From January 1 through November 16, 2018, the Centers for Disease Control and Prevention (CDC) received 273 reports of patients with acute flaccid limb weakness; 106 cases of AFM were classified as confirmed (from 29 states). This represents a threefold increase in confirmed cases compared with the same time period in 2017. Among confirmed cases, the median patient age was 4 years old and all were hospitalized. More than 90% of confirmed cases had a mild respiratory illness or fever consistent with a viral infection during the four weeks preceding the onset of limb weakness.
Health care providers who care for a child with acute onset of limb weakness should immediately contact the Fairfax County Health Department’s (FCHD) Communicable Disease Unit at 703-246-2433. FCHD will coordinate sending the report and specimens through the Virginia Department of Health to the CDC for review and testing.
- AFM is reportable in Virginia, under the category of an “unusual occurrence of disease of public health concern.” Reporting is important to characterize the risk in Fairfax County and, when aggregated with other reports, to help us better understand the spectrum of AFM illness, possible etiologies, risk factors, and outcomes for this condition. Clinicians should continue to be vigilant and report all suspect AFM patients who meet the clinical criteria (sudden onset of flaccid limb weakness) for this condition. Information that the health department will request includes:
- Admission and discharge notes.
- Neurology and infectious disease consult notes.
- Magnetic resonance imaging (MRI) reports AND images.
- Complete vaccination history.
- Laboratory test results.
- FCHD will work with the reporting provider to complete the AFM patient summary form.
- Clinicians should collect specimens from patients under investigation for AFM as early as possible in the course of illness, preferably on the day of onset of limb weakness. Contact FCHD, 24/7, for additional information on specimen collection and handling. Specimens to collect include:
- A nasopharyngeal (NP) or oropharyngeal (OP) swab.
- Please note the collection of stool specimens is required for AFM surveillance. Two stool specimens should be collected at least 24 hours apart early during the course of illness to rule out poliovirus infection.
- Pathogen-specific testing for diagnostic purposes should continue at hospital or state public health laboratories.
- AFM testing at CDC includes:
- Routine enterovirus/rhinovirus (EV/RV) testing and typing from CSF, respiratory, and stool specimens and poliovirus testing of stool specimens. Results will be provided to the submitter once testing is completed.
- Additional testing of CSF and serum to examine the etiology/mechanism for AFM. Patient-level results for the additional testing will not be provided since the testing protocols are not performed under the Clinical Laboratory Improvement Amendments (CLIA) and are not intended for clinical diagnosis.
The process for CDC case classification requires collection of many different pieces of information, including hospital notes and MRI images, which are then reviewed by several experts. Case classification is used for surveillance and investigation purposes and should not interfere with the clinical diagnosis or treatment of the patient. The case classification will be communicated through FCHD when the review is complete, generally at least 4 weeks after all of the information is received.
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