Acute Flaccid Myelitis

Acute Flaccid Myelitis

August 4, 2020

Dear Colleague,

I would like to make you aware of the approaching acute flaccid myelitis (AFM) season and provide you with the necessary resources for evaluating and reporting a suspect case. AFM cases in the United States have surged biennially since 2014. In 2018, the most recent peak year, Virginia reported seven confirmed cases and one probable case. Given this trend, VDH is preparing for a rise in cases in late summer into early fall of this year.

AFM is a rare but serious illness for which there is no known definitive treatment or means of prevention. It is most commonly seen in young children, the majority of whom experience a respiratory illness or fever prior to the onset of AFM symptoms. Symptoms include sudden arm or leg weakness, loss of muscle tone, and loss of reflexes. Some individuals experience drooping eyelids, facial droop or weakness, difficulty swallowing, slurred speech, or pain in the arms or legs. Severe cases can experience serious neurologic complications and respiratory failure.

Please contact your local health department immediately if you encounter a patient exhibiting sudden onset of acute focal limb weakness and an MRI showing a spinal cord lesion(s) with grey matter involvement. Initial specimen collection should be collected as early as possible and include an upper respiratory tract specimen, CSF, serum, and stool. The national case definition can be found here.

Although the cause of AFM has not yet been determined, a number of cases have been linked to respiratory illness caused by enterovirus D68 (EV-D68). CDC’s AFM Task Force is working to identify other possible viral etiologies, understand potential risk factors, and provide resources for patients and families. In addition, VDH is working closely with CDC on enhanced surveillance activities to evaluate the long-term impact of AFM on patients’ development and mobility.

We greatly appreciate your continued commitment to AFM surveillance. Through partnership with members of the clinical community in the Commonwealth such as yourself, VDH is able to help thoroughly investigate cases of AFM and contribute further to the body of knowledge on the cause and treatment of this condition.

If you have questions about reporting AFM, please contact your local health district epidemiologist or Meredith Robinson at the Virginia Department of Health at 804-864-8074 or via e-mail at


M. Norman Oliver, MD, MA

State Health Commissioner