Alert from BCDH: Acute Flaccid Myelitis

October 26, 2015

Please see this memo from the NC Division of Public Health re: identification, management and reporting of cases of acute flaccid myelitis (AFM).

  • Despite the close association in timing in late 2014 between the national outbreak of severe respiratory illness among children caused by enterovirus-D68 and the increase in AFM cases, an etiology for the AFM cases was not determined. We are asking for your continued vigilance in identifying cases of AFM, irrespective of enterovirus status and age of patient.  Reporting of these cases will help public health officials monitor for increases in this illness and better understand potential causes, risk factors, and preventive measures or therapies.

Here is some of the key info from the memo:

Case Definition

The case definition for AFM has been expanded to include all ages and to provide a more complete picture of the full spectrum of illness.

Confirmed Case:

  • An illness with onset of acute focal limb weakness AND
  • MRI showing spinal cord lesion largely restricted to gray matter and spanning one or more spinal segments

Probable Case:

  • An illness with onset of acute focal limb weakness AND
  • CSF showing pleocytosis (white blood cell count >5 cells/mm3, may adjust for presence of red blood cells by subtracting 1 white blood cell for every 500 red blood cells present).


Clinicians suspecting AFM in patients meeting the probable or confirmed case definition (irrespective of laboratory testing results) are asked to report these cases to their local health department (Buncombe County Disease Control staff are available 24/7 at 828-250-5109) or to the NC DPH Communicable Disease Branch at 919-733-3419.

·         Please consult with DPH re: laboratory testing of CSF, blood, serum, respiratory, and stool specimens for enteroviruses, West Nile virus, and other known infectious etiologies.

Specimen Collection and Testing

Clinicians should collect specimens (see memo for details on what specimens) from patients suspected of having AFM as early as possible in the course of illness, preferably on the day of onset of limb weakness.

Clinical Management and Follow-up of Patients

For guidance on managing care of persons with AFM that meet CDC’s case definition see

Additional Information

Additional information about AFM is available at


As always, contact your local health department for any questions re: this or any other public health matter. 

Thanks for the care your provide to our community,


Jennifer Mullendore, MD, MSPH

Medical Director

Buncombe County Health and Human Services

Office:  (828) 250-6308