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Epi News

Increase in suspected cases of Acute Flaccid Myelitis in Washington state since September 2016

Brianne Probasco

As of November 4, 2016 no cases of Acute Flaccid Myelitis have been reported in Grays Harbor County.

Current Situation in Washington

  • A cluster of suspected acute flaccid myelitis (AFM) has been reported among Washington residents.

  • As of November 3rd, 2016, two cases have been confirmed and seven others are being evaluated by CDC.

  • All cases are among children between 3 and 14 years of age who presented with acute paralysis of one or more limbs. All had a febrile prodrome 1 to 2 weeks prior to presentation with symptoms of AFM.

  • The earliest onset of limb weakness was on September 14th and the most recent on October 27th.

  • The cases are residents of King County (3), Pierce County (1), Franklin County (2), Snohomish County (1) and Whatcom County (2).

Actions Requested

  • Report suspected cases of AFM promptly (see case definition below) to Grays Harbor County Public Health and Social Services at 360-532-8631, or the 24 hour emergency number: 360-581-1401.

  • Complete the AFM patient summary form when reporting patients to Grays Harbor County Public Health and Social Services.

  • Collect specimens from patients suspected of having AFM as early as possible in the course of illness (see details below)*.

  • Notify Grays Harbor County Public Health and Social Services if you are aware of patients of any age that presented to your facility or practice in 2016 and fit the case definition (must have CSF results or MRI report available).

  • Contact Grays Harbor County Public Health and Social Services for guidance.

Background Information

From January 1st to September 30th, 2016, a total of 89 people in 33 states across the country have been confirmed to have AFM. This represents an increase over the previous 2 years (reporting only started in 2014). Most of these have been in children. No etiology for the infections has been established although a potential association with enterovirus D68 has been reported. AFM is also known to be associated with other neurotropic enteroviruses, adenovirus, herpes viruses, arboviruses including West Nile virus, and other etiologies. Non-infectious causes have not been ruled out.

Resources

CSTE case definition: Clinicians should be vigilant and consider AFM in patients presenting with:

  • Onset of acute limb weakness

  • AND a magnetic resonance image (MRI) showing spinal cord lesion largely restricted to gray matter and spanning one or more spinal segments

  • OR cerebrospinal fluid (CSF) showing pleocytosis (white blood cell count >5 cells/mm3)

Specimen collection guidance

Collect specimens from patients suspected of having AFM as early as possible in the course of illness including:

  • Cerebrospinal fluid,

  • Serum (acute and convalescent) and whole blood*,

  • Two stool specimens separated by 24 hours (whole stool preferred over rectal swab),

  • Upper respiratory tract sample (in order of preference: nasopharyngeal swap > nasal swab > nasal wash/aspirate > oropharyngeal swab,

  • Oropharyngeal swab should always be collected in addition to the nasopharyngeal specimen on any patient suspected to have polio.

*Whole blood should be sent refrigerated to CDC and arrive within 24 hours of collection.

WA Department of Health – AFM Investigation

Centers for Disease Control and Prevention – Acute Flaccid Myelitis website

 For questions or further information, contact Lisa Leitz, RN, Communicable Disease Program Coordinator, at 532-8631 x4044.


EPI NEWS is faxed to healthcare offices during events of public health significance.  Please share or post so that others may see this.  Sign up for Epi News by email atlleitz@co.grays-harbor.wa.us.