Acute Flaccid Myelitis (AFM)

Updated July 9, 2019
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A female doctor talks with a boy laying in a hospital bed who is a patient, and his father.

Acute Flaccid Myelitis (AFM)

Promptly recognize & rapidly report

232 AFM cases occurred in 41 states in 2018.
232 AFM cases occurred in 41 states in 2018.
233 AFM cases occurred in 41 states in 2018.
The average age of patients with AFM was 5 years old.
The average age of patients with AFM was 5 years old.
The average age of patients with AFM was 5 years.
On average, CDC received reports of suspected AFM cases 18 days after patient’s limb weakness began.
On average, CDC received reports of suspected AFM cases 18 days after patient’s limb weakness began.

On average, CDC received reports of suspected AFM cases 18 days after patient’s limb weakness began.

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Overview

Acute flaccid myelitis (AFM) is a rare but serious syndrome (a pattern of symptoms) that causes limb weakness, mostly in children. Three national outbreaks have occurred starting in 2014, when CDC began surveillance for AFM.

  • Most patients developed AFM in late summer or early fall.
  • Most patients had respiratory symptoms or fever consistent with a viral infection less than a week before onset of limb weakness.
  • CDC believes viruses, including enteroviruses, play a role in AFM.
  • Currently, there are no proven ways to treat or prevent AFM.
  • Prompt symptom recognition, specimen collection, and reporting to CDC are all critical to improve understanding of this complex syndrome, including its risk factors, outcomes, possible treatments, and ways to prevent it.

Clinicians: Timing is Key for AFM

Clinicians: Timing is Key for AFM. Recognize AFM early: Be alert for onset of acute flaccid limb weakness and consider AFM on your differential diagnosis. Collect specimens %26 then get MRI: Collect cerebrospinal fluid (CSF), serum, stool, and nasopharyngeal (NP) swab as soon as possible, and handle and store specimens properly. Rapidly report to health department: If the MRI shows a spinal lesion with some gray matter involvement, alert the health department and send specimens and medical records.Diagnosis %26 medical management: Refer to specialists, monitor for signs of worsening symptoms, hospitalize if indicated, and begin treatment and rehabilitation.

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Putting Together the Pieces of AFM

Putting Together the Pieces of AFM. WHO: 570 AFM cases, mostly children, since 2014. WHEN: AFM outbreaks have occurred every two years starting in 2014, in late summer and early fall. WHERE: 48 states and D.C. have had AFM cases since 2014. WHAT: CDC believes viruses, including enteroviruses, play a role in AFM.SOURCE: CDC Vital Signs, July 2019

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SOURCE: CDC Vital Signs, July 2019

Problem
Recognizing AFM is challenging.
  • AFM is rare, and there is no lab test available yet to diagnose patients.
  • When clinicians recognize AFM early, they can quickly:
    • Get patients the best care, including treatment and rehabilitation.
    • Collect lab specimens like blood or urine to better understand AFM and its causes.
    • Report suspected cases for prompt investigation and outbreak detection.
The Way Forward
CDC Is:
  • Monitoring AFM trends and the clinical presentation.
  • Researching possible risk factors.
  • Conducting advanced lab testing and research to understand how viral infections may lead to AFM.
  • Tracking long-term patient outcomes.
Clinicians Can:
Health Departments Can:
  • Work with CDC to collect medical information, MRI images, and specimens, and classify cases.
  • Communicate information about AFM to clinicians and the public.
Parents Can:
  • Immediately seek medical care if their child develops sudden arm or leg weakness.
Most AFM cases occur in late summer & early fall
Image of a child holding his or her wrist.

Clinicians should:

  • 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.
Issue Details
Related Pages and Resources
Other Sites
Science Behind the Issue

For More Information
1-800-CDC-INFO (232-4636)
TTY: 1-888-232-6348
Web: www.cdc.gov

Centers for Disease Control and Prevention
1600 Clifton Road NE
Atlanta, GA 30333
Publication date: July 9, 2019