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Acute Flaccid Myelitis

Health Alerts

Topic Priority Date of Alert
Acute Flaccid Myelitis: Clinical Reminders and Reporting Requirements Advisory Oct 3, 2018
Acute Flaccid Myelitis: Clinical Reminder and Reporting Requirements Advisory Sep 9, 2016
Acute Flaccid Myelitis: Identification, Testing, and Reporting Guidelines Advisory Sep 3, 2015

Surveillance

CDC Acute Flaccid Myelitis Surveillance
National Library of Medicine's Current Treatments of Children with AFM

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 (in order of priority):

  • Cerebrospinal fluid (CSF)
  • Blood (serum and whole blood)
  • 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
  • Specimens should be shipped within 24–48 hours of collection, if possible

More information on specimen collection can be found at CDC’s AFM Specimen Collection page.
Click here for a CDC Job Aid for Clinicians on sending information on suspected AFM cases to the health department.

Resources

For Healthcare Providers:

  • As part of mandates for reporting of unusual disease occurrences in the City of Philadelphia, 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 at 215-685-6748.
  • Report any illness to PDPH that meets all of the current Council of State and Territorial Epidemiologists (CSTE) case definition criteria:
    • A person with acute onset of focal limb weakness, AND
    • A magnetic resonance image showing a spinal cord lesion largely restricted to gray matter*+, and spanning one or more vertebral segments OR
    • Cerebrospinal fluid (CSF) with pleocytosis (CSF white blood cell count >5 cells/mm3); CSF protein may or may not be elevated

* 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-Barrè syndrome
    • West Nile virus and other arboviral infections
    • Lyme disease
    • Varicella and herpes zoster

For Patients and Community Members:

There are no patient or community resources for Acute Flaccid Myelitis.

Posters:

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