The recent severe flu season has revealed a lesser-known risk of influenza infection in children: acute necrotizing encephalopathy or a rare brain disease called ANE.
This is a rapid condition usually caused by the flu, causing sudden swelling of the brain. The virus is thought to encourage the immune system to stimulate hay.
An affected child can suffer from mild flu symptoms and end up with seizures, coma, or even death within a few days. Most of them are children with no other health issues.
Historically, inflammatory diseases are diagnosed in only a handful of children each year. However, this January and February, pediatric neurologists began to see an abnormal increase in ANE cases and began comparing notes.
“We reached out to colleagues around the country and said, ‘Hey, are you watching this?” said Dr. Molly Wilson Murphy, a pediatric neurologist at Boston Children’s Hospital. And we get back to the reaction from many people who say, “Yes, we too.” ”
The collaboration gave birth to the first large multicenter look for Wilson Murphy’s ANE case in the US.
Doctors have identified 41 cases during the last two flu seasons. Most of the children were around five years old.
Brain inflammation was often rapid and severe. Usually, 11 children (27%) died within three days, but usually under pressure on the brain tissue.
Children who survived for at least three months often had long-term complications, including walking, dieting and ongoing attacks.
ANEs are very rare and there are no specific treatment protocols. Most of the 41 children in the new study received plasma exchanges such as steroids, antiviral drugs, intravenous immunoglobulins, or dialysis.
The reason for the increase in ANE cases is unknown. However, the report comes after the United States experienced 266 pediatric influenza deaths, one of the most deadly flu seasons for children on record, according to the Centers for Disease Control and Prevention. At least three of these children died outside the typical flu season in June and July this year.
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Until now, there has been no official tally of the ANE incident. The CDC began tracking them in February after hearing anecdotal reports from the study authors.
Dr. Timothy Uyeki of CDC wrote an editorial for the new research.
“From a public health perspective, there is a need to implement a “national public health surveillance” to understand how often ANE occurs and whether certain children have specific risk factors.
Why influenza shots are important to children
The study authors highlighted the importance of annual flu shots for children. Six of six of ANE’s 41 children had been vaccinated.
This is especially important for children who already have an ANE, as they are at risk of taking it again with subsequent influenza infections.
In general, fewer children are getting shots of the flu.
Over half of 55% of children won the vaccine during the 2023-2024 season. This is the lowest rate in over 10 years.
Dr. Keith Van Harlen, a pediatric neurologist at Stanford Medicine in Palo Alto, California, said: “We are a pediatric neurologist at Stanford Medicine in Palo Alto, California. “But that doesn’t take everything into consideration.”
And of the 266 children who have died of the flu over the past year, 90% have not been fully vaccinated, according to the CDC.
The American Academy of Pediatrics recommends that all children over six months old should get their annual flu shots, ideally by the end of October.
Young children who did not have shots may need two doses about a month apart.
ANE warning sign
In the early stages, ANEs are similar to typical flu symptoms. Children tend to have a fever of 103 degrees, on average, with sore throat, cough, vomiting, or diarrhea.
Within about two days of symptoms onset, doctors say there is a noticeable difference in the child’s mental state. They may have seizures, be extraordinarily weak and tired.
This behavior is different from the typical lethargy associated with the flu, Wilson Murphy said. The affected children are not feeling well even after ibuprofen or acetaminophen. They are meaningless and cannot interact meaningfully.
“You get that ‘mama gut’ where something feels incorrect,” she said. “Parents need to listen to their intuition and have their kids check out as soon as they feel something is off.”
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