[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]
Vital Signs: Surveillance for Acute Flaccid Myelitis — United States, 2018
Early Release / July 9, 2019 / 68
Adriana Lopez, MHS1; Adria Lee, MPH1; Angela Guo, MPH1; Jennifer L. Konopka-Anstadt, PhD1; Amie Nisler, MPH1; Shannon L. Rogers, MS1; Brian Emery1; W. Allan Nix1; Steven Oberste, PhD1; Janell Routh, MD1; Manisha Patel, MD1
1 Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC.
Corresponding author: Adriana Lopez, firstname.lastname@example.org, 404-639-8369.
All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.
Suggested citation for this article: Lopez A, Lee A, Guo A, et al. Vital Signs: Surveillance for Acute Flaccid Myelitis — United States, 2018. MMWR Morb Mortal Wkly Rep. ePub: 9 July 2019. DOI: http://dx.doi.org/10.15585/mmwr.mm6827e1external icon.
- What is already known about this topic?
- Biennial U.S. outbreaks of acute flaccid myelitis (AFM) have been recognized since 2014. Most cases occur in children during late summer and early fall.
- What is added by this report?
- During 2018, 233 confirmed AFM cases were reported, the largest number since surveillance began in 2014.
- Upper limb involvement only was more prevalent in confirmed cases (42%), as was report of respiratory symptoms or fever (92%) within 4 weeks preceding limb weakness onset.
- Median intervals from onset of limb weakness to hospitalization, magnetic resonance imaging, and reporting to CDC were 1, 2, and 18 days, respectively.
- What are the implications for public health practice?
- Prompt recognition, early specimen collection, and rapid reporting will expedite public health investigations and help characterize AFM.
Acute flaccid myelitis (AFM), a serious paralytic illness, was first recognized as a distinct condition in 2014, when cases were reported concurrent with a large U.S. outbreak of severe respiratory illness caused by enterovirus D-68 (EV-D68). Since 2014, nationwide outbreaks of AFM have occurred every 2 years in the United States; the cause for the recent change in the epidemiology of AFM in the United States, including the occurrence of outbreaks and a biennial periodicity since 2014, is under investigation. This report updates clinical, laboratory, and outcome data for cases reported to CDC during 2018.
Clinical data and specimens from persons in the United States who met the clinical criterion for AFM (acute onset of flaccid limb weakness) with onset in 2018 were submitted to CDC for classification of the illnesses as confirmed, probable, or non-AFM cases. Enterovirus/rhinovirus (EV/RV) testing was performed on available specimens from persons meeting the clinical criterion. Descriptive analyses, laboratory results, and indicators of early recognition and reporting are summarized.
From January through December 2018, among 374 reported cases of AFM, 233 (62%) (from 41 states) were classified as confirmed, 26 (7%) as probable, and 115 (31%) as non-AFM cases. Median ages of patients with confirmed, probable, and non-AFM cases were 5.3, 2.9, and 8.8 years, respectively. Laboratory testing identified multiple EV/RV types, primarily in respiratory and stool specimens, in 44% of confirmed cases. Among confirmed cases, the interval from onset of limb weakness until specimen collection ranged from 2 to 7 days, depending on specimen type. Interval from onset of limb weakness until reporting to CDC during 2018 ranged from 18 to 36 days, with confirmed and probable cases reported earlier than non-AFM cases.
Identification of risk factors leading to outbreaks of AFM remains a public health priority. Prompt recognition of signs and symptoms, early specimen collection, and complete and rapid reporting will expedite public health investigations and research studies to elucidate the recent epidemiology of AFM and subsequently inform treatment and prevention recommendations.
Keywords: Acute Flaccid Myelitis; Enterovirus; Rhinovirus; EV-D68; USA.