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AFM Chapter

A.  Agent

AFM can result from a variety of causes, including viral infections.

B.  Clinical Description

Most patients will have sudden onset of limb weakness and loss of muscle tone and reflexes. Some patients, in addition to the limb weakness, will experience:

• facial droop/weakness,
• difficulty moving the eyes,
• drooping eyelids, or
• difficulty with swallowing or slurred speech.

Numbness or tingling is rare in patients with AFM, though some patients have pain in their arms or legs. Some patients with AFM may be unable to pass urine. The most severe symptom of AFM is respiratory failure that can happen when the muscles involved with breathing become weak. This can require urgent ventilator support (breathing machines).

C.  Reservoirs

Conditions like AFM can be caused by a variety of germs, including several viruses.  Therefore, potential reservoirs are varied.

D.  Modes of Transmission

Conditions like AFM can be caused by a variety of germs, including several viruses.  Therefore, modes of transmission are varied.

E.  Incubation Period

Conditions like AFM can be caused by a variety of germs, including several viruses.  Therefore, incubation periods are varied.

F.  Period of Communicability or Infectious Period

Conditions like AFM can be caused by a variety of germs, including several viruses.  Therefore, communicability periods are varied.

G.  Epidemiology

This condition is not new, but the increase in cases we saw starting in 2014 is new. Still, CDC estimates that less than one in a million people in the United States will get AFM every year. There are a variety of possible causes of AFM, such as viruses, environmental toxins, and genetic disorders. Most of the cases that CDC has learned about have been in children.

H.  Bioterrorism Potential

None.

A.  Purpose of Surveillance and Reporting

• To identify cases of AFM
• To help identify causes of AFM
• To understand the impact of AFM among all ages groups

B.  Laboratory and Healthcare Provider Reporting Requirements

Acute flaccid myelitis was first made temporarily reportable in January, 2016 and this order was reissued on October 15, 2018.  Iowa Administrative Code 641-1.3(139) stipulates that healthcare provider must immediately report any unusual syndromes or uncommon diseases.

The reporting phone number for IDPH Center for Acute Disease Epidemiology (CADE) is (800) 362-2736; fax number (515) 281-5698, mailing address:

Laboratory Testing Services Available 

The Iowa Department of Public Health will work with the health care provider to facilitate testing at the Centers for Disease Control and Prevention (CDC).

C.  Local Public Health Agency (LPHA) Follow-Up Responsibilities

None

C.  Preventive Measures

Being up to date on polio vaccinations is one way to protect yourself and your family. Check with your doctor to make sure your family is up to date on all recommended vaccines.

You can protect yourself from mosquito-borne viruses such as West Nile virus—another known cause of acute flaccid myelitis— by using mosquito repellent and staying indoors at dusk and dawn, which is the prime period that mosquitoes bite. Removal of standing or stagnant water from nearby property to minimize the number of mosquitoes is also recommended.

While we don’t know if effective in preventing AFM, washing your hands the right way is one of the best things you and your children can do to protect against getting sick. Wash your hands

• before you touch food;
• after going to the bathroom, blowing your nose, changing a baby’s diaper, or touching an animal, an animal’s food, urine or feces; and
• before and after taking care of a sick person or a cut or wound.

References

Acute Flaccid Myelitis. (2018, January 03). Retrieved April 09, 2018, from https://www.cdc.gov/acute-flaccid-myelitis/index.html

CDC. Acute Flaccid Myelitis (AFM). (n.d.). Retrieved April 09, 2018, from https://wwwn.cdc.gov/nndss/conditions/acute-flaccid-myelitis/