Abstract
In August 2018, CDC noted an increased number of reports of patients having symptoms clinically compatible with acute flaccid myelitis (AFM), a rare condition characterized by rapid onset of flaccid weakness in one or more limbs and spinal cord gray matter lesions, compared with August 2017. Since 2014, CDC has conducted surveillance for AFM using a standardized case definition (1,2). An Epi-X* notice was issued on August 23, 2018, to increase clinician awareness and provide guidance for case reporting.
Highlights
Patients who meet the clinical case criteria for acute flaccid myelitis (AFM), defined as acute flaccid limb weakness, are classified using the Council of State and Territorial Epidemiologists case definitions of “confirmed”, “probable”, or “not a case.”
CDC conducts enterovirus/rhinovirus (EV/RV) testing for all patients meeting the clinical criteria for AFM, when specimens are available
Specimens from 38 (54%) patients were positive by EV/RV real-time reverse transcription–polymerase chain reaction testing, including 11 (29%) for EV-A71, 14 (37%) for EV-D68, and 13 (34%) for other viruses, primarily from nonsterile sites
Summary
Patients who meet the clinical case criteria for AFM, defined as acute flaccid limb weakness, are classified using the Council of State and Territorial Epidemiologists case definitions of “confirmed” (magnetic resonance imaging [MRI] with spinal cord lesion largely restricted to gray matter and spanning ≥1 spinal segments), “probable” (cerebrospinal fluid [CSF] pleocytosis [>5 white blood cells per mm3]), or “not a case.”. The median interval from limb weakness to CSF collection was 1 day (range = 0–16; IQR = 1–3). The median interval from sign or symptom onset to CSF collection was 7 days (range = 0–23; IQR = 5–8) for respiratory illness, 4 days (range = 0–22; IQR = 3–7) for gastrointestinal symptoms, and 3 days (range = 0–17; IQR = 2–6) for fever.
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