Severe Rising Cases of ANE in Children Linked to Flu
Recent severe flu seasons have highlighted a significant risk for kids: a rare brain condition known as acute necrotizing encephalopathy (ANE). This swift-moving ailment is often triggered by the flu virus, which seems to throw the immune system into chaos, resulting in quick brain swelling.
Children can quickly deteriorate from mild flu symptoms to suffering seizures, lapsing into a coma, or worse, within just a few days. What’s alarming is that most of these affected kids don’t have any preexisting health issues.
Typically, only a small number of children are diagnosed with this inflammatory disease each year. However, during January and February of this year, pediatric neurologists noted an unusual rise in ANE cases and started communicating with each other about their findings.
Dr. Molly Wilson-Murphy from Boston Children’s Hospital mentioned, “We were reaching out to our colleagues all over the country, asking, ‘Are you seeing this?’ and we quickly got responses from several indicating they were experiencing the same thing.”
This collaboration led to the first significant examination of ANE cases across the U.S. Wilson-Murphy is among over 60 doctors who shared their findings in a recent publication by the Journal of the American Medical Association.
Out of the analyzed cases over the past two flu seasons, there were 41 instances of ANE, predominantly in kids around the age of five.
The brain inflammation often progressed rapidly, with 27% of these children—11 in total—dying within three days, primarily due to increased pressure in their brain tissue.
For those who survived at least three months, many faced long-term complications, including difficulties with walking, eating, and persistent seizures.
There’s no established treatment for ANE due to its rarity. Most of the children from the study received treatments like steroids, antiviral medications, intravenous immunoglobulin, or plasma exchanges, which are similar to dialysis.
It’s unclear why there’s been a spike in ANE cases, but this surge follows one of the deadliest flu seasons recorded for children, with 266 pediatric flu deaths, as reported by the Centers for Disease Control and Prevention (CDC). Notably, at least three children passed away in June and July of this year, which is unusual for the flu.
Previously, there hadn’t been an official count of ANE cases. The CDC initiated tracking in February after receiving anecdotal evidence from the study’s authors.
Dr. Timothy Uyeki from the CDC commented on the findings, noting the need for “multiyear national surveillance” to better understand the frequency of ANE and whether certain children are at higher risk.
The Importance of Flu Vaccinations for Children
Study authors underscored the critical role of annual flu vaccinations for children, revealing that only six out of the 41 children with ANE had been vaccinated.
It’s particularly crucial for those who have previously experienced ANE since they are at risk of recurrence with any future influenza infections, Wilson-Murphy pointed out.
Unfortunately, the overall vaccination rate among children has been declining. This 2023-2024 season saw only about 55% of kids vaccinated—the lowest in over ten years.
“That might be contributing somewhat to this rise in cases,” mentioned Dr. Keith Van Haren, another study co-author. However, he acknowledged that it doesn’t explain everything.
Among those 266 children who died from the flu last year, about 90% were not fully vaccinated, according to the CDC.
The American Academy of Pediatrics advises all children aged six months and older to receive an annual flu shot, ideally by the end of October. Young children who are getting vaccinated for the first time may require two doses, spaced about a month apart.
Recognizing ANE Warning Signs
Initially, ANE can mimic typical flu symptoms. Kids often experience high fevers—averaging 103 degrees—along with a sore throat, cough, and gastrointestinal issues like vomiting or diarrhea.
However, within two days of the onset of these symptoms, a noticeable change in a child’s mental state can occur. They may experience seizures and exhibit unusual weakness or fatigue.
This different behavior stands out from the normal lethargy associated with flu; affected children do not seem to recover even after taking fever reducers like ibuprofen or acetaminophen. They struggle with communication and interaction.
As Dr. Wilson-Murphy stated, “If you have that ‘mom gut’ feeling that something isn’t right, trust it. Parents should seek medical advice as soon as things feel off, especially concerning neurological symptoms.”
