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For Health Care Professionals

2014 Investigation of Acute Flaccid Myelitis (AFM)

From August to October 2014, CDC received increased reports of children across the United States who developed a neurologic illness called acute flaccid myelitis (AFM). The specific causes of this illness are still under investigation. However, these cases are most similar to illnesses caused by viruses, including enteroviruses (polio and non-polio), adenoviruses, West Nile virus and similar viruses, and herpesviruses. CDC continues to receive and investigate sporadic reports of cases. It is unclear if an increase in cases could occur again. Therefore, CDC is re-emphasizing to clinicians and health departments the importance of continued vigilance for AFM cases among all age groups. See AFM Surveillance for more information.

Laboratory Testing

Infection with non-polio enteroviruses can be confirmed by:

  • isolating or identifying the virus in cell culture, or
  • polymerase chain reaction (PCR) assay.

Specimen Collection

Non-polio enteroviruses can be detected in stool or rectal swabs and respiratory specimens (including from the throat). Depending on the symptoms, other specimen types such as cerebrospinal fluid, blister fluid, and blood can be collected for testing. For more information, see Specimen Collection, Storage, & Shipment.

A positive laboratory test for non-polio enteroviruses from certain specimens, such as rectal or respiratory swab, does not necessarily mean the virus is the cause of infection. Non-polio enteroviruses can be shed for an extended period of time after the symptoms have resolved.

References

  • American Academy of Pediatrics. Section 3: Enterovirus (nonpoliovirus) - clinical manifestations. In Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Elk Grove Village, IL: American Academy of Pediatrics; 2015.

NOTE: for recommendations on clinical evaluation, reporting, and treatment of EV-D68 as well as laboratory testing and infection control, see Enterovirus D68 for Health Care Professionals.

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