Tuesday, November 13, 2018

CDC AFM Update - Nov 13th

UPDATED: CDC COCA Call posted Audio[MP3 – 5 MB]
Plus a new MMWR Early Release has been published


In advance of today's COCA Call: November 13 – Acute Flaccid Myelitis (AFM): What Health Care Providers Need to Know, the CDC has revamped and updated their Acute Flaccid Myelitis pages, raising the number of confirmed cases for 2018 to 90 of 252 reports of patients under investigation (PUIs).
Investigations take time, and so that number is likely to rise.
While the cause of these polio-like paralysis remains a mystery, a number of enteroviruses (EV-71, EV-D68, etc.) are high on the suspect list. The CDC notes, however, that most cases have tested negative for any virus.

As paralysis often only appears days or even weeks after a suspected viral infection, that may help explain the lack of positive lab tests.  

What CDC has learned since 2014

  • Most of the patients with AFM (more than 90%) had a mild respiratory illness or fever consistent with a viral infection before they developed AFM.
    • Viral infections such as from enteroviruses are common, especially in children, and most people recover. We don’t know why a small number of people develop AFM, while most others recover. We are continuing to investigate this.
  • These AFM cases are not caused by poliovirus; all patients tested negative for poliovirus.
  • We detected coxsackievirus A16, EV-A71, and EV-D68 in the spinal fluid of four of 414 confirmed cases of AFM since 2014, which points to the cause of their AFM. For all other patients, no pathogen (germ) has been detected in their spinal fluid to confirm a cause.
  • Most patients had onset of AFM between August and October, with increases in AFM cases every two years since 2014. At this same time of year, many viruses commonly circulate, including enteroviruses, and will be temporally associated with AFM.
  • Most AFM cases are children (over 90%) and have occurred in 44 states.
  AFM remains exceedingly rare, striking fewer than 1 person in a million each year, but of those who are affected, 90% are under the age of 18.
We should have the audio recording and a transcript from today's COCA call either later today or in the morning.  I'll post a link at the top of this blog when they become available.
If you suspect you or your child is suffering from unexplained muscle weakness or paralysis, it is important to seek medical care immediately. The CDC continues to investigate, but until more is known, the CDC can only offer the following advice.


Poliovirus and West Nile virus may sometimes lead to AFM.
  • You can protect yourself and your children from poliovirus by getting vaccinated.
  • You can protect against bites from mosquitoes, which can carry West Nile virus, by using mosquito repellent, staying indoors at dusk and dawn (when bites are more common), and removing standing or stagnant water near your home (where mosquitoes can breed).
While we don’t know if it is effective in preventing AFM, washing your hands often with soap and water is one of the best ways to avoid getting sick and spreading germs to other people. Learn about when and how to wash your hands.
For more information on what CDC is doing, see our AFM Investigation page.

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