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10 Aug 2017

Acute Flaccid #Myelitis [#AFM] Among #Children — #Washington, September–November 2016 (@CDCgov, MMWR, abstract)

Title: Acute Flaccid #Myelitis [#AFM] Among #Children — #Washington, September–November 2016.

Subject: AFM outbreak in the US, Washington State.

Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.

Code: [     ]


Acute Flaccid Myelitis Among Children — Washington, September–November 2016


Weekly / August 11, 2017 / 66(31);826–829

Format: [ PDF [108K] ]


Jesse Bonwitt, BVSc1,2; Amy Poel, MPH2; Chas DeBolt, MPH2; Elysia Gonzales, MPH3; Adriana Lopez, MHS4; Janell Routh, MD4; Krista Rietberg, MPH3; Natalie Linton, MPH2; James Reggin, MD5; James Sejvar, MD6; Scott Lindquist, MD2; Catherine Otten, MD7

1Epidemic Intelligence Service, CDC; 2Office of Communicable Disease Epidemiology, Washington State Department of Health; 3Public Health—Seattle & King County, Seattle, Washington; 4National Center for Immunization and Respiratory Diseases, CDC; 5Providence Child Neurology, Providence Sacred Heart Medical Center & Children’s Hospital, Spokane, Washington; 6National Center for Emerging and Zoonotic Infectious Diseases, CDC; 7Pediatric Neurology, Seattle Children’s Hospital, Washington.

Corresponding author: Jesse Bonwitt,, 206-418-5500.

Suggested citation for this article: Bonwitt J, Poel A, DeBolt C, et al. Acute Flaccid Myelitis Among Children — Washington, SeptemberNovember 2016. MMWR Morb Mortal Wkly Rep 2017;66:826–829. DOI:


  • What is already known about this topic?
    • Acute flaccid myelitis (AFM) is a neurologic condition with newly standardized clinical criteria that aid in its recognition.
    • AFM is characterized by acute onset of flaccid limb weakness and lesions in the gray matter of the spinal cord evident on magnetic resonance imaging.
    • Investigation of previously reported clusters did not identify a specific etiology, although during 2014, a temporal association between clusters of AFM and increased incidence of enterovirus-D68 (EV-D68) infections was reported.
    • Because reporting is voluntary, the range of clinical signs, severity, and incidence in the United States is difficult to determine.
  • What is added by the report?
    • During September–November 2016, 10 confirmed cases of AFM were reported in Washington.
    • No common etiology or source of exposure was identified.
    • Enterovirus-A71 was detected in one patient and EV-D68 in two patients, one of whom also tested positive for adenovirus.
    • Mycoplasma spp. immunoglobulin M titer was detected in two patients, but polymerase chain reaction testing of an upper respiratory swab was negative in both.
  • What are the implications for public health practice?
    • Clinicians should remain vigilant for AFM and report cases to state or local health departments as soon as possible.
    • Timely collection of specimens for laboratory testing and expansion of testing to include infectious and noninfectious causes might help uncover a common etiology within a cluster.


In October 2016, Seattle Children’s Hospital notified the Washington State Department of Health (DOH) and CDC of a cluster of acute onset of limb weakness in children aged ≤14 years. All patients had distinctive spinal lesions largely restricted to gray matter detected by magnetic resonance imaging (MRI), consistent with acute flaccid myelitis (AFM). On November 3, DOH issued a health advisory to local health jurisdictions requesting that health care providers report similar cases. By January 24, 2017, DOH and CDC had confirmed 10 cases of AFM and excluded two suspected cases among residents of Washington during September–November 2016. Upper respiratory tract, stool, rectal, serum, buccal, and cerebrospinal fluid (CSF) specimens were tested for multiple pathogens. Hypothesis-generating interviews were conducted with patients or their parents to determine commonalities between cases. No common etiology or source of exposure was identified. Polymerase chain reaction (PCR) testing detected enterovirus D68 (EV-D68) in nasopharyngeal swabs of two patients, one of whom also tested positive for adenovirus by PCR, and detected enterovirus A71 (EV-A71) in the stool of a third patient. Mycoplasma spp. immunoglobulin M (IgM) titer was elevated in two patients, but both had upper respiratory swabs that tested negative for Mycoplasma spp. by PCR. Clinicians should maintain vigilance for AFM and report cases as soon as possible to state or local health departments.


Keywords: US CDC; USA; Updates; Abstracts; AFM; EV-D68; EV-71; Mycoplasma spp.