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Acute flaccid myelitis (AFM) is not nationally notifiable; CDC relies on
clinician recognition and health department reporting of suspected AFM cases to
learn more about AFM and what causes it1. Texas is participating in
enhanced AFM surveillance.
Clinicians should continue to be vigilant and send all information about
patients that meet the clinical criteria (sudden onset of flaccid limb
weakness) for AFM to their state or local health department. Since AFM is a
relatively new condition, we need information on all patients to help us better
understand the spectrum of AFM illness, all possible causes, risk factors, and
outcomes for this condition. Clinicians
should send information on patients who meet the clinical criteria regardless
of any laboratory results or MRI findings.1
Clinicians should work with their state or local health department to
complete the patient summary form provided below as soon as possible after
patient identification so that they can be monitored in real time. Information should be sent to the local or
state public health department regardless of any laboratory and MRI results.1
How to report
and AFM procedures can be found in the Job Aid for Clinicians PDF.
CDC Requested Information and Documents:
- Patient
summary form
- Medical
record information
- History and physical (H & P)
- All MRI reports
- All neurology consult notes
- EMG (if done)
- Infectious disease consult notes (if available)
- Vaccination record
- Diagnostic laboratory reports
- All MRI images on CD
- Mail CD to CDC
- Contact DSHS or local health department for address to mail CD to CDC
Per CDC request please submit all above requested information to your local health department. Requested documents can also be sent
to Department of State Health Services via secure email to AFMTexas@dshs.texas.gov or faxed to 512-776-7616.
AFM Specimen Shipping and Handling
Clinicians should collect specimens from patients suspected of having
AFM as early as possible in the course of illness, preferably on the day of
onset of limb weakness. Prior to
shipping contact local or state public health. CDC requests specimens be
submitted to the DSHS laboratory not directly to the CDC.
Specimen Type
|
Minimum Amount
|
Collection
|
Storage
|
Shipping
|
Comments
|
Required Specimens
|
Cerebrospinal fluid (CSF)
|
1 mL
|
Spun
and processed; standard cryovial tube; collect at same time or within 24
hours as whole blood
|
Freeze
at -70°C
|
Ship on
dry ice
|
|
Respiratory - NP swab | 1ml | Store in viral transport medium | Freeze at -20°C | Ship on dry ice | Send for EV/RV testing at CDC regardless of previous test results |
Serum
|
0.4 mL
|
Spun
and processed; Tiger/red top tube
|
Freeze
at -70°C
|
Ship on
dry ice
|
|
Stool | ≥1gram | Collect in sterile container, no special medium required | Freeze at -20°C | Ship on dry ice | Two samples total, collected at least 24 hours apart, both collected as early in illness as possible and ideally within 14 days of illness onset |
In the
event of death, please send the following specimens, if possible
|
Fresh-frozen tissue
|
|
Place
directly on dry ice or liquid nitrogen
|
Freeze
at -70°C
|
Ship on
dry ice
|
Representative
sections from various organs are requested, but particularly from
brain/spinal cord (including gray and white matter), heart, lung, liver,
kidney, and other organs as available.
|
Formalin-fixed or formalin-fixed,
paraffin-embedded tissue
|
|
Avoid
prolonged fixation—tissues should have been fixed in formalin for 3 days,
then transferred to 100% ethanol
|
Room
temperature
|
Ship at
room temperature with paraffin blocks in carriers to prevent breakage
|
See comment above regarding frozen tissue
|
Please ship specimens overnight so they arrive at DSHS
Lab in Austin on Tuesday through Friday. Do not ship specimens on Friday or
over the weekend.
*Common cause for rejection is no two patient identifiers and missing
G-2V forms. Ensure each specimen has two patient identifiers such as first and
last name AND date of birth. Each specimen must have a completed G-2V form.
Texas Department of State Health Services G-2V
form
- If
your facility does not have a G-2V form, please contact LabInfo@dshs.state.tx.us
- You
will need the following information for your request
- Submitter Number
- Submitter National
Provider Identification Number (NPI)
- Provider Name
- Mailing Address
- City, State, Zip
- Phone Number
- Fax Number
- Contact person name
- Physician Name
- Physician's NPI Number
- Physician's UPIN Number
- Email address
To ensure correct submission please ensure
the below areas are completed on the G-2V form:

Ship specimens to:
Laboratory Services Section, MC-1947
Texas Department of State Health
Services
Attn. Walter Douglass (512) 776-7569
1100 West 49th Street
Austin, TX 78756-3199
1 Centers for Disease Control and
Prevention Acute Flaccid Myelitis for Clinicians and Health Departments