Acute Flaccid Myelitis new Polio like children's disease

[coffeesippin]

Dear Editor,

      Family vehicle Air Conditioning systems harbouring moulds, viruses and bacteria may account for 150 U.S. children per year, and 45 Canadian children per year potentially affected by lifelong paralysis through the new but already epidemic polio-like disease Acute Flaccid Myelitis (AFM), the Canadian rate being 1/155,000 in the affected 17 and under age group, not the 1/1,000,000 reported in some news articles. The U.S. rate is 1/490,000, that epidemic beginning in 2014, while AFM seems new in Canada.

      The disease pattern is: upper respiratory infection with high fever then sudden paralysis through spinal infection. Cases spike in August, then higher in September, decreasing rapidly to near zero in following months. Infected AC causes several deadly diseases including Legionnaires which accounts for 8,000 to 18,000 U.S. hospitalizations per year. While AC is used in July, an Enterovirus D68 candidate in AFM has a two week incubation, pushing many cases into August.

      September's spike can be accounted for by that same two week incubation, along with contagious children in tightly packed school buses. Children 10 and under are most affected, and it is mostly they who sit in the restricted back seat air space in family vehicles with AC on and windows tightly up preventing pathogen dispersal.  U.S. Centre for Disease Control suggests siblings are not affected, but older siblings spend time in far more 'airy' environments than younger children, the older playing outdoors more for instance, the younger crammed together with young children in days cares is another example.  

[swansont]

7 hours ago, coffeesippin said:

Dear Editor,

!

Moderator Note

This isn't a publication, nor is it a blog. What is it you wish to discuss?

 

[mistermack]

I can't picture why air conditioning should be a factor in a virus infection. Legionnaires is bacterial, and breeds in cooling towers. It's not spread in car AC. 

It could be a rare complication from a flu-like virus, or even a midge carrying a virus or similar. Lucky it's rare, it sounds nasty. 

[coffeesippin]

I want to discuss ways and means this epidemic originates and spreads .. to discuss ways to save children's lives.  I've been talking with the U.S. Centre for Disease Control and they're happy to get any information that might help them stop this disease.  I wrote the letter, emailed it to many agencies and newspapers, and posted it here in a slightly modified form but I forgot to removed the Dear Editor.

2 hours ago, mistermack said:

I can't picture why air conditioning should be a factor in a virus infection. Legionnaires is bacterial, and breeds in cooling towers. It's not spread in car AC. 

It could be a rare complication from a flu-like virus, or even a midge carrying a virus or similar. Lucky it's rare, it sounds nasty. 

An endovirus is found in a large majority of cases.  Yes Legionnaires is bacterial, but bacteria are not the only agents that breed in AC, especially in filters loaded with damp organics.  "... the U.S. Environmental Protection Agency has since pointed out that poorly maintained heating, ventilation, and air conditioning (HVAC) systems — especially those in apartment buildings — may support the growth of bacteria and viruses that cause those symptoms. Indeed, in 2016, scientists reported in *The Washington Post* that the cases of Legionella in the U.S. had quadrupled in the past 15 years, likely because HVAC systems in apartment buildings were getting older."                        Moulds are another instigator or respiratory illness .. and often associated with AC.

Edited November 14, 2018 by coffeesippin
Clarity

[CharonY]

Note that viruses do not "breed" as bacteria. They require host cells to multiply. 

[Strange]

53 minutes ago, coffeesippin said:

I've been talking with the U.S. Centre for Disease Control and they're happy to get any information that might help them stop this disease.

Do you have any data to support your air con hypothesis?

[coffeesippin]

1 hour ago, CharonY said:

Note that viruses do not "breed" as bacteria. They require host cells to multiply. 

Thanks for the reminder, Charon Y.  Clarity helps, as I'm not a health scientist, but my asthma and respiratory allergies cause me to focus sharply on environments leading to stress on airways.  As well, I have a 20 year old granddaughter left with a limp after a bout of either AFM or something very similar 10 years ago in which her legs were paralyzed, black mould on her bathroom ceiling located next to her bedroom is what I believe caused her illness.  Moulds have been mentioned in AFM literature.  What I wrote as endovius is actually enterovirus.  

1 hour ago, Strange said:

Do you have any data to support your air con hypothesis?

U.S. Centre for Disease Control graphs show the disease spiking almost out of nowhere in August, then higher in September.  That is the pattern in the Northern Hemisphere, and follows AC diseases like Legionnaires, which hospitalizes between 8,000 and 18,000 a year in the U.S.   With AFM a strongly suspected Enterovirus found in a majority of cases (but not all) has a two week incubation .. meaning cases contracted in the last two weeks of July during which air conditioning can be near its peak use will mostly show up in August, cases contracted in the last two weeks of August will show up in September, and September is of course the month children are packed together in the confined air spaces of school buses.  The lower per capita rate in the U.S. can be accounted for by Canadian children confined in our colder climate's closed window restricted air circulation environments earlier than the U.S., and also by Canadian homes'  forced air heating systems sending bacteria and moulds into the homes from dirty filters and ducts when the furnace comes on often in early September, we have a sudden drop in temperatures after the Labour Day weekend.  I would be interested to know the statistics for home heating systems in AFM cases, whether central AC is in the home, etc.  Most often the children are 10 and under affected, no children older than 18, no difference between girls and boys.  My main concern is the tightly closed air space of the rear seats of automobiles, in which the youngest, and most affected children, normally sit for crash safety purposes.   The CDC said siblings are not often affected so even though they were welcoming, they at first they discounted my auto ac idea, but I pointed out that older children have vastly different environments, seated in front seats of vehicles, being outside playing much more than young children, not being in crowded day cares, etc., and they became more appreciative.  As this is a science forum, I am hoping scientific curiosity can bring more information.    

Edited November 14, 2018 by coffeesippin
Relationship between Legionnaires and AFM pattern

[mistermack]

A friend of mine got legionnaires disease, it nearly killed him. It was a one-off, there was no local outbreak at the time. The authorities thoroughly checked out his house and found no source. 

Some time later, he was telling me about pressure washing cars, (he's a dealer) taking water from a pool of standing water. I said to him, "there's your legionnaire's source". Pressure washers can easily produce droplets that you can breathe in, and standing water is of course a breeding ground for Legionella bacteria. I think they were using two stroke high powered pressure washers. Pretty dangerous I think. I wouldn't dream of using anything other than mains water in one.

[coffeesippin]

1 hour ago, mistermack said:

A friend of mine got legionnaires disease, it nearly killed him. It was a one-off, there was no local outbreak at the time. The authorities thoroughly checked out his house and found no source. 

Some time later, he was telling me about pressure washing cars, (he's a dealer) taking water from a pool of standing water. I said to him, "there's your legionnaire's source". Pressure washers can easily produce droplets that you can breathe in, and standing water is of course a breeding ground for Legionella bacteria. I think they were using two stroke high powered pressure washers. Pretty dangerous I think. I wouldn't dream of using anything other than mains water in one.

Good post, Mack, thanks, any information and suggestion is going to help.  Even showers in the home can carry dangerous mists, hot tubs can be like going to the tropics and swimming in stagnant water, etc.    

[CharonY]

1 hour ago, coffeesippin said:

Good post, Mack, thanks, any information and suggestion is going to help.  Even showers in the home can carry dangerous mists, hot tubs can be like going to the tropics and swimming in stagnant water, etc.    

Depends. The risk is of pathogens in general (Legionella are often less of an issue in the wild  as they tend not to be as competitive as other bugs. However, they are opportunists and under the right condition they can pop up) is associated with warm standing water. Showers themselves are not a huge problem, but badly maintained water tanks are. Hot tubs need to be disinfected. and if badly maintained are obviously a risk for many nasties. Since acute flaccid myelitis is still a very rare disease, looking at associations is bound to identify tons of incidental co-occurrences so I doubt that a source can be reliably tracked that way. Moreover if a virus is to blame, AC is rather an unlikely place to look at. However with the little data we have we can at least superficially test your hypothesis.  If ACs are associated with AFM, there are a at least two predictions we can try to make. 1) it is more prevalent in areas where AC use is heavier. 2) timing should be close or around heavy AC use.  

Looking at 2014 data (there is a report by Sejvar et al 2016 , Clin Inf Disease) we see that CA had the highest incidence rate was in California but if we account for population, Pennsylvania and Virginia have similar rates and Colorado has roughly double that rate. On the other hand other states with traditionally heavy AC use (Texas, Arizona, New Mexico) had none or only a single case. So the geographic distribution does not lend a strong support that AC use is correlated with incidence.

Next, looking at the incidence rate as a function of date we see a peak around the last two weeks of September. If car AC was the main culprit, It would probably be more likely to have  peaks around late summer. Moreover, the incidents continued to occur up to late December, when AC use should not play any role anymore. 

What has more merit among the things you listed is probably school. There children are in fact packed together, but rather than getting infected by ACs, they infect each other. For example it is known that acute asthma cases in kids cases peak in September, often caused by rhinovirus infections.

Lastly, if we look enterovirus infection, we see all-year infections with no noticeable peak around the summer months. However, peaks are also observed in September , which could coincide with exposure e.g. at school. 

I.e. as noted, the AC could be just a random co-occurence, with school onset being a likelier cause for transmission.

[coffeesippin]

28 minutes ago, CharonY said:

Depends. The risk is of pathogens in general (Legionella are often less of an issue in the wild  as they tend not to be as competitive as other bugs. However, they are opportunists and under the right condition they can pop up) is associated with warm standing water. Showers themselves are not a huge problem, but badly maintained water tanks are. Hot tubs need to be disinfected. and if badly maintained are obviously a risk for many nasties. Since acute flaccid myelitis is still a very rare disease, looking at associations is bound to identify tons of incidental co-occurrences so I doubt that a source can be reliably tracked that way. Moreover if a virus is to blame, AC is rather an unlikely place to look at. However with the little data we have we can at least superficially test your hypothesis.  If ACs are associated with AFM, there are a at least two predictions we can try to make. 1) it is more prevalent in areas where AC use is heavier. 2) timing should be close or around heavy AC use.  

Looking at 2014 data (there is a report by Sejvar et al 2016 , Clin Inf Disease) we see that CA had the highest incidence rate was in California but if we account for population, Pennsylvania and Virginia have similar rates and Colorado has roughly double that rate. On the other hand other states with traditionally heavy AC use (Texas, Arizona, New Mexico) had none or only a single case. So the geographic distribution does not lend a strong support that AC use is correlated with incidence.

Next, looking at the incidence rate as a function of date we see a peak around the last two weeks of September. If car AC was the main culprit, It would probably be more likely to have  peaks around late summer. Moreover, the incidents continued to occur up to late December, when AC use should not play any role anymore. 

What has more merit among the things you listed is probably school. There children are in fact packed together, but rather than getting infected by ACs, they infect each other. For example it is known that acute asthma cases in kids cases peak in September, often caused by rhinovirus infections.

Lastly, if we look enterovirus infection, we see all-year infections with no noticeable peak around the summer months. However, peaks are also observed in September , which could coincide with exposure e.g. at school. 

I.e. as noted, the AC could be just a random co-occurence, with school onset being a likelier cause for transmission.

     Wow .. thank you Charon .. an excellent post, the kind I was hoping for, I think you could be very helpful in slowing this disease.   However:  AFM is NOT a rare disease, publicity says 'don't be afraid it's one in a million' but real statistics involving number of children under 17 put the U.S. number into the 1/150,000 range, closer to 1/100.000 in Canada.  Geographic differences: as you undoubtedly know, humidity is a factor in bacterial, mould and viral infections.  Arizona, New Mexico and the greater part of Texas which have low rates are dry; California is high and its coast is wet.  It would be interesting to compare interior and coastal cases in California, I suspect a difference would show, but lack of difference could be explained by frequent trips to the ocean by dwellers in the dryer interior.  Car interiors in a dry area will be dryer and far less infected.  If we look at education and income levels how does California compare with Pennsylvania and Virginia where per capita rates are similar?  Would newer, less infected and more frequently cleaned ACs in cars and homes be located in California or Virginia and Pennsylvania?  I've traveled in my camper across the U.S. two recent winters for about 10 months in the U.S. and from what I saw I believe old and dirty ACs will be found far less in California.    Incidences DO spike very high in late summer, supporting my car AC cause, it's just that that the September spike is much higher probably due to return to school combined with the 2 week incubation of enteroviruses epidemiologically associated with AFM, August infections often showing in September.                                                                                                                                                   Yes, incidences continue past September as into December and probably beyond,  but by far the highest peak is September, and both of us seem to suspect the back to school cause, with greatly decreased numbers following.  It would be interesting to chart climate with cases .. I am sure we would see case numbers follow closely the temperature line south after September, with air conditioning being used less.  I think we can account for far lower but still substantial numbers in October and November to the car interior not drying out because of dogs in the back seat, the vehicles will stay damp and hosting infections.  I think my oldest daughter is a typical modern middle class dog owner, the dog is clean and healthy but enjoys the water during walks, the car often used to take the dog to dog parks besides water bodies.                                                                                                                                                 I'm not saying enterovirus is the only cause, I strongly suspect moulds too.  Yes enteroviruses appear year round, but conditions for their accumulation in environments are riper in the peak months of August and September.  I'm not saying car AC is the only cause, but a major cause.  In Canada, with its higher per capita rate, home central heating sytsems infected with mould are often fired up in September.                                                                                                                                                                                               I hope you and I especially can continue our exchanges .. I don't have the skills and resources to easily graph how rates could follow temperature declines.  Perhaps you do, or perhaps someone you know could.  I'm friends with with a Public Health officer in my town, I hope he can find data.                                                                                                                                                                                                                                                                      

[CharonY]

8 minutes ago, coffeesippin said:

AFM is NOT a rare disease,

The issue is that e.g for a peak year in 2014 there were only 120 pediatric cases. I.e. we only have 120 data points to look into and as such statistical associations will be very, very weak. That being said, the latest lit implies that enterovirus D68  may yet be the strongest link and that AFM is a rare (as many more do get infected without these symptoms), but severe symptomatic manifestation in certain susceptible folks.

[coffeesippin]

9 minutes ago, CharonY said:

The issue is that e.g for a peak year in 2014 there were only 120 pediatric cases. I.e. we only have 120 data points to look into and as such statistical associations will be very, very weak. That being said, the latest lit implies that enterovirus D68  may yet be the strongest link and that AFM is a rare (as many more do get infected without these symptoms), but severe symptomatic manifestation in certain susceptible folks.

I thought the CDC graph I looked at showed 2014 as being the first year of study, with 150 cases in 2016 and going into 150 cases in 2018.  (Alternate year peaks said to be a peculiarity with no known reason distinct to the U.S. compared to the world .. could those be hot years on a climate graph?)   

120 cases is a LOT if 90% of them sit in the back seat of cars .. or it 70% of them have dogs in the same back seat.  Certainly almost 100% will have and use AC if they have cars.       Susceptibility .. Are the children susceptible, or are the conditions ripe for those children?  How much exposure to the infectious agents time does the child get through sitting in the car?  How much time do they spend in a daycare with AC?  How many hours a day are they in an AC environment?  How much outdoor air do they get?  Are the parents smokers?  I sure wish I could question each parent.   With lifelong paralysis possible, we need to do what we can.  If you have any suggestions I could use for research please let me know.

[CharonY]

10 minutes ago, coffeesippin said:

120 cases is a LOT if 90% of them sit in the back seat of cars .

Not really, if you consider the number of children sitting in back seats. In 2014 there were about 70 million children and the vast majority would have been in cars at some point. That would have an incidence rate of roughly 1.7 per million cases. Even if we think that only half of them were in cars and if we assume that indeed AC exposure would be a strong factor it would still be just 3.4 cases per million. In almost all  situations these would be considered rare cases. The rate for non-symptomtic enterovirus infection is much, much higher for example. 

To provide other reference values, in the US  in the same year about 16,000 children were shot and about 2,500 died from gunshot. Perhaps on would not consider it a rare event at this point, but consider this, in the last few years about 50 people (i.e. just a tad less than half of the AFM events in children) were shot annually accidentally by toddlers. I think at this point it is really fair to declare the range as "rare".

But regardless of how to classify it, the issue is still that for a proper epidemiological analysis we simply do not have enough data points. even if it is 300 across the nation, creates too many variable to reasonably handle and too low statistical power to get some conclusion. If the use of ACs was a rare event, it would be easier to figure out. Even worse, even if we assume that AC use would be reasonable cause until end of September, we still have got almost half of the cases (~55) between October and December. So AC use could reasonably only be associated with half of the already low data set.

My overall point is that you may look at things too specifically, the link is not terribly strong and, perhaps even more complicated, if it is really viral, then there is no good way an AC can contribute. Other factors including genetics, previous diseases or perhaps even diet could equally or more play a role and should not be overlooked in favour of one particular pet theory. While it may be worthwhile to look into other agents including mold, there is little to support that at this point. For example, in Florida the frequency is the same as in Arizona (one case each). Ultimately, one key aspect is identifying the actual causative agent, which will require more biomolecular work.

[Ghideon]

2 hours ago, coffeesippin said:

 Even showers in the home can carry dangerous mists

8 hours ago, coffeesippin said:

the cases of Legionella in the U.S. had quadrupled in the past 15 years

I got curious and did some quick research regarding showers and water taps in case you are interested. Notes:
-Only Legionella was addressed.
-I concentrated on local conditions (Sweden) and documents from official sources, I’ve not had time to track down or read original scientific papers.
-The sources are in Swedish only but links to original documents are included.

-----

One source* states that showers are a common source. This has resulted in detailed rules for new buildings and maintenance guidelines for older houses. Short extract of the information available: Water containers contain bacterias but they are killed if temperature is high enough. At temperatures of 70 ° C, 90 percent of bacteria die in less than ten seconds. Problems:
1: Water containers may have too low temperature
2: There may be stagnant water between the container and the tap

There are recommendations regarding minimum temperature in water heater, (50 ° C)

The recommendation is also to let the water flow for a while if the tap has not been in use for some extended time. For new buildings there are rules regarding the minimum and maximum temperature allowed at the tap. The hot water may not be too cool before mixing with cool water.

I also did a check of the hot water system in my house. The system heats the water to a high temperature periodically (default=weekly) to kill bacterias, but it is not permanently keeping the temperature at this level. (The manual for the control panel says “Legionella function” by the way)

------

Now some speculation based on the information above, I have no sources for this.

-It may possible to save energy by lowering the temperature in the tank or by disabling the periodical extra heating. That may increase the risk for bacterias.

-Geothermal systems popular here usually have lower operating temperatures than other, older types of systems. Incorrect setup may result in hot water stored at temperatures were bacterias are not killed, especially if focus is on low energy consumption only. This could increase the risk in newer systems. 

End of speculation.

----

As a comparison to the quadrupled levels in the U.S I checked some statistics on national level in Sweden. Official statistics*** does not give any clear support for any specific source or major changes. 

Quote

From being largely unchanged over the past decade by about 1.5 cases per 100,000 inhabitants and years, in 2017 an increase was observed in the incidence of 1.9 cases per 100,000 inhabitants. The increase was largely due to the fact that the number of domestic cases (126) increased compared with 2016 when 84 domestic cases were reported. 

Two outbreaks of legionella infection occurred in Sweden in 2017. In both cases, the suspected source of infection was identified and corrected. In 2017, the incidence of legionella casualties in Sweden increased, an increase that may be attributed to the fact that more domestic cases have been reported.

 

*) the National Board of Housing, Building and Planning (swedish only) www.boverket.se -legionella pdf

**) A Swedish study, but the reference list is mainly in english: www.folkhalsomyndigheten.se pdf 

***) public health authority statistics, Swedish:  https://www.folkhalsomyndigheten.se/folkhalsorapportering-statistik/statistikdatabaser-och-visualisering/sjukdomsstatistik/legionellainfektion/

 

 

[coffeesippin]

9 minutes ago, CharonY said:

Not really, if you consider the number of children sitting in back seats. In 2014 there were about 70 million children and the vast majority would have been in cars at some point.

          How many would sit in the back seat of an air conditioned car frequently?  That cuts the numbers dramatically.  How many are in the prime age group generally 10 to 4?  Another dramatic cut in numbers.   How many back seats are dampened frequently by dogs?  Another major cut.  How many go from the car to a small AC environment like a Daycare?  Another huge cut.  How many cars are older than three years in which infectious agents would accumulate in the cabin air cleaner?  Another huge cut.  Already I think we can take that 70 million down to, say,  five million.  

The rate for non-symptomtic enterovirus infection is much, much higher for example. 

          Okay .. you're looking at enterovirus only here.  Combine the virus with mould which would be frequent in AC.  And, I just learned that viruses thrive in colder air in the upper respiratory area (the area children with AFM are attacked first.)  The air conditioner would provide that colder air.

To provide other reference values ...

          I'm not after gun control, I'm after one specific disease.

But regardless of how to classify it, the issue is still that for a proper epidemiological analysis we simply do not have enough data points. even if it is 300 across the nation, creates too many variable to reasonably handle and too low statistical power to get some conclusion. If the use of ACs was a rare event, it would be easier to figure out. Even worse, even if we assume that AC use would be reasonable cause until end of September, we still have got almost half of the cases (~55) between October and December. So AC use could reasonably only be associated with half of the already low data set.

          I can't see any graph that supports your statement half of cases occur between October and December.   A proper epidemiological analysis would be inexpensive .. a thorough questionaire sent to each parent.  If a set of parents than each parent could fill out a questionaire, this would provide a more accurate picture.  It would be very cheap.  And analyzing the data would be very cheap also BECAUSE of the low numbers involved.

..... if it is really viral, then there is no good way an AC can contribute.

          The AC lowers the air temperature to make the upper respiratory tract hard hit (rather than the warmer lower respiratory tract.)  It is the upper respiratory tract which gets hit first in AFM.   There is plenty of literature on viruses in ACs.

Other factors including genetics, previous diseases or perhaps even diet could equally or more play a role and should not be overlooked in favour of one particular pet theory.

          Excellent point, and why I see you as potentially valuable in the effort.  Include those things in the questionnaire.  Although genetics would be a tough one .. 'how often do you get ill, how often did your grandparents get ill' could be accounted for by lifestyle passed down instead of genetics.

While it may be worthwhile to look into other agents including mold, there is little to support that at this point.

         CDC mentions it as one of the major areas of investigation .. environmental factors including mould.

For example, in Florida the frequency is the same as in Arizona (one case each). Ultimately, one key aspect is identifying the actual causative agent, which will require more biomolecular work.

          The disease spread from west to east, Florida will be among the last states affected.  Florida people will also be most likely to spend time outdoors .. and the ocean winds will radically disperse the infectious agents.  

           I value your input highly, you raise real cause for thought, and that is needed, but I suggest your view is skewed towards treatment rather than prevention.  Biomolecular work will enable a vaccine instead of erasing the need for a vaccine.  That spirit was already evident in the CDC literature and correspondence.  It is evident in the HPV vaccines, etc.  There are hundreds of billions of dollars of profit to me made in vaccines, but there are also hundreds of billions of dollars to be considered in treatment, rehabilitation, lifelong care of a paralyzed child, etc .. plus, the automobile industry and auto mechanics would profit a great deal from improving systems, changing cabin filters, disinfecting systems and interiors.  The home maintenance industry would also profit in the same ways.  And children would not need vaccines.

   Please see my interjections in your post.    

25 minutes ago, Ghideon said:

I got curious and did some quick research regarding showers and water taps in case you are interested. Notes:
-Only Legionella was addressed.
-I concentrated on local conditions (Sweden) and documents from official sources, I’ve not had time to track down or read original scientific papers.
-The sources are in Swedish only but links to original documents are included.

-----

One source* states that showers are a common source. This has resulted in detailed rules for new buildings and maintenance guidelines for older houses. Short extract of the information available: Water containers contain bacterias but they are killed if temperature is high enough. At temperatures of 70 ° C, 90 percent of bacteria die in less than ten seconds. Problems:
1: Water containers may have too low temperature
2: There may be stagnant water between the container and the tap

There are recommendations regarding minimum temperature in water heater, (50 ° C)

The recommendation is also to let the water flow for a while if the tap has not been in use for some extended time. For new buildings there are rules regarding the minimum and maximum temperature allowed at the tap. The hot water may not be too cool before mixing with cool water.

I also did a check of the hot water system in my house. The system heats the water to a high temperature periodically (default=weekly) to kill bacterias, but it is not permanently keeping the temperature at this level. (The manual for the control panel says “Legionella function” by the way)

------

Now some speculation based on the information above, I have no sources for this.

-It may possible to save energy by lowering the temperature in the tank or by disabling the periodical extra heating. That may increase the risk for bacterias.

-Geothermal systems popular here usually have lower operating temperatures than other, older types of systems. Incorrect setup may result in hot water stored at temperatures were bacterias are not killed, especially if focus is on low energy consumption only. This could increase the risk in newer systems. 

End of speculation.

----

As a comparison to the quadrupled levels in the U.S I checked some statistics on national level in Sweden. Official statistics*** does not give any clear support for any specific source or major changes. 

 

*) the National Board of Housing, Building and Planning (swedish only) www.boverket.se -legionella pdf

**) A Swedish study, but the reference list is mainly in english: www.folkhalsomyndigheten.se pdf 

***) public health authority statistics, Swedish:  https://www.folkhalsomyndigheten.se/folkhalsorapportering-statistik/statistikdatabaser-och-visualisering/sjukdomsstatistik/legionellainfektion/

 

 

    Thanks Ghideon  .. your information on temperatures and mist is valuable and answered one question I had .. that of 'could showers for children have a part of Acute Flaccid Myelitis's upper respiratory infection.'  AFM appears at this point to have a strong viral involvement rather than bacteria which is involved in Legionnaires, and viruses are said to do better at the low termperatures induced by AC than by warmer or hot temps.   The low temps of AC could easily account for the virus attacking the upper respiratory system rather than the lower, warmer lungs.  I'll more closely examine which part of the respiratory system Legionnaires attacks, but at this point I get the picture of it being in the lower lung, pneumonia like.  Legionnaires and AFM do not seem related other than the potential for AC to be a/the cause in both.   AFM is spreading rapidly, it's in Europe, I don't know if it's in Sweden, but it's something to watch out for.  No cases were officially reported in Canada until this year, and we have over 45 this first official year of reporting.  In the U.S. it spread from west coast to east coast in five years or under.

1 hour ago, CharonY said:

Not really, if you consider the number of children sitting in back seats. In 2014 there were about 70 million children and the vast majority would have been in cars at some point. That would have an incidence rate of roughly 1.7 per million cases  .........

Here's more support for the AC theory, if I can call it that without raising eyebrows.

    Thanks Ghideon  .. your information on temperatures and mist is valuable and answered one question I had .. that of 'could showers for children have a part of Acute Flaccid Myelitis's upper respiratory infection.'  AFM appears at this point to have a strong viral involvement rather than bacteria which is involved in Legionnaires, and viruses are said to do better at the low temperatures induced by AC than by warmer or hot temps.   The low temps of AC could easily account for the virus attacking the upper respiratory system (first illness involved with AFM)  rather than the lower, warmer lungs.  

[CharonY]

34 minutes ago, coffeesippin said:

  I can't see any graph that supports your statement half of cases occur between October and December.

Your interjections are hard to read, but take a look at the citation I provided earlier. There the case for 2014 is listed by week.

[coffeesippin]

8 minutes ago, CharonY said:

Your interjections are hard to read, but take a look at the citation I provided earlier. There the case for 2014 is listed by week.

Thanks for the suggestion to look at it by the week.  In case I miss what you're looking at can you send me the url?   I'll say that 2014 was the first year of reporting that I can find.  I was looking at CDC graphs for that year, 2016 and this year to come to my estimate.  I hope you can go through the points I made, the more I look at this, the more I learn about viruses (thrive in colder air for instance) the stronger my conclusion is that it's infected AC and particularly auto AC that is the main problem.     I hope you'll find the time to go through my expansions of your comments.    Like the 70million kids in car AC I cut down to an estimate of about 5million who MIGHT be exposed to the right conditions.   You may not agreed with much of what I say, but I hope you'll go through what I wrote.

Edited November 14, 2018 by coffeesippin
Clarity

[CharonY]

I do not have a link, I just have the paper here. However, it should be easy enough to find. The full reference is Sejvar et al 2016 , Clin Inf Disease 15;63(6):737-745. If you are unfamiliar with literature references, you still should be able to get a hit by just googling it (or use scholar.google.com for example.

[coffeesippin]

11 minutes ago, CharonY said:

I do not have a link, I just have the paper here. However, it should be easy enough to find. The full reference is Sejvar et al 2016 , Clin Inf Disease 15;63(6):737-745. If you are unfamiliar with literature references, you still should be able to get a hit by just googling it (or use scholar.google.com for example.

Thanks Charon.  I have the CDC graphs at https://www.cdc.gov/acute-flaccid-myelitis/afm-cases.html    In looking at these I'm reminded that AC months of (sometimes June) July and August in Canada are Greatly extended in the U.S.                                                                   

Partial year 2014: begins August and Sept with 74 cases, then 51 cases Oct Nov Dec.   

2015:  20 cases, 6 until end of May, 6 till end of Sept, 8 following.   

2016: Jan Feb Mar Ap May 11 cases,   June July Aug Sept 100 cases,    Oct Nov Dec 39 cases. 

2017: 26 cases 10 of them June July Aug Sept.   

2018:  7 cases until end of May, then 68 cases June July Aug Sept,   then drops to 6 in October.   More cases being investigated.

      The alternate peak years so far are said to have no explanation, and the U.S. is said to be unique that way in the world. 

      It seems obvious to me that the extended AC season in the U.S. will easily account for most of the cases.   I don't know where you are located, Charon, but I hope that doesn't reduce your idea of the length of AC season in the U.S.     

     As I said earlier, viruses are reported to do well in colder air,  and with AC it is in the colder air in the upper respiratory system of the child that the disease strikes first.   CDC literature specifically mentions moulds as a possible environmental factor, and AC systems are generally full of moulds.  

     Thanks for prompting me to further research .. everything I look at strengthens my convictions.  

[coffeesippin]

8 hours ago, CharonY said:

Your interjections are hard to read, but take a look at the citation I provided earlier. There the case for 2014 is listed by week.

At the end of this post is an example of paralysis in 8 of 11 cases of spinal mould infection.                                         Your citation showing the rates by week, to me, confirmed the  involvement of AC, with cases later than September probably caused by contagion or mould in forced air heating systems.  Another thing about 2014 .. 24 of the cases were in California with the next highest state having 10, and other states having four or less down to 0.  2014 California had its hottest year on record to that date, .. so AC would have been used more than normal.  I'm moving my opinion towards mould in car AC rather than virus as the major cause.  It may be that virus may cause the initial upper respiratory tract infection, opening the way for mould to become established.             "Mold is also known to cause asthma and life-threatening primary and secondary infections in immune-compromised patients that have been exposed. Toxic moldexposure has also been linked to more serious, long-term effects like memory loss, insomnia, anxiety, depression, confusion, trouble concentrating, and confusion."          "Exposure to mold's toxins and structural proteins may trigger an immune response in the brain. The findings, Harding says, may help explain some of the conditions that people living in moldy buildings complain about, such as anxiety and cognitive problems. ... Mold chemical linked to movement disorder."

    Here is the example of mould in the spine causing paralysis in 8 of 11 cases:   https://www.ncbi.nlm.nih.gov/pubmed/11315785           

Edited November 15, 2018 by coffeesippin
Added the paralysis involving mould in the spine