens and medical records. Refer to specialists, monitor the patient for worsening symptoms, hospitalize if indicated, and begin treatment and rehabilitation.

In short: no specific etiology, no specific way to diagnose, and no specific treatment exist for AFM. Treatments, including immunoglobulin, corticosteroids, and antivirals have been tried, but no clear evidence exists that any have affected recovery. Other treatment is supportive, with physical and occupational therapy.

The length of recovery time varies. Some people make a full recovery, most have continued muscle weakness even after a year.

The CDC is researching possible risk factors, conducting advanced laboratory testing and research to determine how viral infections may lead to AFM, and tracking long-term patient outcomes.

Clinicians can contact neurologists who specialize in AFM through the AFM Physician Consult and Support Portal: https://myelitis.org/living-with-myelitis/resources/afm-physician-support-portal/.

The Indian Health Service (IHS) and the Cherokee Nation Health Service are launching a new pilot project to help “accelerate progress” toward ending the HIV epidemic in native communities.

The project, which will investigate the most effective prevention strategies and share the findings locally, is part of the initiative Ending the HIV Epidemic: A Plan for America. That plan focuses prevention and treatment efforts on 48 counties and 7 southern states with a higher proportion of HIV diagnosis in rural areas. The Cherokee Nation is in Oklahoma, which has the highest American Indian population among the 7 southern states.

Recent data show new HIV infections at the lowest level yet, but progress in prevention has slowed, in part due to new threats such as the opioid crisis: 10% of new HIV infections are among injectable-drug users.

The Cherokee Nation’s proven track record in hepatitis C prevention and treatment makes it a valuable partner in the project. Half of its health services patients have been screened, and among the 3.2% testing positive, 90% have been cured. The pilot project will use a similar model, IHS says. Current statistics show that 35% of Cherokee National patients using the tribe’s health centers have been screened for HIV, with < 1% testing positive. Of the patients diagnosed with HIV, 90% are receiving care and 90% of those are virally suppressed. The pilot project is aimed at boosting the screening numbers.

The pilot is one of several HHS efforts to jumpstart key activities in select communities using resources from the Minority HIV/AIDS fund. The CDC also is launching projects in select communities.

“Improved health care over multiple generations is our top priority,” said Cherokee Nation Principal Chief Bill John Baker. “If we can collaborate with our federal partners at IHS to raise awareness, increase education, and actively work to prevent new cases of HIV, then we will be creating a healthier future for northeast Oklahoma.”

The Indian Health Service (IHS) and the Cherokee Nation Health Service are launching a new pilot project to help “accelerate progress” toward ending the HIV epidemic in native communities.

The project, which will investigate the most effective prevention strategies and share the findings locally, is part of the initiative Ending the HIV Epidemic: A Plan for America. That plan focuses prevention and treatment efforts on 48 counties and 7 southern states with a higher proportion of HIV diagnosis in rural areas. The Cherokee Nation is in Oklahoma, which has the highest American Indian population among the 7 southern states.

Recent data show new HIV infections at the lowest level yet, but progress in prevention has slowed, in part due to new threats such as the opioid crisis: 10% of new HIV infections are among injectable-drug users.

The Cherokee Nation’s proven track record in hepatitis C prevention and treatment makes it a valuable partner in the project. Half of its health services patients have been screened, and among the 3.2% testing positive, 90% have been cured. The pilot project will use a similar model, IHS says. Current statistics show that 35% of Cherokee National patients using the tribe’s health centers have been screened for HIV, with < 1% testing positive. Of the patients diagnosed with HIV, 90% are receiving care and 90% of those are virally suppressed. The pilot project is aimed at boosting the screening numbers.

The pilot is one of several HHS efforts to jumpstart key activities in select communities using resources from the Minority HIV/AIDS fund. The CDC also is launching projects in select communities.

“Improved health care over multiple generations is our top priority,” said Cherokee Nation Principal Chief Bill John Baker. “If we can collaborate with our federal partners at IHS to raise awareness, increase education, and actively work to prevent new cases of HIV, then we will be creating a healthier future for northeast Oklahoma.”

The Indian Health Service (IHS) and the Cherokee Nation Health Service are launching a new pilot project to help “accelerate progress” toward ending the HIV epidemic in native communities.

The project, which will investigate the most effective prevention strategies and share the findings locally, is part of the initiative Ending the HIV Epidemic: A Plan for America. That plan focuses prevention and treatment efforts on 48 counties and 7 southern states with a higher proportion of HIV diagnosis in rural areas. The Cherokee Nation is in Oklahoma, which has the highest American Indian population among the 7 southern states.

Recent data show new HIV infections at the lowest level yet, but progress in prevention has slowed, in part due to new threats such as the opioid crisis: 10% of new HIV infections are among injectable-drug users.

The Cherokee Nation’s proven track record in hepatitis C prevention and treatment makes it a valuable partner in the project. Half of its health services patients have been screened, and among the 3.2% testing positive, 90% have been cured. The pilot project will use a similar model, IHS says. Current statistics show that 35% of Cherokee National patients using the tribe’s health centers have been screened for HIV, with < 1% testing positive. Of the patients diagnosed with HIV, 90% are receiving care and 90% of those are virally suppressed. The pilot project is aimed at boosting the screening numbers.

The pilot is one of several HHS efforts to jumpstart key activities in select communities using resources from the Minority HIV/AIDS fund. The CDC also is launching projects in select communities.

“Improved health care over multiple generations is our top priority,” said Cherokee Nation Principal Chief Bill John Baker. “If we can collaborate with our federal partners at IHS to raise awareness, increase education, and actively work to prevent new cases of HIV, then we will be creating a healthier future for northeast Oklahoma.”