4 AFM Cases Confirmed During 2019

So far in 2019, there have been 4 confirmed cases of Acute Flaccid Myelitis (AFM) in Nebraska, North Carolina, Utah, and West Virginia. 

During 2018, there were 228 confirmed cases of AFM in 41 states, led by Texas, which reported 31 cases.

As of April 1, 2019, the Centers for Disease Control and Prevention (CDC) is not aware of any deaths in confirmed AFM cases during 2018 or 2019. 

Since 2014, AFM, a long-recognized condition associated with polioviruses, nonpolio enteroviruses, and various other viral and nonviral causes, has been reemerging every year:

• In 2017, 35 confirmed cases of AFM in 16 states.
• In 2016, 149 confirmed cases of AFM in 39 states and DC.
• In 2015, 22 confirmed cases of AFM in 17 states.

During 2018, the United Kingdom experienced an increase in reports of cases of acute flaccid paralysis (AFP). As of January 21, 2019, 40 cases had been identified, with a peak in October 2018.

AFM is a complex condition, and it is difficult to determine why only some people go from having a mild respiratory illness or fever to developing AFM. 

This unanticipated reemergence is ironic, given that polioviruses, once the major causes of AFM, are now at the very threshold of global eradication and cannot, therefore, explain any aspect of AFM reemergence, said a new review published on April 2, 2019. 

Instead, the new AFM epidemic has been temporally associated with reemergences of nonpolio enteroviruses such as EV-D68, until recently thought to be an obscure virus of extremely low endemicity. 

Separately, on January 22, 2019, a cluster of 11 suspect cases of pediatric AFM was identified in 2016 in Phoenix, AZ. Multiple genomic analyses identified the presence of EV-D68 in the majority of clinical AFM cases.

These findings strengthen the likelihood that EV-D68 is a cause of AFM and show that the rapid molecular assays developed for this study are useful for investigations of AFM and EV-D6.

The Acute Flaccid Myelitis: 'Something Old and Something New’ analysis, published by the American Society for Microbiology, offers a perspective reviews the enigmatic epidemiologic, virologic, and diagnostic aspects of epidemic AFM reemergence; examines current options for clinical management; discusses future research needs; and suggests that the AFM epidemic offers important clues to mechanisms of viral disease emergence.

Until such time as the causes of the AFM epidemic are better understood, the development of preventive vaccines will remain challenging, said these researchers. 

Furthermore, the CDC published an updated “Interim Considerations for Clinical Management of Patients with AFM” in November 2018.