10.19.18 – Acute Flaccid Myelitis (AFM) and Maryland Clinicians 

October 18, 2018

Dear Colleagues,

Recently there have been several media reports concerning a national increase in cases of acute flaccid myelitis (AFM). Maryland currently has five suspect AFM cases under investigation, reported between the last week of September to October 15. The cases range between one year and eight years old, and reside in four counties. None of the AFM cases are known to be connected to each other.

Maryland clinicians are strongly encouraged to report all suspect AFM cases to the Maryland Department of Health (MDH) at 410-767-6679 or mdh.afminfo@maryland.gov. A MDH epidemiologist will advise on clinical data and specimens to collect for submission to CDC. Expert neurologists at the Centers for Disease Control and Prevention (CDC) will review clinical information and laboratory results for each case in order to make a final determination.

AFM is a rare but serious condition, occurring in less than one in a million people in the United States per year. It is not a new condition. AFM presents as acute flaccid limb weakness in one or more limbs, accompanied by pleocytosis (white blood cell count >5 cells/mm3) in cerebrospinal fluid, and/or a magnetic resonance image (MRI) showing spinal cord lesion(s) largely restricted to gray matter and spanning one or more vertebral segments. MRIs may be negative or normal within the first 72 hours after weakness. Cases may also have facial droop/weakness, difficulty moving the eyes, drooping eyelids, or difficulty with swallowing or slurred speech. Many cases have a recent history of upper respiratory or gastrointestinal infections prior to weakness onset, but some do not. AFM itself is not contagious, but clinicians should continue to follow syndromic or pathogen-appropriate infection control precautions.

Case counts have historically risen between August and October of even-numbered years. Most AFM cases occur in children and are initially identified in pediatric emergency departments and by pediatric neurologists.

Please see the FAQ and Job Aid for Clinicians.

Additional information about AFM may be found at: https://www.cdc.gov/acute-flaccid-myelitis/afm-surveillance.html

Thank you for your attention to this important public health issue.

Sincerely,

Emma Stanislawski, MPH, CPH, AFM Surveillance Coordinator
David Blythe, MD, MPH, State Epidemiologist