CDC Urges Clinicians to Rapidly Recognize and Report AFM Cases

PUBLISHED: Jul 15, 2019
Relevant to: Ambulatory Care, Critical Access Hospitals, Hospitals, Medical Office, Rural Health Clinics

The U.S. Centers for Disease Control and Prevention (CDC) has published a new Vital Signs report encouraging clinicians to quickly recognize acute flaccid myelitis (AFM) symptoms and report all suspected cases to their health department. According the to CDC, early recognition and reporting are critical for providing patients with appropriate care and rehabilitation and a better understanding of AFM.

Background:

CDC began tracking AFM in 2014, when the first outbreak of 120 cases occurred. Another outbreak occurred in 2016 with 149 cases, and again with 233 patients in 41 states in 2018– the largest outbreak so far. AFM cases have so far followed a seasonal and biennial pattern, spiking between August and October every other year.

In an analysis of cases confirmed in 2018, CDC detected enteroviruses and rhinoviruses in nearly half of respiratory and stool specimens. Of the 74 cases with a cerebral spinal fluid specimen, only two were positive for enteroviruses (EV-A71 and EV-D68). CDC and other scientists continue to investigate how enteroviruses, including EV-D68, might initiate AFM. All specimens tested negative for poliovirus, a related enterovirus that can cause AFM.

Recommendations:

  • Strongly suspect AFM in patients with acute flaccid limb weakness, especially after respiratory illness or fever, and between August and October.
  • Hospitalize patients immediately, collect lab specimens, diagnose, and begin medical management.
  • Don’t wait for CDC’s case classification for diagnosis.
  • Alert the health department and send lab specimens and medical records.

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