Vital Signs : Clinical Characteristics of Patients with Confirmed Acute Flaccid Myelitis, United States, 2018

Details

• Alternative Title:
  Clinical Characteristics of Patients with Confirmed Acute Flaccid Myelitis, United States, 2018
• Personal Author:
  Kidd, Sarah ; Lopez, Adriana ; Nix, W. Allan ; Anyalechi, Gloria ; Itoh, Megumi ; Yee, Eileen ; Oberste, M. Steven ; Routh, Janell
• Corporate Authors:
  National Center for Immunization and Respiratory Diseases (U.S.)Division of Viral Diseases. ; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (U.S.)Division of STD Prevention. ; Center for Global Health (U.S.)Division of Global HIV and TB.
• Description:
  What is already known about this topic? Since U.S. Surveillance for acute flaccid myelitis (AFM) began in 2014, reported cases have peaked biennially. Most cases occur in children during late summer and early fall.
  
  What is added by this report? Among 238 patients with confirmed AFM during 2018, most (92%) had prodromal fever, respiratory illness, or both. In addition to weakness, common symptoms were gait difficulty (52%), neck or back pain (47%), fever (35%), and limb pain (34%). Among 211 who were outpatients when weakness began, 64% sought treatment at an emergency department. Overall, 23% required endotracheal intubation and mechanical ventilation.
  
  What are the implications for public health practice? Clinicians should suspect AFM in children with acute flaccid limb weakness, especially when accompanied by neck or back pain and a recent History of febrile respiratory illness. Increasing awareness in frontline settings such as emergency departments should aid rapid recognition and hospitalization for AFM.
  
  Background: Acute flaccid myelitis (AFM) is a serious neurologic syndrome that affects mostly children and is characterized by the acute onset of limb weakness or paralysis. Since U.S. Surveillance for AFM began in 2014, reported cases have peaked biennially. This report describes the clinical characteristics of AFM patients during 2018, the most recent peak year.
  
  Methods: Medical records from persons meeting AFM clinical criterion (acute onset of flaccid limb weakness) were submitted to CDC. Patients with confirmed AFM met the clinical criterion and had magnetic resonance imaging indicating spinal cord lesions largely restricted to gray matter and spanning one or more vertebral segments. Symptoms, physical findings, test and imaging results, and hospitalization data were abstracted and described.
  
  Results: Among 238 patients with confirmed AFM during 2018, median age was 5.3 years. Among the 238 patients, 205 (86%) had onset during August–November. Most (92%) had prodromal fever, respiratory illness, or both beginning a median of 6 days before weakness onset. In addition to weakness, common symptoms at clinical evaluation were gait difficulty (52%), neck or back pain (47%), fever (35%), and limb pain (34%). Among 211 who were outpatients when weakness began, most (76%) sought medical care within 1 day, and 64% first sought treatment at an emergency department. Overall, 98% of patients were hospitalized, 54% were admitted to an intensive care unit, and 23% required endotracheal intubation and mechanical ventilation.
  
  Conclusion: Clinicians should suspect AFM in children with acute flaccid limb weakness, especially during August–November and when accompanied by neck or back pain and a recent History of febrile respiratory illness. Increasing awareness in frontline settings such as emergency departments should aid rapid recognition and hospitalization for AFM.
  
  Suggested citation for this article: Kidd S, Lopez A, Nix WA, et al. Vital Signs: Clinical Characteristics of Patients with Confirmed Acute Flaccid Myelitis, United States, 2018. MMWR Morb Mortal Wkly Rep. ePub: 4 August 2020.
  
  mm6931e3.htm?s_cid=mm6931e3_w
  
  pdfs/mm6931e3-H.pdf
  
  
• Subjects:
  Central Nervous System Viral Diseases Myelitis Neuromuscular Diseases Signs And Symptoms
• Source:
  MMWR: Morbidity and Mortality Weekly Report 2020; v. 69 Early Release
• Series:
  Weekly Report: Morbidity and Mortality Weekly Report (MMWR)
• ISSN:
  0149-2195 (print) ; 1545-861X (digital)
• Document Type:
  Journal Article
• Name as Subject:
  Vital Signs ; Vital Signs
• Place as Subject:
  United States
• Pages in Document:
  8 pdf pages
• Volume:
  69
• Collection(s):
  Morbidity and Mortality Weekly Report (MMWR)
• Main Document Checksum:
  urn:sha-512:e28aa9aefed5806d03eee96f4f186f0a3489db68e4f4f06f1506c7a9c8167b1c0f75e2f21cd7231597e456c50c141e48a495f2c423c482d9b479ec96b4234803
• Download URL:
  https://stacks.cdc.gov/view/cdc/91495/cdc_91495_DS1.pdf
• File Type:
  [PDF - 274.88 KB ]