New Cluster of Acute Flaccid Myelitis in Western Pennsylvania

Cramer, Natan; Munjal, Neil; Ware, Danielle; Ramgopal, Sriram; Simon, Dennis; Freeman, Megan Culler; Michaels, Marian G.; Stem, Christopher; Thakkar, Kavita; Williams, John V.; Panigrahy, Ashok; Neville, Desiree N; Owusu‐Ansah, Sylvia

doi:10.1016/j.annemergmed.2019.01.024

Cited by 5 publications

(6 citation statements)

References 16 publications

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“…AFM can progress rapidly and might require respiratory support (14)(15)(16)(17); patients evaluated with signs and symptoms consistent with AFM should be hospitalized for close monitoring. In the absence of a confirmatory diagnostic test for AFM, management decisions for individual patients in the acute setting should be informed by careful review of the patient's signs and symptoms, laboratory testing, MRI results, and other test results, including electromyography, and in close consultation with infectious disease specialists and neurologists.…”

Section: Discussionmentioning

confidence: 99%

Vital Signs: Surveillance for Acute Flaccid Myelitis — United States, 2018

Lopez

Lee

Guo

et al. 2019

MMWR Morb. Mortal. Wkly. Rep.

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Background: Acute flaccid myelitis (AFM), a serious paralytic illness, was first recognized as a distinct condition in 2014, when cases were reported concurrent with a large U.S. outbreak of severe respiratory illness caused by enterovirus D-68 (EV-D68). Since 2014, nationwide outbreaks of AFM have occurred every 2 years in the United States; the cause for the recent change in the epidemiology of AFM in the United States, including the occurrence of outbreaks and a biennial periodicity since 2014, is under investigation. This report updates clinical, laboratory, and outcome data for cases reported to CDC during 2018.Methods: Clinical data and specimens from persons in the United States who met the clinical criterion for AFM (acute onset of flaccid limb weakness) with onset in 2018 were submitted to CDC for classification of the illnesses as confirmed, probable, or non-AFM cases. Enterovirus/rhinovirus (EV/RV) testing was performed on available specimens from persons meeting the clinical criterion. Descriptive analyses, laboratory results, and indicators of early recognition and reporting are summarized.Results: From January through December 2018, among 374 reported cases of AFM, 233 (62%) (from 41 states) were classified as confirmed, 26 (7%) as probable, and 115 (31%) as non-AFM cases. Median ages of patients with confirmed, probable, and non-AFM cases were 5.3, 2.9, and 8.8 years, respectively. Laboratory testing identified multiple EV/RV types, primarily in respiratory and stool specimens, in 44% of confirmed cases. Among confirmed cases, the interval from onset of limb weakness until specimen collection ranged from 2 to 7 days, depending on specimen type. Interval from onset of limb weakness until reporting to CDC during 2018 ranged from 18 to 36 days, with confirmed and probable cases reported earlier than non-AFM cases. Conclusion:Identification of risk factors leading to outbreaks of AFM remains a public health priority. Prompt recognition of signs and symptoms, early specimen collection, and complete and rapid reporting will expedite public health investigations and research studies to elucidate the recent epidemiology of AFM and subsequently inform treatment and prevention recommendations.Please note: An erratum has been published for this issue. To view the erratum, please click here.

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Section: Discussionmentioning

confidence: 99%

Vital Signs: Surveillance for Acute Flaccid Myelitis — United States, 2018

Lopez

Lee

Guo

et al. 2019

MMWR Morb. Mortal. Wkly. Rep.

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“…After removal of duplicates and initial screening, 500 were reviewed and assessed for eligibility. After application of inclusion and exclusion criteria, 99 articles were included in this study (55 case reports/series, 1,4–7,9–57 33 retrospective cohort studies, 2,3,58–88 seven cross-sectional studies, 89–95 and four case-control studies 96–99 ) (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

Acute Flaccid Myelitis: Review of Clinical Features, Diagnosis, and Management with Nerve Transfers

Kozlowski¹,

Linzey

Muhlestein

et al. 2022

Plastic &Amp; Reconstructive Surgery

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cute flaccid myelitis (AFM) is a polio-like illness in children that causes inflammation of the spinal cord gray matter. AFM is characterized by a viral prodrome that is followed by mild to severe weakness in one to four limbs that can be persistent even after conservative management. 1 Almost one-third of patients admitted to the hospital require intubation because of weakness of respiratory muscles or bulbar muscle weakness. 2 AFM was initially recognized after the first major outbreak in the United States in 2014.

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“…4 -8 Several recent reports describe confirmed acute flaccid myelitis cases in the 2016 and 2018 outbreaks. 3,9 Although not exclusively following a biennial pattern, the vast majority of cases occur in the late summer and fall every 2 years (Figure 1, last accessed May 5, 2020). 8,10,11 In 2014, 2016, and 2018 there were 120, 153, and 238 confirmed cases of acute flaccid myelitis, respectively; in 2015 there were 22, and in 2017 there were 37.…”

Section: Clinical Overview Of Acute Flaccid Myelitismentioning

confidence: 99%

“…10 Weakness may be rapidly progressive and, when the muscles of respiration are involved, lead to ventilatory failure and the need for mechanical ventilation. 9 Permanent disability is common. The majority of patients will have some physical disability 1 year after diagnosis.…”

Section: Clinical Overview Of Acute Flaccid Myelitismentioning

confidence: 99%

Acute Flaccid Myelitis: A Multidisciplinary Protocol to Optimize Diagnosis and Evaluation

et al. 2020

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Acute flaccid myelitis is an emerging neurologic disease, first described in 2014 and predominantly affecting young children. Acute flaccid myelitis cases tend to spike every 2 years, in the late summer to fall, and the next peak is expected in 2020. The diagnosis of acute flaccid myelitis is often delayed, leading to suboptimal evaluation, including incomplete laboratory assessment. Acute and chronic morbidity are high, and a standardized, multidisciplinary approach to evaluation and treatment is essential to optimizing outcomes. In a review of acute flaccid myelitis patients treated in 2018 at our institution, we noted considerable variability in days to presentation, evaluation, and treatment. In response, the authors developed a protocol for the evaluation and management of pediatric patients suspected of having acute flaccid myelitis. The protocol was developed using local experience/case review, expert consensus, and the relevant literature. The protocol spans the spectrum of care, from initial evaluation in a primary care or emergency setting, to acute hospital management and evaluation and long-term inpatient and rehabilitation settings. The purpose of this report is both to share the findings from our 2018 case review and to disseminate our acute flaccid myelitis protocol. Our hope is that publication of our protocol will both inform the development of a standardized approach to acute flaccid myelitis and to encourage other centers to form a multidisciplinary acute flaccid myelitis team to provide expert care throughout the disease process, from presentation to recovery.

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New Cluster of Acute Flaccid Myelitis in Western Pennsylvania

Cited by 5 publications

References 16 publications

Vital Signs: Surveillance for Acute Flaccid Myelitis — United States, 2018

Vital Signs: Surveillance for Acute Flaccid Myelitis — United States, 2018

Acute Flaccid Myelitis: Review of Clinical Features, Diagnosis, and Management with Nerve Transfers

Acute Flaccid Myelitis: A Multidisciplinary Protocol to Optimize Diagnosis and Evaluation

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