Frequently Asked Questions for Healthcare Professionals

A: Clinicians: If you believe your patient has symptoms of AFM, please fill out the patient summary form and send information about the case to your state or local health department. Please collect biological specimens as soon as possible. Talk with your state or local health department to coordinate sending specimens to CDC; your state/local health department will inform you immediately once the case has undergone review and received a determination by CDC’s AFM Surveillance team. In the meantime, specimens should be stored per the instructions on the Specimen Collection Instructions, to preserve the integrity of the specimens. It is very important to remind the clinical laboratory to NOT dispose of any biological specimens from suspected AFM cases until you hear back from your state / local health department.

Health departments: If you have received information about a case of AFM, please contact CDC (limbweakness@cdc.gov), and please have the clinician fill out the patient summary form. CDC will work with you to confirm if the patient meets the case definition for AFM.

A: Yes, we encourage information about patients meeting the AFM case definition to be sent to CDC regardless of laboratory testing results. Although the outbreak of severe respiratory illness caused by EV-D68 and the national cluster of AFM cases occurred around the same time in 2014, the pathogen or biologic mechanism responsible for the AFM cases has not been identified yet. Therefore, the AFM case definition does not include laboratory testing results. We are still seeking a cause for these unusual cases of AFM, and while EV-D68 is one hypothesis, this has not been substantially confirmed as most instances of EV-D68 infection result in mild respiratory illness. We request information and provision of biological specimens from ANY patient suspected of having AFM, regardless of whether they test positive for an enterovirus.

A: Since we are still determining potential causes of AFM, we cannot recommend any one treatment. However, CDC received input from an expert group of neurologists, infectious disease experts, pediatricians, immunologists, and public health experts that convened in the fall of 2014 to develop a document with considerations for clinical management of patients with AFM. These considerations are encouraged by this expert group to be used by medical providers for clinical management of AFM.

A: CDC has updated the laboratory testing protocol and is no longer conducting pathogen-specific testing for suspect cases of AFM. Pathogen-specific testing can be conducted at the hospital or state public health laboratory. However, we request that sterile (i.e., cerebrospinal fluid, blood) and stool specimens be sent to CDC for testing using our expanded approach. For instructions on how to submit specimens to CDC, see Specimen Collection and Submission.

A: Please recognize that CDC will not provide specific test results for individual samples since the new testing to be done uses assays that are not CLIA-approved and not intended for clinical diagnosis. However, results that indicate a possible cause of AFM will be rapidly disseminated. The primary purpose of CDC laboratory testing is to guide epidemiological investigations, including determining the pathogen causing the AFM cases, rather than to inform clinical management.

A: Currently we are considering the most efficient ways of following up on cases of AFM detected through routine information gathering and close collaboration with institutions caring for these affected children. We conducted a short-term follow-up survey on cases with information collected during the 2014 investigation, and received responses from roughly half (56) of the identified cases. A small number described complete recovery of limb function after a median of about 4 months after onset of limb weakness. The majority described some improvement of function, though it is not clear how much improvement occurred. A small number described no improvement in limb function. No deaths were noted.