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  • AFM Surveillance (acute flaccid myelitis)

    Source: http://www.cdc.gov/acute-flaccid-mye...veillance.html
    AFM Surveillance



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    A total of 32 people have been confirmed as AFM cases from January through July, 2016.

    ^ Cases reported as of July 31, 2016. Case count is preliminary and subject to change.
    For more information on AFM case definitions, visit the Case Definitions page.

    Number of confirmed AFM cases by year of illness onset, 2014-2016

    2014 (Aug-Dec) 120 34
    2015 21 16
    2016* 32 17
    *Case counts are preliminary and subject to change.

    Investigation of Acute Flaccid Myelitis in U.S. Children, August 2014-December 2014

    From August to October 2014, CDC received increased reports of children across the United States who developed a sudden onset of weakness in one or more arms or legs with MRI scans that showed inflammation of the gray matter?nerve cells?in the spinal cord. This illness is called acute flaccid myelitis. CDC continues to receive sporadic reports of cases.
    From August 2014 to December 2014, CDC verified reports of 120 children in 34 states who developed acute flaccid myelitis that meets CDC's outbreak case definition (onset of acute limb weakness on or after August 1, 2014, and a magnetic resonance image showing a spinal cord lesion largely restricted to gray matter in a patient age <21 years).
    • The median age of the children was about 7 years.
    • Almost all of them were hospitalized; some were put on ventilators (breathing machines).
    • Most patients had fever and/or respiratory illness before onset of neurologic symptoms.
    • Eighty percent of the children had elevated white blood cell counts, often with elevated protein levels, in their spinal fluid.
    • Half of the children had follow-up information (median period of observation: 4 months) available after their illness; about 85% reported some improvement in symptoms, while 15% showed no improvement. Only three of the children have fully recovered.
    • CDC tested many different specimens from these patients for a wide range of pathogens that can result in this syndrome.
    • Despite extensive testing, no pathogen was consistently detected in the patients? spinal fluid; a pathogen detected in the patients? spinal fluid would be good evidence to indicate cause of the illness.

    The specific causes of this illness are still under investigation. However, these cases are most similar to illnesses caused by viruses. See a list of viruses associated with acute flaccid myelitis.
    The apparent increase in cases of acute flaccid myelitis in 2014 coincided with a national outbreak of severe respiratory illness among children caused by enterovirus D68 (EV-D68). However, despite this close association in timing, a cause for the 2014 acute flaccid myelitis cases has not been determined.
    See Prevention for information about how to protect your family from acute flaccid myelitis.
    Top of Page
    What CDC is Doing

    To further understand the impact of AFM and help identify a cause of AFM in the United States, CDC is currently:
    • re-emphasizing the importance of continued attention by healthcare professionals for cases of AFM among all age groups
    • verifying reports of cases of AFM
    • working with healthcare professionals and state and local health departments to investigate and better understand the cases of AFM, including potential causes and how often the illness occurs
    • testing specimens, including stool, respiratory and cerebrospinal fluid, from people with AFM, when specimens are provided to CDC
    • providing information to healthcare professionals, policymakers, general public, and partners in various formats, such as the Morbidity and Mortality Weekly Report, health alerts, websites, social media, and presentations
    • pursuing an approach that uses multiple methods to further explore the potential association of AFM with possible causes as well as risk factors for AFM. This includes collaborating with several medical institutions to review MRI scans of children from the past 10 years to determine how many AFM cases occurred before 2014.

    For more information, see COCA Clinical Reminder (August 27, 2015) ? Notice to Clinicians: Continued Vigilance Urged for Cases of Acute Flaccid Myelitis.
    The 2014 investigation summary is available here: Acute Flaccid Myelitis in the United States?August ? December 2014: Results of Nation-Wide Surveillance.
    Top of Page









  • #2
    Source: http://www.cdc.gov/acute-flaccid-mye...veillance.html
    AFM in the United States



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    On this Page




    At a Glance

    • CDC is concerned about AFM, a serious illness that we do not know the cause of or how to prevent it.
    • CDC is investigating the increase in AFM in 2016. As of September 2016, 89 people in 33 states were confirmed to have AFM.
    • Even with an increase in cases in 2016, AFM remains a very rare disease (less than one in a million).
    • While the AFM case count for 2016 is less than the 2014 case count, CDC is concerned about the increase in cases in recent months.
    • CDC is intensifying efforts to understand the cause and risk factors of AFM.
    • It's always important to practice disease prevention steps, like washing your hands, staying up-to-date on vaccines, and protecting yourself from mosquito bites.



    Acute flaccid myelitis (AFM) is a rare illness that anyone can get. It affects a person?s nervous system, specifically the spinal cord. AFM can result from a variety of causes, including viral infections.
    Beginning in August 2014, CDC received an increase in reports of people across the United States with AFM for which no cause could be found. Since then, CDC has been actively investigating this illness. We continue to receive reports of sporadic cases of AFM. From January 1 to September 30, 2016, a total of 89 people in 33 states across the country were confirmed to have AFM.

    Updated November 1, 2016
    ^ Cases reported as of October 31, 2016 with onset of illness through September 30, 2016. The case counts are subject to change. CDC updates the case counts monthly with a one month lag to allow the time needed for case review.
    * The data shown from August 2014 to July 2015 are based on the AFM investigation case definition: onset of acute limb weakness on or after August 1, 2014, and a magnetic resonance image (MRI) showing a spinal cord lesion largely restricted to gray matter in a patient age ≤21 years.
    ? The data shown from August 2015 to present are based on a revised AFM case definition adopted by CSTE: acute onset of focal limb weakness and an MRI showing spinal cord lesion largely restricted to gray matter and spanning one or more spinal segments, regardless of age.
    For more information on AFM case definitions, visit the Case Definitions page.

    Top of Page What This Graph Shows

    • From January 1 to September 30, 2016, 89 people were confirmed to have AFM. (Note: The cases occurred in 33 states across the U.S.)
    • In 2015, 21 people were confirmed to have AFM. (Note: The cases occurred in 16 states across the U.S.)
    • From August to December 2014, 120 people were confirmed to have AFM. (Note: The cases occurred in 34 states across the U.S.)
    • The case counts represent only those cases reported to and confirmed by CDC.
    • There has been an increase in reports of confirmed AFM cases in 2016 compared with 2015 (21 cases in 16 states).

    The graph shows reports of cases confirmed by CDC as of October 31, 2016 with onset of illness through September 30, 2016.
    It is currently difficult to interpret trends of the AFM data since reporting only started in 2014 and is voluntary in most states. Also, since AFM reporting is relatively new, there may initially be more variability in the data from year to year making it difficult to interpret or compare case counts between years. One possible reason for the differences in annual reporting is more awareness among and reporting by healthcare providers and health departments.
    To protect patient confidentiality, CDC is not specifying the states with confirmed AFM cases. We defer to the states to release information as they choose.
    Number of confirmed AFM cases by year of illness onset, 2014-2016

    2014 (Aug-Dec) 120 34
    2015 21 16
    2016* (Jan-Sept) 89 33
    *The case counts are subject to change.

    What We Know

    What we know about the AFM cases reported since August 2014:
    • Most patients are children.
    • The patients? symptoms have been most similar to those caused by certain viruses, including poliovirus, non-polio enteroviruses, adenoviruses, and West Nile virus. See a list of viruses associated with AFM.
      • Enteroviruses can cause neurologic illness, including meningitis. However, more severe disease, such as encephalitis and AFM, is not common. Rather, they most commonly cause mild illness.
    • CDC has tested many different specimens from the patients for a wide range of pathogens (germs) that can cause AFM. To date, we have not consistently detected a pathogen (germ) in the patients? spinal fluid; a pathogen detected in the spinal fluid would be good evidence to indicate the cause of AFM since this illness affects the spinal cord.
    • The increase in AFM cases in 2014 coincided with a national outbreak of severe respiratory illness among people caused by enterovirus D68 (EV-D68). Among the people with AFM, CDC did not consistently detect EV-D68 in the specimens collected from them. In 2015 there were no cases of EV-D68 detected and so far in 2016, only limited sporadic cases of EV-D68 have been detected in the United States.

    Top of Page
    What We Don't Know

    What we don?t know about the AFM cases reported since August 2014:
    • Despite extensive testing, CDC does not yet know the cause of the AFM cases.
    • It is unclear what pathogen (germ) or immune response is causing the disruption of signals sent from the nervous system to the muscles causing weakness in the arms and legs.
    • CDC has not yet determined who is at higher risk for developing AFM, or the reasons why they may be at higher risk.

    See Prevention for information about how to protect your family from viral infections that may cause AFM.
    Top of Page What CDC Is Doing

    CDC is actively investigating the AFM cases and monitoring disease activity. We are working closely with healthcare providers and state and local health departments to increase awareness and reporting for AFM, and investigate the AFM cases, risk factors, and possible causes of this illness.
    CDC activities include:
    • encouraging healthcare providers to be vigilant for AFM among their patients, and to report suspected cases to their health departments
    • verifying reports of suspected AFM cases submitted by health departments using a case definition adopted by the Council of State and Territorial Epidemiologists (CSTE)
    • testing specimens, including stool, blood, respiratory and cerebrospinal fluid, from people confirmed to have AFM
    • working with clinicians and state and local health departments to investigate and better understand the AFM cases, including potential causes and how often the illness occurs
    • providing new and updated information to clinicians, health departments, policymakers, the public, and partners in various formats, such as the Morbidity and Mortality Weekly Report, the AFM website, and CDC social media
    • pursuing an approach that uses multiple research methods to further explore the potential association of AFM with possible causes as well as risk factors for AFM. This includes collaborating with several medical institutions to review MRI scans of people from the past 10 years to determine how many AFM cases occurred before 2014.

    For more information, see COCA Clinical Reminder (August 27, 2015) ? Notice to Clinicians: Continued Vigilance Urged for Cases of Acute Flaccid Myelitis.
    The 2014 investigation summary is available here: Acute Flaccid Myelitis in the United States?August ? December 2014: Results of Nation-Wide Surveillance.
    For more information on AFM surveillance, see the CSTE Standardized Case Definition for Acute Flaccid Myelitis.




    Comment


    • #3
      Source: https://www.cdc.gov/acute-flaccid-my...veillance.html On this Page




      At a Glance

      • CDC is concerned about AFM, a serious illness that we do not know the cause of or how to prevent it.
      • CDC is investigating the increase in AFM in 2016. As of October 2016, 108 people in 36 states were confirmed to have AFM.
      • Even with an increase in cases in 2016, AFM remains a very rare disease (less than one in a million).
      • While the AFM case count for 2016 is less than the 2014 case count, CDC is concerned about the increase in cases in recent months.
      • CDC is intensifying efforts to understand the cause and risk factors of AFM.
      • It's always important to practice disease prevention steps, like washing your hands, staying up-to-date on vaccines, and protecting yourself from mosquito bites.



      Acute flaccid myelitis (AFM) is a rare illness that anyone can get. It affects a person?s nervous system, specifically the spinal cord. AFM can result from a variety of causes, including viral infections.
      Beginning in August 2014, CDC received an increase in reports of people across the United States with AFM for which no cause could be found. Since then, CDC has been actively investigating this illness. We continue to receive reports of sporadic cases of AFM. From January 1 to October 31, 2016, a total of 108 people in 36 states across the country were confirmed to have AFM.

      Updated December 1, 2016
      ^ Cases reported as of November 30, 2016 with onset of illness through October 31, 2016. The case counts are subject to change. CDC updates the case counts monthly with a one month lag to allow the time needed for case review.
      * The data shown from August 2014 to July 2015 are based on the AFM investigation case definition: onset of acute limb weakness on or after August 1, 2014, and a magnetic resonance image (MRI) showing a spinal cord lesion largely restricted to gray matter in a patient age ≤21 years.
      ? The data shown from August 2015 to present are based on a revised AFM case definition adopted by CSTE: acute onset of focal limb weakness and an MRI showing spinal cord lesion largely restricted to gray matter and spanning one or more spinal segments, regardless of age.
      For more information on AFM case definitions, visit the Case Definitions page.

      Top of Page What This Graph Shows

      • From January 1 to October 31, 2016, 108 people were confirmed to have AFM. (Note: The cases occurred in 36 states across the U.S.)
      • In 2015, 21 people were confirmed to have AFM. (Note: The cases occurred in 16 states across the U.S.)
      • From August to December 2014, 120 people were confirmed to have AFM. (Note: The cases occurred in 34 states across the U.S.)
      • The case counts represent only those cases reported to and confirmed by CDC.
      • There has been an increase in reports of confirmed AFM cases in 2016 compared with 2015 (21 cases in 16 states).

      The graph shows reports of cases confirmed by CDC as of November 30, 2016 with onset of illness through October 31, 2016.
      It is currently difficult to interpret trends of the AFM data since reporting only started in 2014 and is voluntary in most states. Also, since AFM reporting is relatively new, there may initially be more variability in the data from year to year making it difficult to interpret or compare case counts between years. One possible reason for the differences in annual reporting is more awareness among and reporting by healthcare providers and health departments.
      To protect patient confidentiality, CDC is not specifying the states with confirmed AFM cases. We defer to the states to release information as they choose.
      Number of confirmed AFM cases by year of illness onset, 2014-2016

      2014 (Aug-Dec) 120 34
      2015 21 16
      2016* (Jan-Oct) 108 36
      *The case counts are subject to change.
      What We Know

      What we know about the AFM cases reported since August 2014:
      • Most patients are children.
      • The patients? symptoms have been most similar to those caused by certain viruses, including poliovirus, non-polio enteroviruses, adenoviruses, and West Nile virus. See a list of viruses associated with AFM.
        • Enteroviruses can cause neurologic illness, including meningitis. However, more severe disease, such as encephalitis and AFM, is not common. Rather, they most commonly cause mild illness.
      • CDC has tested many different specimens from the patients for a wide range of pathogens (germs) that can cause AFM. To date, we have not consistently detected a pathogen (germ) in the patients? spinal fluid; a pathogen detected in the spinal fluid would be good evidence to indicate the cause of AFM since this illness affects the spinal cord.
      • The increase in AFM cases in 2014 coincided with a national outbreak of severe respiratory illness among people caused by enterovirus D68 (EV-D68). Among the people with AFM, CDC did not consistently detect EV-D68 in the specimens collected from them. In 2015 there were no cases of EV-D68 detected and so far in 2016, only limited sporadic cases of EV-D68 have been detected in the United States.

      Top of Page
      What We Don't Know

      What we don?t know about the AFM cases reported since August 2014:
      • Despite extensive testing, CDC does not yet know the cause of the AFM cases.
      • It is unclear what pathogen (germ) or immune response is causing the disruption of signals sent from the nervous system to the muscles causing weakness in the arms and legs.
      • CDC has not yet determined who is at higher risk for developing AFM, or the reasons why they may be at higher risk.

      See Prevention for information about how to protect your family from viral infections that may cause AFM.
      Top of Page
      What CDC Is Doing

      CDC is actively investigating the AFM cases and monitoring disease activity. We are working closely with healthcare providers and state and local health departments to increase awareness and reporting for AFM, and investigate the AFM cases, risk factors, and possible causes of this illness.
      CDC activities include:
      • encouraging healthcare providers to be vigilant for AFM among their patients, and to report suspected cases to their health departments
      • verifying reports of suspected AFM cases submitted by health departments using a case definition adopted by the Council of State and Territorial Epidemiologists (CSTE)
      • testing specimens, including stool, blood and cerebrospinal fluid, from people confirmed to have AFM
      • working with clinicians and state and local health departments to investigate and better understand the AFM cases, including potential causes and how often the illness occurs
      • providing new and updated information to clinicians, health departments, policymakers, the public, and partners in various formats, such as the Morbidity and Mortality Weekly Report, the AFM website, and CDC social media
      • pursuing an approach that uses multiple research methods to further explore the potential association of AFM with possible causes as well as risk factors for AFM. This includes collaborating with several medical institutions to review MRI scans of people from the past 10 years to determine how many AFM cases occurred before 2014.

      For more information, see COCA Clinical Reminder (August 27, 2015) ? Notice to Clinicians: Continued Vigilance Urged for Cases of Acute Flaccid Myelitis.
      The 2014 investigation summary is available here: Acute Flaccid Myelitis in the United States?August ? December 2014: Results of Nation-Wide Surveillance.
      For more information on AFM surveillance, see the CSTE Standardized Case Definition for Acute Flaccid Myelitis.
      Top of Page






      Comment


      • #4
        Source: https://www.cdc.gov/acute-flaccid-my...veillance.html
        At a Glance

        • CDC is concerned about AFM, a serious illness that we do not know the cause of or how to prevent it.
        • CDC is investigating the increase in AFM in 2016. As of November 2016, 120 people in 37 states were confirmed to have AFM.
        • Even with an increase in cases in 2016, AFM remains a very rare disease (less than one in a million).
        • CDC is concerned about the increase in cases in 2016.
        • CDC is intensifying efforts to understand the cause and risk factors of AFM.
        • It's always important to practice general disease prevention steps, like washing your hands, staying up-to-date on vaccines, and protecting yourself from mosquito bites.



        Acute flaccid myelitis (AFM) is a rare illness that anyone can get. It affects a person?s nervous system, specifically the spinal cord. AFM can result from a variety of causes, including viral infections.
        Beginning in August 2014, CDC received an increase in reports of people across the United States with AFM for which no cause could be found. Since then, CDC has been actively investigating this illness. We continue to receive reports of sporadic cases of AFM. From January 1 to November 30, 2016, a total of 120 people in 37 states across the country were confirmed to have AFM.

        Updated January 2, 2017
        ^ Cases reported as of December 31, 2016 with onset of illness through November 30, 2016. The case counts are subject to change. CDC updates the case counts monthly with a one month lag to allow the time needed for case review.
        * The data shown from August 2014 to July 2015 are based on the AFM investigation case definition: onset of acute limb weakness on or after August 1, 2014, and a magnetic resonance image (MRI) showing a spinal cord lesion largely restricted to gray matter in a patient age ≤21 years.
        ? The data shown from August 2015 to present are based on a revised AFM case definition adopted by CSTE: acute onset of focal limb weakness and an MRI showing spinal cord lesion largely restricted to gray matter and spanning one or more spinal segments, regardless of age.
        For more information on AFM case definitions, visit the Case Definitions page.

        Top of Page What This Graph Shows

        • From January 1 to November 30, 2016, 120 people were confirmed to have AFM. (Note: The cases occurred in 37 states across the U.S.)
        • In 2015, 21 people were confirmed to have AFM. (Note: The cases occurred in 16 states across the U.S.)
        • From August to December 2014, 120 people were confirmed to have AFM. (Note: The cases occurred in 34 states across the U.S.)
        • The case counts represent only those cases reported to and confirmed by CDC.
        • There has been an increase in reports of confirmed AFM cases in 2016 compared with 2015 (21 cases in 16 states).

        The graph shows reports of cases confirmed by CDC as of December 31, 2016 with onset of illness through November 30, 2016.
        It is currently difficult to interpret trends of the AFM data since reporting only started in 2014 and is voluntary in most states. Also, since AFM reporting is relatively new, there may initially be more variability in the data from year to year making it difficult to interpret or compare case counts between years. One possible reason for the differences in annual reporting is more awareness among and reporting by healthcare providers and health departments.
        To protect patient confidentiality, CDC is not specifying the states with confirmed AFM cases. We defer to the states to release information as they choose.
        Number of confirmed AFM cases by year of illness onset, 2014-2016

        2014 (Aug-Dec) 120 34
        2015 21 16
        2016* (Jan-Nov) 120 37
        *The case counts are subject to change.
        What We Know

        What we know about the AFM cases reported since August 2014:
        • Most patients are children.
        • The patients? symptoms have been most similar to complications of infection with certain viruses, including poliovirus, non-polio enteroviruses, adenoviruses, and West Nile virus. See a list of viruses associated with AFM.
          • Enteroviruses can cause neurologic illness, including meningitis. However, more severe disease, such as encephalitis and AFM, is not common. Rather, they most commonly cause mild illness.
        • CDC has tested many different specimens from the patients for a wide range of pathogens (germs) that can cause AFM. To date, we have not consistently detected a pathogen (germ) in the patients? spinal fluid; a pathogen detected in the spinal fluid would be good evidence to indicate the cause of AFM since this illness affects the spinal cord.
        • The increase in AFM cases in 2014 coincided with a national outbreak of severe respiratory illness among people caused by enterovirus D68 (EV-D68). Among the people with AFM, CDC did not consistently detect EV-D68 in the specimens collected from them. In 2015 there were no cases of EV-D68 detected and so far in 2016, only limited sporadic cases of EV-D68 have been detected in the United States.

        Top of Page
        What We Don't Know

        What we don?t know about the AFM cases reported since August 2014:
        • Despite extensive testing, CDC does not yet know the cause of the AFM cases.
        • It is unclear what pathogen (germ) or immune response is causing the disruption of signals sent from the nervous system to the muscles causing weakness in the arms and legs.
        • CDC has not yet determined who is at higher risk for developing AFM, or the reasons why they may be at higher risk.

        See Prevention for information about how to protect your family from viral infections that may cause AFM.
        Top of Page
        What CDC Is Doing

        CDC is actively investigating the AFM cases and monitoring disease activity. We are working closely with healthcare providers and state and local health departments to increase awareness and reporting for AFM, and investigate the AFM cases, risk factors, and possible causes of this illness.
        CDC activities include:
        • urging healthcare providers to be vigilant for AFM among their patients, and to report suspected cases to their health departments
        • verifying reports of suspected AFM cases submitted by health departments using a case definition adopted by the Council of State and Territorial Epidemiologists (CSTE)
        • testing specimens, including stool, blood and cerebrospinal fluid, from people confirmed to have AFM
        • working with clinicians and state and local health departments to investigate and better understand the AFM cases, including potential causes and how often the illness occurs
        • providing new and updated information to clinicians, health departments, policymakers, the public, and partners in various formats, such as the Morbidity and Mortality Weekly Report, the AFM website, and CDC social media
        • pursuing an approach that uses multiple research methods to further explore the potential association of AFM with possible causes as well as risk factors for AFM. This includes collaborating with several medical institutions to review MRI scans of people from the past 10 years to determine how many AFM cases occurred before 2014.

        For more information, see COCA Clinical Reminder (August 27, 2015) ? Notice to Clinicians: Continued Vigilance Urged for Cases of Acute Flaccid Myelitis.
        The 2014 investigation summary is available here: Acute Flaccid Myelitis in the United States?August ? December 2014: Results of Nation-Wide Surveillance.
        For more information on AFM surveillance, see the CSTE Standardized Case Definition for Acute Flaccid Myelitis.
        Top of Page




        Comment

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