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This is a message from the Louisiana Department of Health Emergency Operation Center (LDH EOC). This is a message for the Louisiana Health Alert Network (LA HAN). Please read the letter below regarding acute flaccid myelitis (AFM). Please share and distribute this AFM Alert with relevant health care professionals as well as other LDH stakeholders and partners through your own distribution channels.

Acute flaccid myelitis (AFM) is an illness characterized by acute onset of flaccid limb weakness and magnetic resonance imaging (MRI) showing lesions in the gray matter of the spinal cord. AFM has been under investigation by health departments and the Centers for Disease Control and Prevention (CDC) for the past 4 years. Surveillance has shown that AFM cases generally peak in the months of September and October. A biennial pattern has been observed, with the majority of cases reported in 2014 and 2016, and smaller numbers reported in 2015 and 2017.

In 2018, this pattern has continued with an increase in AFM cases nationwide.

As of October 16, 2018, CDC has confirmed 62 cases of AFM in 22 states. Out of the 62 cases, 58 have been in individuals less than 18 years old. These 62 confirmed cases are among the total of 127 reports that CDC received of patients under investigation (PUIs). CDC recently received increased reports for PUIs with onset of symptoms in August and September. We are sending this letter to encourage you to be aware of the symptoms of AFM, and to provide some resources to help with the identification and reporting of suspected AFM cases and specimen collection. Even with the increase in cases, AFM remains very rare (less than 1 in a million).

AFM appears to start with a prodromal respiratory or gastrointestinal illness about 1 week before limb weakness onset. Pain in the neck or back often directly precedes weakness in one or more limbs, and cranial nerve findings such as slurred speech, difficulty swallowing, and eyelid or facial droop may occur. On exam, the weak limb(s) displays poor tone and diminished reflexes. Cerebrospinal fluid may show a lymphocytic pleocytosis and elevated protein. MRI findings in AFM cases include lesions in the central, or gray matter, of the spinal cord.

Since AFM is a relatively new condition, CDC and the Louisiana Department of Health (LDH) are investigating all patients to help us better understand the spectrum of illness, and all possible causes, risk factors, and outcomes for AFM. CDC does not know what causes most AFM cases, despite extensive lab testing. There are several possible causes of AFM, such as viruses (e.g., poliovirus, non-polio enteroviruses such as EV-A71, adenoviruses, and West Nile Virus), environmental toxins, and genetic disorders. To date, all of the AFM cases have tested negative for poliovirus.

We ask that you report all patients to LDH’s Infectious Disease Epidemiology section that meet the clinical criterion for AFM (sudden onset of flaccid limb weakness). 

Patients should be reported who meet the clinical criterion regardless of any laboratory results or MRI findings

. Note: there is no age restriction for reporting suspected cases. The case definition includes people of all ages to allow us to collect information on the full spectrum of the condition in both children and adults. For more information about the case definition for AFM, please see 

https://www.cdc.gov/acute-flaccid-myelitis/hcp/case-definition.html

. For CDC’s updated case counts, please see 

https://www.cdc.gov/acute-flaccid-myelitis/afm-surveillance.html

For questions or to notify us of any patients who you are evaluating for acute onset of flaccid limb weakness, you may call the Infectious Disease Epidemiology Section of the Louisiana Office of Public Health at 504-568-8313 or 800-256-2748.

Health Alert Regarding Acute Flaccid Myelitis (AFM)