Characteristics of Patients with Acute Flaccid Myelitis, United States, 2015-2018

Abstract

Observed peaks of acute flaccid myelitis (AFM) cases have occurred biennially since 2014 in the United States. We aimed to determine if AFM etiology differed between peak and nonpeak years, considering that clinical features of AFM differ by virus etiology. We compared clinical and laboratory characteristics of AFM cases that occurred during peak (2016 and 2018, n = 366) and nonpeak (2015 and 2017, n = 50) years. AFM patients in peak years were younger (5.2 years) than those in nonpeak years (8.3 years). A higher percentage of patients in peak years than nonpeak years had pleocytosis (86% vs. 60%), upper extremity involvement (33% vs. 16%), and an illness preceding limb weakness (90% vs. 62%) and were positive for enterovirus or rhinovirus RNA (38% vs. 16%). Enterovirus D68 infection was associated with AFM only in peak years. Our findings suggest AFM etiology differs between peak and nonpeak years.

Keywords: EV-D68; United States; acute flaccid myelitis; clinical characteristics; demographics; enterovirus; epidemiology; myelitis; paralysis; pediatrics; pleocytosis; respiratory infections; surveillance; viruses.

Figure

Confirmed AFM cases in patients <22 years of age by week of limb weakness onset, United States, January 2015–December 2018. AFM, acute flaccid myelitis.