Acute Flaccid Myelitis (AFM) Resources for Health Care Providers
Acute flaccid myelitis (AFM) is a rare but serious neurologic condition that causes paralysis and affects the gray matter of the spinal cord.
Report? Yes.
Suspected cases of AFM should be reported to the NCDHHS Division of Public Health Communicable Disease Branch.
Case reporting requires submission of medical records and MRI images. The U.S. Centers for Disease Prevention and Control, or CDC, does case review and classification. However, treatment of AFM cases should begin immediately.
AFM Overview
Cases of AFM typically present with limb weakness, as well as muscle and reflex weakness. This usually starts in the proximal muscles (neck, shoulder, trunk, hips). Most cases (about 90%) occur in young children.
No single pathogen causes AFM, but enteroviruses, specifically enterovirus D68 (EV-D68), seem to be the most common cause.
Case tracking for AFM in the United States and North Carolina began in 2014. AFM was added to North Carolina's reportable diseases list in 2020. North Carolina averages about one case per year.
Acute Flaccid Myelitis (AFM) (NCDHHS YouTube)
This short, informative video is for health care providers who are treating a patient they believe may have AFM. (14:18)
Case Reporting
Because there is no laboratory test diagnostic for AFM, public health case classification requires the CDC's expert review of the:
- Clinical notes
- MRI reports
- MRI images
CDB works closely with health care providers and public health epidemiologists, or PHEs, to gather and submit materials for review.
Specimen Collection
AFM testing must be approved by CDB. Contact the epidemiologist on call: 919-733-3419.
Multiple specimens must be submitted for an AFM review:
- Stool
- CSF
- Respiratory swab(s)
- Serum
Get details on minimum specimen volume, processing, storage and shipment: CDC Specimen Collection Instructions.
Freeze specimens immediately after collection. Ship overnight on dry ice to the NCDHHS State Laboratory for Public Health. Our state lab will help send specimens to the CDC.
Reporting Resources
More Information
This page was last modified on 10/19/2026