Acute Flaccid Myelitis (AFM) Information for Healthcare Providers

Reporting Criteria

All individual cases of Acute Flaccid Myelitis (AFM) should be reported to the Georgia Department of Public Health. Find out more about Reporting AFM. 

Information collected on AFM cases is included in the  GDPH AFM Case Report Form.  Magnetic resonance imaging (MRI) copies are required to complete AFM case classification.

Suspect cases of AFM reportable to DPH are classified according to the following criteria:  

Clinical Criteria

 An illness with onset of acute flaccid(a) limb weakness 

Laboratory/Imaging Criteria  

• Confirmatory laboratory/imaging evidence:  
  • MRI showing spinal cord lesion with predominant gray matter involvement(b) and spanning one or more vertebral segments 
  • Excluding persons with gray mater lesions in the spinal cord resulting from physician diagnosed malignancy, vascular disease, or anatomic abnormalities 
• Presumptive laboratory/imaging evidence:  
  • MRI showing spinal cord lesion where gray matter involvement(b) is present, but predominance cannot be determined 
  • Excluding persons with gray mater lesions in the spinal cord resulting from physician diagnosed malignancy, vascular disease, or anatomic abnormalities 
• Supportive laboratory/imaging evidence:
  • MRI showing a spinal cord lesion in at least some gray matter(b) and spanning one or more vertebral segments, AND
  • Excluding persons with gray matter lesions in the spinal cord resulting from physician diagnosed malignancy, vascular disease, or anatomic abnormalities.

(a) Low muscle tone, limp, hanging loosely, not spastic or contracted 

(b) Spinal cord lesions may not be present on initial MRI; a negative or normal MRI performed within the first 72 hours after onset of limb weakness does not rule out AFM. Terms in the spinal cord MRI report such as “affecting mostly gray matter,” “affecting the anterior horn or anterior horn cells,” “affecting the central cord,” “anterior myelitis,” or “poliomyelitis” would all be consistent with this terminology.

Death Reporting Criteria

• Any person whose death certificate lists acute flaccid myelitis as a cause of death or a condition contributing to death. 
• Autopsy findings that include histopathologic evidence of inflammation largely involving the anterior horn of the spinal cord spanning one or more vertebral segments.

Case Definitions  

(c) Assignment of final case classification for all suspected AFM cases is done by experts in national AFM surveillance 

Laboratory Testing 

Specimens should be collected from patients suspected of having AFM as soon as possible, ideally on the day of limb weakness onset. Requested specimens include: 

• Cerebrospinal Fluid (CSF) 
• Blood serum 
• A nasopharyngeal swab 
• Stool  
• Two stool specimens collected as soon after onset of limb weakness as possible and separated by 24 hours   

For detailed instructions visit the CDC’s webpage on AFM specimen collection. 

DO NOT ship specimens directly to CDC, call your local health department to coordinate shipment to the Georgia Public Health Laboratory, who will then coordinate testing and shipping with CDC. 

Clinical Management of Cases 

• Visit the U.S. Centers for Disease Control and Prevention (CDC) Acute Flaccid Myelitis (AFM) webpage for updated provider resources:  
  • https://www.cdc.gov/acute-flaccid-myelitis/hcp/clinicians-health-departments.html 
• Visit The Transverse Myelitis Association's AFM Physician Consult and Support Portal for consults available 24/7:   
  • https://myelitis.org/living-with-myelitis/resources/afm-physician-support-portal/
• View CDC's Interim Considerations for the Clinical Management of AFM:   
  • https://www.cdc.gov/acute-flaccid-myelitis/hcp/clinical-management.html 

Page last updated 12/22/2022