What CDC is Doing to Investigate AFM

We work closely with national experts, healthcare providers, and state and local health departments to thoroughly investigate AFM by looking for possible risk factors and causes, figuring out why some people develop this condition, monitoring AFM activity nationwide, and updating possible treatment options.

Specific activities include:

Obtaining National Data and Monitoring AFM Activity

  • Encouraging healthcare providers to recognize and report to their health departments all patients who they suspect may have AFM, then for health departments to send this information to CDC to help us understand AFM activity nationwide
  • Conducting enhanced surveillance for AFM by initiating a study at seven pediatric hospitals across a geographically diverse area of the United States. These hospitals are also conducting surveillance for acute respiratory and gastrointestinal illness and collecting samples for viral testing. Enhancing AFM surveillance at these hospitals will allow a comparison of AFM case counts with current circulating respiratory and gastrointestinal viruses in these locations
  • Supporting states that want to confirm their own cases, by providing standard operating procedures, a medical chart abstraction tool, and training on how to interpret the information. We also created a secure database to collect medical information including symptoms, findings from their clinical exam, treatment, and laboratory test results
  • Collaborating with experts to review MRI scans of people from the past 10 years to estimate how many AFM cases occurred before 2014
  • Assisting state and local health departments to better characterize potential common exposures, evaluate potential non-infectious and infectious etiologies, and describe the healthcare seeking behaviors of AFM patients and their families prior to AFM diagnosis

Confirming Cases of AFM

  • Verifying clinical information of patients under investigation (PUIs) for AFM submitted by health departments, and working with health departments and neurologists to classify cases using a standard case definition adopted by the Council of State and Territorial Epidemiologists (CSTE)

Exploring Treatment Options

  • Providing an updated “Interim Considerations for Clinical Management of Patients with AFM” in November 2018 after four years of best practices in patient care and treatment experience, in consultation with national experts in infectious diseases, neurology, pediatrics, critical care medicine, public health epidemiology, and virology in response to the rapid emergence of AFM.

Laboratory Testing of Specimens from PUIs for AFM

  • Testing specimens, including stool, blood, and spinal fluid, from PUIs for enteroviruses and other viruses
  • Collecting data from laboratories outside of CDC about their testing results to complete records of laboratory test results for all PUIs
  • Using metagenomic sequencing approaches to identify known and unknown pathogens (germs) not currently considered in the EV-D68 specifically targeted approaches
  • Developing assays to look for biomarkers associated with AFM for earlier identification of children at risk of becoming paralyzed
  • Investigating how damage to the spinal cord in AFM patients could occur days or weeks after an infection to understand how viruses may be causing this disease

Consulting with experts to better understand AFM

  • Establishing an AFM task force to foster collaborations between CDC and the scientific community to better understand what’s causing AFM, how to prevent it, and how to treat it
  • Hosted a one-day technical consultation in September 2017 with 12 nationally-recognized experts in AFM and 20 CDC medical officers, epidemiologists, and laboratory scientists to discuss how viruses could cause AFM and what viruses were most likely responsible

Educating healthcare providers and the public

  • Working with health departments, professional medical organizations, and partners to educate healthcare providers in specific clinical specialties so they are aware of the symptoms of AFM, how to report PUIs, what specimens to collect, and the clinical management considerations for patients with AFM. Some educational activities and materials include health alerts, job aids, toolkits, webinars, and scientific publications and presentations.
  • Updating our AFM website regularly with new information about AFM, and current counts of confirmed AFM cases. This website has information about AFM and CDC’s investigation, and a section for healthcare providers with information about the AFM case definitions, data collection and reporting of PUIs, specimen collection and shipping, and clinical management of patients
  • Publishing data and findings of our AFM investigation in scientific journals, and presenting at scientific conferences