Health Information Portal (HIP)

Acute Flaccid Myelitis

Topic	Priority Priority Alert Conveys the highest level of importance; warrants immediate action or attention. Advisory Provides important information for a specific incident or situation; may not require immediate action. Notification Provides information regarding an incident or situation; unlikely to require immediate action. Update Provides updated information regarding an incident or situation; unlikely to require immediate action.	Date of Alert
Acute Flaccid Myelitis: Recognition, Testing, and Reporting Requirements	Advisory	Dec 5, 2022
Acute Flaccid Myelitis: Clinical Reminders and Reporting Requirements	Advisory	Oct 3, 2018

Surveillance

Acute Flaccid Myelitis (AFM) is an immediately notifiable condition. Upon suspicion of AFM, report cases to PDPH by calling 215-685-6740 during business hours (M-F, 8:30am-5:00pm), press 5, and ask to speak with someone in the ACD Program. If calling after hours, call 215-686-4514, press 1 for Unified Dispatch, and ask to speak with the DDC on-call staff.

National Surveillance

• CDC Case Definition
• CDC AFM Cases and Outbreaks

Vaccine Information

Because the pathogen responsible for causing acute flaccid myelitis (AFM) has not been identified, no vaccine recommendations are available at this time.

Diagnosis & Management

If AFM is suspected, specimen collection should occur as early as possible, ideally on the day of limb weakness onset. Please call PDPH to coordinate testing of the following clinical specimens:

• Cerebrospinal fluid (CSF)
• Serum
• Stool (preferably two specimens collected 24 hours apart)
• Upper respiratory specimen (nasopharyngeal or oropharyngeal swab)
• Specimens should be shipped overnight to arrive at CDC Tuesday through Friday

More information on specimen collection can be found at CDC’s AFM Specimen Collection page.

Read more about sending information about suspected AFM cases to the Health Department in CDC's Job Aid for Clinicians.

Resources

For Healthcare Providers:

Any patient regardless of age who meets the following criteria for AFM should be immediately reported to the Philadelphia Department of Public Health (PDPH) Division of Disease Control:

• A person with acute onset of flaccid limb weakness, AND
  • A magnetic resonance image showing a spinal cord lesion largely restricted to gray matter*+, and spanning one or more vertebral segments
• A person whose death certificate lists AFM as the cause of death or a contributing cause of death
• A person with autopsy findings that include histopathologic evidence of inflammation largely involving the anterior horn of the spinal cord

*Spinal cord lesions may not be present on initial MRI; a negative or normal MRI performed within the first 72 hours after onset of limb weakness does not rule out AFM. MRI studies performed 72 hours or more after onset should also be reviewed if available.

+Terms in the spinal cord MRI report such as “affecting mostly gray matter,” “affecting the anterior horn or anterior horn cells,” “affecting the central cord,” “anterior myelitis,” or “poliomyelitis” would all be consistent with this terminology.

Providers should also remember to routinely report any patient (suspected or confirmed) with the following conditions and infections that cause neurologic symptoms to PDPH:

• Encephalitis or meningitis regardless of etiology
• Guillain-Barré syndrome
• West Nile virus and other arboviral infections
• Lyme disease
• Varicella and herpes zoster

For Patients and Community Members:

Posters:

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