Laboratory Information for Health Departments

Test methods

• CDC will conduct routine testing and typing of CSF, respiratory specimens and stool for enterovirus/rhinovirus, and poliovirus testing of stool specimens to rule out the presence of poliovirus.
• Additional testing protocols are being developed to look for AFM biomarkers and studies to identify possible mechanisms for AFM are underway.
• Pathogen-specific testing should continue at hospital or state public health laboratories and should include CSF, respiratory swab, serum, and stool specimens.

Specimen collection

Instruct clinicians to collect specimens from patients under investigation (PUIs) for AFM as early as possible in the course of illness, preferably on the day of onset of limb weakness. Early specimen collection has the best chance to yield a cause of AFM.

Instructions for clinicians

For patients under investigation (PUIs), instruct clinicians to follow instructions for Collecting Specimens for AFM Testing.

In the event of death, instruct clinician to follow separate instructions for Postmortem Specimen Submission for AFM Testing.

If specimens have not been collected or all of the available specimens have been used and no specimen remains, repeat specimen collection, when feasible.

Sending specimens

State and local health departments and clinicians treating PUIs may contact CDC for further laboratory and epidemiologic support by:

• Phone: CDC Emergency Operations Center (770-488-7100)
• Email: AFMinfo@cdc.gov (epidemiologic support)
• Email: AFMLab@cdc.gov (laboratory support)

Overnight shipping

CDC advises overnight shipment of available clinical specimens from patients under investigation (PUIs) for AFM to CDC to optimize yield from specialized testing.

Arrive Tuesday through Friday

Please ship specimens overnight so they arrive at CDC on Tuesday through Friday. Do not ship specimens on Friday or over the weekend.

For samples that should be frozen

Please freeze them at ≤-20°C and make arrangements to ship the samples overnight to CDC frozen on dry ice.

Include Patient Forms

Samples from each patient should be shipped with completed hard copies of

1. The AFM Patient Summary Form AND
2. A specimen submission form for each specimen submitted. Please note: for Test Order Name, please select "Picornavirus Special Study".

If 10 or more patient specimens are submitted: Please provide an electronic line listing by email. Use the following headers in this order: patient ID number; date of birth; sex; onset date; fatal y/n; specimen ID number; specimen collected date; specimen type; if culture isolate—cell line and passage number.

How to report test results

• Since the testing protocols include several assays that are not performed under the Clinical Laboratory Improvement Amendments (CLIA) nor intended for clinical diagnosis, CDC will be unable to provide patient-specific results for certain tests that are performed.
• Results following testing of samples from multiple cases that may indicate a possible cause of AFM will be rapidly disseminated.
• Results from certain tests, such as EV/RV testing and typing and stool testing, will be shared with the health department upon completion.