Acute Flaccid Myelitis (AFM)
What is AFM?
Acute flaccid myelitis (AFM) is a serious neurologic condition that causes rapid onset of flaccid weakness in one or more limbs and has distinct abnormalities of the spinal cord gray matter on magnetic resonance imaging (MRI). AFM is a rare condition that is considered a medical emergency.
Symptoms
AFM looks a lot like polio, this must be evaluated during workup for AFM.
- Arm or leg weakness
- Loss of muscle tone and reflexes
- Difficulty moving the eyes or drooping eyelids
- Facial droop or weakness
- Difficulty swallowing or slurred speech
- Pain in arms or legs
- Pain in neck or back
- Numbness or tingling in limbs
Causes
AFM can be caused by viruses, including enteroviruses. Most patients develop AFM from August-November when these viruses are commonly spread. EV-D68 is the most common virus detected in AFM patients but can also be caused by other viruses such as flaviviruses, herpesviruses and adenoviruses.
Prevention
It is unknown how AFM is caused; there is no specific prevention method available. It is recommended by the CDC to take steps to prevent getting sick from a virus such as,
- Practice hand hygiene
- Avoid touching your face with unwashed hands
- Avoid close contact with those who are sick
- Stay up to date on recommended vaccinations
Surveillance
AFM cases and outbreaks (CDC)
Per Washington State Department of Health, clinicians treating patients who meet the AFM case ascertainment criteria should expedite neurology and infectious disease consultations to discuss treatment and management considerations and should pursue laboratory testing for enteroviruses, West Nile virus, and other known infectious etiologies at their usual clinical and reference laboratories. Clinicians may contact Thurston County Public Health and Social Services for assistance with any testing that is not available locally. Specimens should not be shipped to WA DOH without first consulting with Thurston County Public Health and Social Services.
Acute Flaccid Myelitis (WA DOH)
AFM specimen collection instructions (CDC)
AFM Lab Clinicians & Health Departments (CDC)
- If you are a clinician or from a health department and have a non-urgent question about AFM, email the AFM team at AFMInfo@cdc.gov.
- For urgent questions about AFM, please call the Emergency Operations Center (EOC) at 770-488-7100.
- Need a consult on a possible AFM case? Go to AFM Physician Consult and Support Portal.
- AFM Cases & Outbreaks (CDC)
Recommendations for hospitalized patients: Standard, contact, and droplet precautions. No pathogen-specific recommendations currently. This is consistent with the CDC’s recommendations for EV-D68. Non-enveloped viruses such as EV-D68 may be less susceptible to alcohol than enveloped viruses or vegetative bacteria. After removing and before donning gloves, perform hand hygiene using either alcohol-based hand sanitizer (ABHS) or soap and water.
Contact management: Contacts should be educated regarding specific etiology if an agent is suspected and advised when to seek medical care.
Healthcare providers and healthcare facilities: notifiable to local health jurisdictions within 24 hours.
Laboratories: no requirements for reporting.
Report a Notifiable Condition: 360-786-5470 (24-hour Reporting Line)
Contact our Disease Control and Prevention division at 360-867-2610 or email PHSS_DCP_CDTeam@Thurstoncounty.onmicrosoft.com if you have additional questions.