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Friday, January 06, 2017

CDC Acute Flaccid Myelitis Update - January 2017 

The number of AFM cases dropped by nearly 80% in 2015 (see chart above), but has once again spiked in 2016 - and this time without a concurrent EV-D68 outbreak spreading across the nation.

While a circumstantial case has been posited to link AFM to EV-D68 over the past couple of years (see EID Journal  Enterovirus D68 Infection in Children with Acute Flaccid Myelitis, Colorado, USA, 2014), no definitive causal link has been established.

All of which leaves us with a medical mystery as to what is causing this resurgence of AFM, one that equaled by the end of last November, the 120 cases reported in 2014.

This January update from the CDC.

AFM in the United States

At a Glance

Since then, CDC has been actively investigating this illness. We continue to receive reports of sporadic cases of AFM. From January 1 to November 30, 2016, a total of 120 people in 37 states across the country were confirmed to have AFM. Updated January 2, 2017

^ Cases reported as of December 31, 2016 with onset of illness through November 30, 2016. The case counts are subject to change. CDC updates the case counts monthly with a one month lag to allow the time needed for case review.

† The data shown from August 2015 to present are based on a revised AFM case definition adopted by CSTE: acute onset of focal limb weakness and an MRI showing spinal cord lesion largely restricted to gray matter and spanning one or more spinal segments, regardless of age.

For more information on AFM case definitions, visit the Case Definitions page.

What This Graph Shows

It is currently difficult to interpret trends of the AFM data since reporting only started in 2014 and is voluntary in most states. Also, since AFM reporting is relatively new, there may initially be more variability in the data from year to year making it difficult to interpret or compare case counts between years. One possible reason for the differences in annual reporting is more awareness among and reporting by healthcare providers and health departments.

What we know about the AFM cases reported since August 2014:

Most patients are children.

The patients’ symptoms have been most similar to complications of infection with certain viruses, including poliovirus, non-polio enteroviruses, adenoviruses, and West Nile virus. See a list of viruses associated with AFM.

Enteroviruses can cause neurologic illness, including meningitis. However, more severe disease, such as encephalitis and AFM, is not common. Rather, they most commonly cause mild illness.

CDC has tested many different specimens from the patients for a wide range of pathogens (germs) that can cause AFM. To date, we have not consistently detected a pathogen (germ) in the patients’ spinal fluid; a pathogen detected in the spinal fluid would be good evidence to indicate the cause of AFM since this illness affects the spinal cord.

The increase in AFM cases in 2014 coincided with a national outbreak of severe respiratory illness among people caused by enterovirus D68 (EV-D68). Among the people with AFM, CDC did not consistently detect EV-D68 in the specimens collected from them. In 2015 there were no cases of EV-D68 detected and so far in 2016, only limited sporadic cases of EV-D68 have been detected in the United States.

What We Don't Know

What CDC Is Doing

(Continue . . . )

You can access earlier updates on the following blogs:

CDC Acute Flaccid Myelitis Update - December 2016

CDC Acute Flaccid Myelitis Update - Nov 1st, 2016

CDC Investigating Increase In AFM In The United States

Posted by Michael Coston at 5:06 AM 


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