For Health Care Professionals

2014-2016 Reports of Acute Flaccid Myelitis (AFM)

From August to December, 2014, CDC verified reports of 120 children in 34 states who developed acute flaccid myelitis (AFM) that met CDC's outbreak case definition (onset of acute limb weakness on or after August 1, 2014, and a magnetic resonance image showing a spinal cord lesion largely restricted to gray matter in a patient age <21 years). Passive surveillance for AFM has continued at CDC since 2014. From January through June, 2016, CDC received an increased number of reports of suspected AFM compared to the same period in 2015.

To date, no single pathogen has been consistently detected in CSF, respiratory specimens, stool, or blood at either CDC or state laboratories. Clinicians are encouraged to maintain vigilance for cases of AFM among all age groups and to report suspected cases of AFM to CDC. Reporting of cases will help states and CDC monitor the occurrence of this illness and better understand factors possibly associated with AFM. For more information on AFM cases, see AFM Surveillance.

Laboratory Testing

Infection with non-polio enteroviruses can be confirmed by:

• isolating or identifying the virus in cell culture, or
• polymerase chain reaction (PCR) assay.

Specimen Collection

Non-polio enteroviruses can be detected in stool or rectal swabs and respiratory specimens (including from the throat). Depending on the symptoms, other specimen types such as cerebrospinal fluid, blister fluid, and blood can be collected for testing. For more information, see Specimen Collection, Storage, & Shipment.

A positive laboratory test for non-polio enteroviruses from certain specimens, such as rectal or respiratory swab, does not necessarily mean the virus is the cause of infection. Non-polio enteroviruses can be shed for an extended period of time after the symptoms have resolved.

References

• American Academy of Pediatrics. Section 3: Enterovirus (nonpoliovirus) - clinical manifestations. In Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Elk Grove Village, IL: American Academy of Pediatrics; 2015.

NOTE: for recommendations on clinical evaluation, reporting, and treatment of EV-D68 as well as laboratory testing and infection control, see Enterovirus D68 for Health Care Professionals.