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News From the Centers for Disease Control and Prevention
June 11, 2019

Acute Flaccid Myelitis Cluster

JAMA. 2019;321(22):2156. doi:10.1001/jama.2019.7349

A cluster of 6 cases of acute flaccid myelitis paralysis (AFM) in children was reported in Minnesota in the fall of 2018, according to a CDC report. It was the largest cluster reported in the state to date and part of an uptick in cases across the country.

The children ranged in age from 1 to 9 years. They came from different counties and had no epidemiological ties. All of them developed a fever and respiratory symptoms about 8 days before developing weakness, particularly in the limbs shortly after waking. All the children were hospitalized and had evidence of spinal cord lesions detected by magnetic resonance imaging (MRI). One child remained hospitalized at press time with complete paralysis of all voluntary muscles and the 5 others have been discharged home or to rehabilitation facilities with residual weakness.

Enterovirus D68 was detected in 2 of the patients and was confirmed to be the cause of illness in one of them with evidence of the virus in the cerebral spinal fluid. There is growing evidence that enterovirus D68 may play a causal role in AFM, which has drawn increased attention since a surge of 120 cases in 2014. As of May 3, the CDC had confirmed 230 cases in 2018 and 7 so far in 2019.

Five of the Minnesota children were treated with intravenous immune globulin; one received steroids alone first and another received steroids and plasmapheresis first. One child received only supportive care. In order to ensure timely treatment that may improve outcomes, the authors urge physicians to consider AFM when a child presents with sudden weakness and to report suspected cases to public health authorities.

“AFM is a rare but serious cause of sudden onset limb weakness, especially in children, and should be considered in the differential diagnosis,” the authors wrote. “Diagnosis and care of patients with AFM includes early collection of specimens, including cerebral spinal fluid for laboratory testing, MRI scans, and consultation with neurology and infectious disease experts.”