On Dec. 10, 2018, the U.S. Centers for Disease Control and Prevention (CDC) reported a record 158 confirmed cases of the polio-like condition known as acute flaccid myelitis (AFM) in 36 states. The number surpassed the previous record of 149 confirmed cases in 39 states in 2016.1 As of Dec. 21, 2018, confirmed cases of AFM climbed to 182 in 39 states—an 18 percent increase over 2016.1 The CDC is investigating another 154 possible cases of AFM or “PUIs” (patients under investigation). States reporting the highest number of confirmed cases of AFM include Texas (25), Colorado (15), Ohio (12), New Jersey (10) and Washington (10).2
The CDC began recording cases of AFM in 2014. That year, 120 cases were confirmed in 34 states, followed by 22 cases in 17 states in 2015. In 2017, there were 35 confirmed cases of AFM in 16 states.3
While the cause of AFM is not known, health officials know that AFM involves inflammation of the spinal cord. What remains a mystery is the cause of the inflammation. Nancy Messonnier, MD of the CDC has stated that AFM “seems to be more of an autoimmune syndrome, as opposed to a direct result of a virus.” Dr. Messonnier has compared AFM to what happens with the autoimmune neurological disorder known as Guillain-Barré Syndrome (GBS), in which the immune system attacks healthy nerve cells in the peripheral nervous system.4
On Nov. 19, 2018, the CDC created a task force to investigate the cause of AFM. According to CDC director Robert Redfield, MD, the 16-member Acute Flaccid Myelitis Task Force “will ensure that the full capacity of the scientific community is engaged and working together to provide important answers and solutions to actively detect, more effectively treat, and ultimately prevent AFM and its consequences.”5
Members of the Acute Flaccid Myelitis Task Force include: Ruth Lynfield, MD (co-chair) of the Minnesota Department of Health, Jill Taylor, PhD (co-chair) of the New York State Department of Health, Bonnie Maldonado, MD of the Stanford University School of Medicine, Emily Erbelding, MD, MPH of the National Institutes of Health. These four are members of the CDC’s Board of Scientific Counselors (BSC) of the Office of Infectious Diseases (OID).6
AFM clinical research experts on the task force include: Leslie Benson, MD of Boston Children’s Hospital; Benjamin Greenberg, MD, MHS of the University of Texas Southwestern Medical Center; Bryan Grenfell, PhD of Princeton University’s Woodrow Wilson School of Public and International Affairs; Tory Johnson, PhD, Arun Venkatesan, MD, PhD and Carlos Pardo-Villamizar, MD of the Johns Hopkins University School of Medicine, Kevin Messacar, MD of the University of Colorado School of Medicine; John Modlin, MD of the Bill & Melinda Gates Foundation, Avi Nath, MD of the National Institutes of Health; Matthew Schniederjan, MD of the Emory University School of Medicine; Nathaniel Smith, MD, MPH of the Arkansas Department of Health and Ken Tyler, MD of the University of Colorado School of Medicine.6
The AFM Task Force met in Atlanta, Georgia and presented its initial report at the BSC public meeting on Dec. 6, 2018. Themes covered in the presentation included:
- Important to have strong collaboration encompassing CDC, NIH, expert academic partners and health departments
- Need for understanding CNS (central nervous system) damage: direct pathogen effects, immune response
- Non-human primate model and other model systems may be useful
- Continue work on pathogen detection
- Review and summarize clinical phenotypes of cases
- Strengthen case identification and surveillance
- Work with partners to optimize recognition of AFM
- Utilize surveillance for risk factor and other studies
- Strengthen and expand education and communication outreach
- Implement natural history study to better understand pathogen(s), pathogenesis and long-term outcomes
- Continue close dialogue with parents and families on a variety of issues
- Medical record interoperability7
1 Vaidya A. CDC: 182 confirmed AFM cases in 2018 so far. Becker’s Hospital Review Dec. 27, 2018.
2 Hackett DW. 17 Additional AFM Cases Reported. Precision Vaccinations Dec. 27, 2018.
3 Centers for Disease Control and Prevention. AFM Investigation. CDC.gov.
4 Cáceres M. AFM Compared to Guillain-Barré Syndrome. The Vaccine Reaction Nov. 21, 2018.
5 TVR Staff. CDC Creates AFM Task Force. The Vaccine Reaction Nov. 28, 2018.
6 CDC. CDC Acute Flaccid Myelitis Task Force Members. CDC.gov.
7 CDC. AFM Task Force Report. CDC.gov.