Related Experiment Video
Updated: Jul 4, 2025
Detection of Infectious Virus from Field-collected Mosquitoes by Vero Cell Culture Assay
Published on: June 9, 2011
Surveillance for Acute Flaccid Myelitis - United States, 2018-2022
Abstract:
Acute flaccid myelitis (AFM) is a serious neurologic condition primarily affecting children; AFM can cause acute respiratory failure and permanent paralysis. AFM is a rare but known complication of various viral infections, particularly those of enteroviruses (EVs). Increases in AFM cases during 2014, 2016, and 2018 were associated with EV-D68 infection. This report examines trends in confirmed AFM cases during 2018-2022 and patients' clinical and laboratory characteristics. The number of AFM cases was low during 2019-2022 (28-47 cases per year); the number of cases remained low in 2022 despite evidence of increased EV-D68 circulation in the United States. Compared with cases during the most recent peak year (2018), fewer cases during 2019-2021 had upper limb involvement, prodromal respiratory or febrile illness, or cerebrospinal fluid pleocytosis, and more were associated with lower limb involvement. It is unclear why EV-D68 circulation in 2022 was not associated with an increase in AFM cases or when the next increase in AFM cases will occur. Nonetheless, clinicians should continue to suspect AFM in any child with acute flaccid limb weakness, especially those with a recent respiratory or febrile illness.
Insights
Acute flaccid myelitis (AFM) cases remained low from 2019-2022, even with increased enterovirus D68 (EV-D68) circulation. Clinicians should still suspect AFM in children with acute flaccid weakness, particularly after respiratory illness.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Acute flaccid myelitis (AFM) is a severe neurologic condition in children, potentially causing respiratory failure and paralysis.
- AFM is linked to enterovirus (EV) infections, with notable increases in cases associated with EV-D68 in 2014, 2016, and 2018.
Purpose of the Study:
- To examine trends in confirmed AFM cases and patient characteristics from 2018 to 2022.
- To investigate the relationship between EV-D68 circulation and AFM incidence during this period.
Main Methods:
- Analysis of confirmed AFM case data from 2018-2022.
- Review of clinical and laboratory characteristics of affected patients.
- Correlation of AFM trends with reported EV-D68 circulation patterns.
Main Results:
- AFM cases remained low between 2019-2022 (28-47 cases annually).
- Despite increased EV-D68 circulation in 2022, AFM incidence did not rise.
- Compared to 2018, cases in 2019-2021 showed less upper limb involvement, prodromal illness, and CSF pleocytosis, but more lower limb involvement.
Conclusions:
- The reason for the lack of AFM increase in 2022 despite EV-D68 circulation is unknown.
- Predicting future AFM case surges remains challenging.
- Clinicians must maintain a high index of suspicion for AFM in children presenting with acute flaccid limb weakness, especially following respiratory or febrile illness.
More Related Videos
Related Concept Videos
01:51Vaccinations
01:15Myasthenia Gravis: Diagnostic Tests
The edrophonium test is a diagnostic tool for myasthenia gravis. It involves...