Acute Flaccid Myelitis (AFM) Provider Information

Advisories

Clinical Presentation

Most patients with Acute Flaccid Myelitis report having had a fever, respiratory illness, or gastrointestinal illness 1-2 weeks before the onset of neurological symptoms. Key symptoms include:

  • Rapid onset of weakness: within hours to a few days.
  • Weakness in one or more limbs, typically more proximal than distal.
  • Loss of muscle tone and reflexes in the affected limb(s).
  • Cranial nerve abnormalities including:
    • Facial or eyelid drooping,
    • Difficulty swallowing or speaking, or
    • Hoarse or weak cry.
  • Some patients may report a stiff neck, headache, or pain in the affected limb(s). Numbness and tingling are rare.
  • An MRI will show a spinal cord lesion involving the gray matter, ruling out cases caused by malignancy, vascular disease, or anatomic abnormalities.
  • Severe symptoms include:
    • Respiratory failure requiring mechanical ventilation.
    • Serious neurological complications such as changes in body temperature or unstable blood pressure.

Specimen Submission

  • Testing for Acute Flaccid Myelitis is available at NYSDOH Wadsworth Center. For patients suspected of having Acute Flaccid Myelitis or Acute Flaccid Paralysis/weakness without a known etiology, collect specimens for enterovirus Polymerase Chain Reaction testing. Specimens should be collected as soon as possible after the onset of weakness.

Specimen collection guidelines:

  • Stool specimens: collect two quarter-sized stool samples in a sterile wide-mouth container (no additives), ideally collected 24 hours apart. Keep samples cold (refrigerated or frozen).
  • Oropharyngeal/nasopharyngeal swabs: place in viral transport media.
  • Cerebrospinal fluid: If available, collect 2-3 cc in a sterile tube (no additives). Freeze promptly to -70/-80°C and ship on dry ice.
  • Serum samples: collect acute serum (before IVIG treatment) and convalescent serum (2-3 cc in a red or tiger-top tube).

Include a shipping manifest from an electronically submitted Remote Order or an Infectious Disease Requisition Form requesting enterovirus sequencing, with all specimens sent to Wadsworth. Be sure to note:

  • Symptoms
  • Flaccid weakness onset date
  • Polio immunization history

Store specimens in a refrigerator and ship cold on frozen gel packs or frozen on dry ice. Continue routine pathogen-specific testing at hospital or clinical laboratories as needed. Send specimens immediately, do not hold for batch shipments, and do not ship to the CDC.

For questions regarding specimen submissions, contact Wadsworth Center at wcid@health.ny.gov.

Reporting

Report suspect Acute Flaccid Myelitis cases promptly to the NYSDOH at:

  • Phone: 518-473- 4439 during business hours, or 1-866-881-2809 after hours (evenings, weekends, and holidays) or
  • Email: or AFM@health.ny.gov

For patients who are residents of New York City, report to the New York City Department of Health and Mental Hygiene Provider Access Line at 1-866-692-3641.

For questions about AFM reporting, please contact AFM@health.ny.gov.

Infection Control

The CDC recommends Standard + Contact + Droplet precautions for managing patients with AFM.

For questions about infection control in healthcare facilities, contact the NYSDOH Bureau of Healthcare Associated Infections at 518-474-1142 or icp@health.ny.gov.