The Current: Monthly provider updates from Island County Community & Family Health - October 2022

Having trouble viewing this email? View it as a Web page.

the current

A monthly newsletter for healthcare providers from Island County Community & Family Health. 

October 2022

Acute Flaccid Myelitis - Early Detection is Key

FREE Course

American Academy of Pediatrics course: Acute Flaccid Myelitis - What Pediatricians Should Know About Diagnosis, Treatment, and Care of Ped - AAP


Since the end of August 2022, CDC sentinel surveillance sites for respiratory pathogens have been reporting increases in enterovirus D-68 (EV-D68) respiratory disease. EV-D68 is also the main enterovirus responsible for cases of acute flaccid myelitis (AFM) during years when we see increases in AFM cases. AFM is a rare outcome of EV-D68 infection and is a serious neurologic condition that affects mostly children. It typically presents with sudden limb weakness that can lead to permanent paralysis. Traditionally, increases in EV-D68 respiratory disease have preceded cases of AFM by about 2 weeks. Therefore, increased vigilance for AFM is important.  Early detection of AFM is critical for achieving the best health outcomes.  Clinicians should strongly consider the diagnosis of AFM in patients with acute onset of flaccid weakness, especially during August–November, to ensure prompt hospitalization and referral to specialty care. Recent respiratory illness or fever and the presence of neck or back pain or any neurologic symptom should heighten suspicion for AFM. Clinicians should also report possible cases of AFM to Island County Public Health as soon as they suspect AFM. Case reporting will help states and CDC monitor AFM and better understand factors associated with this illness. 

With the identification of a paralytic polio case in an unvaccinated person in New York in July 2022, healthcare providers should also consider polio in the differential diagnosis of patients with sudden onset of limb weakness, as polio and AFM are clinically similar. Clinicians should obtain stool samples from all patients with suspected AFM to rule out poliovirus infection, especially if the patient is under-vaccinated and has had recent international travel to places where poliovirus is circulating.


As of September 28, 2022, there have been 19 confirmed cases of AFM in 2022 out of 48 reports of patients under investigation. 



  • THINK AFM: Clinicians should strongly consider AFM in patients with acute flaccid limb weakness, especially after respiratory illness or fever, and especially between the months of August and November.
  • CONSIDER POLIO: Clinicians should consider polio in patients with sudden onset of limb weakness, especially in persons who are not vaccinated or under-vaccinated for polio and have traveled to areas with higher risk of polio.
  • HOSPITALIZE IMMEDIATELY: Patients with AFM can progress rapidly to respiratory failure. Clinicians should monitor respiratory status of patients and order MRI of the spine and brain with the highest Tesla scanner available. The clinical signs and symptoms of AFM overlap with other neurologic conditions. Therefore, it is critical to consult with specialists in neurology and infectious diseases for appropriate diagnosis and management.
  • LABORATORY TESTING: Clinicians should collect specimens from patients with possible AFM or polio as early as possible in the course of illness (preferably on the day of onset of limb weakness). Specimen collection instructions are here.
  • Coordinate with Island County Public Health to send specimens in for testing.

Disease Reporting

Clinicians should report possible cases of AFM (acute onset of flaccid limb weakness) along with MRI brain reports, images, and the neurology consult note, OR polio to Island County Public Health using the patient summary form (  Contact Melanie Davis, RN BSN at 360-499-4023 or send a report via confidential fax to 360-221-8480.

Additional Information


Monkeypox Update

Severe Manifestations of Monkeypox Among Immunocompromised People

Since May 2022, more than 25,000 monkeypox cases have been identified in the United States. During the current outbreak in the United States, 38 percent of people diagnosed with monkeypox were coinfected with HIV and most reported cases of monkeypox with severe manifestations have been among people living with untreated HIV.

Some patients with monkeypox in the United States have experienced prolonged hospitalizations or substantial morbidity; two deaths have occurred. As the monkeypox outbreak has progressed, an increasing proportion of cases have been identified among Black and Hispanic/Latino people.  Black and Hispanic/Latino people are disproportionately affected by HIV.

Severe manifestations of monkeypox can occur in both immunocompetent and immunocompromised people; however, most people diagnosed with monkeypox have had mild-to-moderate clinical courses. Of the people with severe manifestations of monkeypox for whom CDC has been consulted, the majority have had HIV with CD4 counts <200 cells/ml, indicating substantial immunosuppression. Healthcare providers should recognize underlying risk factors for severe disease, optimize immune function, and when appropriate, initiate medical countermeasures (such as tecovirimat and vaccinia immunoglobulin) early to prevent or mitigate severe disease.

During the current outbreak, CDC has received reports of people with monkeypox who have severe manifestations of disease, including but not limited to

  • Atypical or persistent rash with coalescing or necrotic lesions, or both, some which have required extensive surgical debridement or amputation of an affected extremity.
  • Lesions on a significant proportion of the total body surface area, which may be associated with edema and secondary bacterial or fungal infections among other complications.
  • Lesions in sensitive areas (including mucosal surfaces such as, oropharynx, urethra, rectum, vagina) resulting in severe pain that interferes with activities of daily living.
  • Bowel lesions that are exudative or cause significant tissue edema, leading to obstruction.
  • Severe lymphadenopathy that can be necrotizing or obstructing (such as in airways).
  • Lesions leading to stricture and scar formation resulting in significant morbidity such as urethral and bowel strictures, phimosis, and facial scarring.
  • Involvement of multiple organ systems and associated comorbidities, including:
    • Oropharyngeal lesions inhibiting oral intake
    • Pulmonary involvement with nodular lesions
    • Neurologic conditions including encephalitis and transverse myelitis
    • Cardiac complications including myocarditis and pericardial disease
    • Ocular conditions including severe conjunctivitis and sight-threatening corneal ulcerations
    • Urologic involvement including urethritis and penile necrosis

Recommendations for Healthcare Providers

  • Upon initial presentation of signs and symptoms consistent with monkeypox, in addition to monkeypox, test all sexually active adults and adolescents for HIV (including acute infection) and other sexually transmitted infections (such as syphilis, herpes, gonorrhea, and chlamydia), and assess for other immunocompromising conditions.
  • Be familiar with severe manifestations of monkeypox and risk factors for severe disease.
  • Contact Island County Public Health early when there is concern for progression to severe manifestations or severe manifestations are present for guidance on management and securing necessary resources for treatment.
  • Island County has a limited supply of tecovirimat available for patients who are immunocompromised and/or at risk for severe manifestations.

Expanded JYNNEOS Vaccine Eligibility

Outreach to and vaccination of individuals who meet the categories below should be prioritized.  We have JYNNEOS vaccine available on Whidbey and Camano Islands.  Please refer patients who meet these criteria to us, so we can schedule them for an appointment:

  • Gay and bisexual men and transgender individuals who have had multiple or anonymous gay, male bisexual, or transgender sex partners in the last 3 months.
  • People who have used methamphetamine in the last 3 months.
  • People who have exchanged sex for money, drugs, or other purposes in the past 3 months.
  • People who have been sexually assaulted, regardless of gender or sexual orientation.
  • People who have had sexual contact or prolonged skin-to-skin exposure with people who were exposed to MPV.

 Refer to the Guidelines for JYNNEOS Vaccine Use for more information.

Disease Reporting

IMMEDIATELY Notifiable to Island County Public Health. Submit Suspect Monkeypox Intake Form to secure fax line 360-221-8480 and call 360-914-0837.

For further information, data, and resources, visit our Monkeypox main page

Additional Information

Study on efficacy of one dose of JYNNEOS vaccine: Incidence of Monkeypox Among Unvaccinated Persons Compared with Persons Receiving ≥1 JYNNEOS Vaccine Dose — 32 U.S. Jurisdictions, July 31–September 3, 2022 | MMWR (


Influenza Surveillance

While current flu activity in Washington State is low, it is expected to increase as we move into fall and winter.  This season may be more severe due in part to lifted COVID-19 restrictions.  Bookmark the following webpages and check regularly to learn more about what respiratory viruses are spreading at any given time this fall and winter:

Contact Jen Krenz at or 360-914-0037 if there are questions.


Other Communicable Disease Updates

Have a topic suggestion? Get in touch! Send your ideas and feedback to