Surveillance for Acute Flaccid Myelitis (AFM):
Information for Health Professionals

Updated 12/29/2021

Clinical guidance

• CDC: Acute Clinical Guidance for the Acute Medical Treatment of AFM

Acute flaccid myelitis surveillance

The Minnesota Department of Health is conducting surveillance for acute flaccid myelitis/paralysis. 

• Criteria:
  • Acute onset of flaccid limb weakness; AND
  • MRI showing a spinal cord lesion largely restricted to gray matter.
• Please contact MDH at 651-201-5414 or 1-877-676-5414 to report patients that meet these criteria.
  • Reporting of patients meeting the criteria is consistent with a case of “Unexplained Critical Illness” as per the Communicable Disease Reporting Rule, Chapter 4605.

Specimen collection and testing

Stool, respiratory, cerebral spinal fluid, and serum specimens from these patients can be submitted to MDH Public Health Laboratory (PHL) for testing.

Collect (all if possible):

• Respiratory Swab/Wash (Nasopharyngeal swab preferred):
  2 ml VTM/UTM or similar viral transport medium.
  Transport at refrigerator temperature or frozen if transport will be delayed more than 2 days.
• Serum:
  1 ml, preferably stored off the clot.
  Transport at refrigerator temperature or frozen if transport will be delayed more than 2 days.
• Stool Sample:
  2 g or 2 ml ParaPak C&S, Modified Carey-Blair, or equivalent.
  Transport at refrigerator temperature.
• Cerebral Spinal Fluid (CSF):
  2 ml.
  Transport at refrigerator temperature or frozen if transport will be delayed more than 2 days.

Based on clinical presentation, MDH may test for arboviruses, picornaviruses/enteroviruses, and other pathogens. Specimens may also be sent to the CDC picronavirus lab. Reports for validated assays will be sent back to submitting laboratories.

Fill out a submission form for EACH specimen:

Use Project #1880 in submitter section of form. 
Test request should be filled out as AFM request. 
Please include the Epidemiologist contact name.

• Infectious Disease Laboratory Submission Form (PDF)
  Printable and/or fillable. More information can be found on Forms for the Infectious Disease Laboratory.
  • MDH Infectious Disease Lab General Submission Form Guidance (PDF)
    Guidelines to complete the submission form.

Label all tubes/containers with the following information:

• Patient name
• Patient date of birth
• Date specimen collected
• Specimen type

Send specimens to the MDH PHL:

Send specimens to arrive Monday-Friday before 4:30 p.m. to:
MDH Public Health Laboratory
Attn: Biological Accessioning
601 Robert St. N. 
St. Paul, MN 55155-2531

Background and more information

• CDC: Acute Flaccid Myelitis Cases
• Health Advisory: Increase in Pediatric Acute Flaccid Myelitis Cases (PDF)
  MDH Health Advisory: October 4, 2018 
• Health Advisory: Acute Neurological Illness - Minnesota Surveillance (PDF)
  MDH Health Advisory: September 29, 2014