Information for Healthcare Providers

Reporting Acute Flaccid Myelitis

Acute Flaccid Myelitis (AFM) is a reportable condition in Kansas. Contact KDHE or your local health department as soon as possible if you suspect AFM in any persons seeking treatment for acute onset of limb or other muscle weakness.

Public health will collect pertinent clinical information and facilitate testing at CDC. Healthcare providers will need to submit the following information (if available) when a patient meets clinical criteria for AFM:

  • Admission and discharge notes
  • Complete vaccination history
  • Laboratory test results
  • Magnetic resonance imaging (MRI) reports and images
  • Neurology and infectious disease consult notes

Diagnosing AFM

  • Clinically, AFM presents with acute onset of muscle weakness in the arms or legs, often following a respiratory illness.
  • Some other symptoms that patients may have include:
    • Difficulty moving eyes
    • Difficulty swallowing or slurred speech
    • Drooping eyelids or a facial droop,
    • Pain in arms or legs
  • AFM is diagnosed based on magnetic resonance imaging (MRI) of the spinal cord. In persons with AFM, the MRI will show a spinal cord lesion largely restricted to gray matter and spanning one or more vertebral segments.
  • Diagnosis may also occur through testing stool, respiratory, sera, and cerebral spinal fluid specimens. It is important that tests are done as soon as possible after someone develops symptoms.

Testing for AFM

  • 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.
  • Coordinate with KDHE to submit the following specimens to CDC for testing:AFM Testing Equipment
    • Note that collection of stool 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.
  • Refer to the AFM Job Aid for Clinicians (PDF) for more details on specimen collection.
  • AFM testing at CDC includes:
    • Routine enterovirus/rhinovirus (EV/RV) testing and typing of CSF, respiratory, and stool specimens and poliovirus testing of stool specimens to rule out the presence of poliovirus. Results will be provided to the submitter once testing is completed.
    • Additional testing of CSF and serum to look for 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) nor intended for clinical diagnosis.
  • Pathogen-specific testing for diagnostic purposes should continue at the hospital or state public health laboratories.

Treating AFM

  • Currently, there is no specific targeted therapy or intervention that should be either preferred or avoided in the treatment for AFM.
  • Clinicians should expedite neurology and infectious disease consultations to discuss treatment and management considerations.
  • CDC received recommendations from an expert group of neurologists, infectious disease experts, pediatricians, immunologists, and public health experts and have developed a summary of considerations for clinical management of patients with AFM: Acute Flaccid Myelitis: Interim Considerations for Clinical Management.
  • The Transverse Myelitis Association created an AFM Physician Consult and Support Portal to connect medical professionals and offer 24/7 consultation.