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Monday, November 18, 2019
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What Nurses and PAs Need to Know About AFM as Its Peak Season Approaches

As fall approaches, so does peak season for acute flaccid myelitis (AFM), a mysterious illness that causes “polio-like” symptoms. AFM affects the spinal cord and causes sudden muscle weakness—usually in previously healthy children around 5 years old.

Although AFM’s exact causes and potential treatments remain unknown, at least one thing is clear: the number of cases spikes between August and October. Since the CDC began tracking AFM in 2014, there has been an outbreak once every other year and a total of 570 individual cases. Of those, 233 occurred during the fall of 2018, the largest outbreak to date. In 2019, there have been 11 confirmed cases in eight states out of 57 patients under investigation, CNN reports.

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AFM is rare: Fewer than one to two in a million kids in the United States get it annually. But its serious symptoms and lack of proven treatments make investigating AFM a CDC priority. With August just around the corner, the agency announced it wants help from RNs, NPs and PAs identifying and understanding this illness.

Healthcare providers “play a critical role,” CDC spokesperson Martha Sharan told Florence Health. “We ask for your help with early recognition of patients with AFM symptoms, prompt specimen collection for testing, and immediate reporting of AFM cases.” 

Here’s how you can do your part:

Keep an eye out for viral infections. 

Most patients develop a respiratory illnesses or fever less than a week before experiencing more recognizable symptoms—weak limbs or paralysis. Although the relationship between these illnesses and AFM is unclear, Sharan says the CDC has found “important pieces of evidence that point to viruses, including enteroviruses in particular, playing a role in AFM.”

Diagnose rapidly.

AFM can progress quickly, and in the worst cases, respiratory muscles are weakened to the point of respiratory failure. To diagnose AFM, immediately refer any patient experiencing sudden muscle weakness for a spinal MRI.

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Remember that “polio-like” does not mean polio.

Though AFM is often called “polio-like,” no AFM patients have tested positive for polio, which remains eliminated in the United States. Of course, you should still talk to parents about vaccinating their children against polio.

Report cases as quickly as possible.

On average, the CDC learns of a suspected AFM case 18 days after a patient first experiences limb weakness. To solve the mystery of AFM, Sharan told us the CDC needs this information earlier: “When specimens are collected as soon as possible after symptom onset, we have a better chance of understanding the causes of AFM, these recurrent outbreaks, and developing a diagnostic test.” As soon as you suspect AFM, collect serum, CSF, stool, and NP swabs. You should also follow CDC guidance on how to report a suspected AFM case to the health department.

References:
CDC Urges Doctors to Rapidly Recognize and Report AFM Cases, Centers for Disease Control.

Last updated on 10/9/19.

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