Department of Public Health - Acute Communicable Disease Control

Acute Flaccid Myelitis (AFM) Case Reporting

AFM became reportable in Los Angeles County (LAC) in January 2016. LAC is currently participating in enhanced AFM surveillance. Clinicians should report any person with onset of acute flaccid limb weakness, regardless of laboratory results to the patient's local health department as early in the course of the illness as possible.

Report all AFM and suspected polio cases within 24 hours by phone:

Weekdays 8:30am–5pm: call 213-240-7941.
After-hours: call 213-974-1234 and ask for the physician on call.

Please also report:

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 involving the anterior horn of the spinal cord spanning ≥1 vertebral segment

For any suspect or confirmed AFM cases in Los Angeles County:

1. Collect all five of the following specimens and ask the laboratory to hold them until specimen testing is approved. Specimens should be collected as early as possible and preferably on the day of onset of limb weakness.

Nasopharyngeal and oropharyngeal swabs (in viral transport media),
Nasopharyngeal wash or aspirate (in viral transport media).
CSF (2-3cc, if available, in sterile collection tube).
Serum (acute and convalescent), collected prior to treatment with IVIG, (2-3 cc in red or tiger-top tube).
Two stool specimens (two quarter-sized amounts in a sterile wide-mouth container) collected 24 hours apart.

2. Contact the Acute Communicable Disease Control Program (ACDC) to report all cases within 24 hours by phone. See weekday and after-hours reporting phone lines above.

3. For Los Angeles County AFM cases, send below documents to ACDC AFM team by fax to 888-397-3778 or
213-482-5508, or by secure email to acdcvector@ph.lacounty.gov

CMR
AFM patient summary form
Spinal MRI Report
Neurology consult notes

The AFM team will review case details for testing approval by next business day.

4. Once specimens are approved for AFM testing, send specimens to the LAC Public Health Laboratory (LAC PHL) and complete both the Test requisition form (H-3021) and CDPH VRDL specimen submittal form.

Approval of AFM testing is required before submitting any specimens to LAC PHL or CDPH Viral and Rickettsia Disease Laboratory (CDPH VRDL). The CDPH VRDL form will need to be completed for each specimen collected. Both the test requisition and CDPH VRDL forms should accompany the specimens to LAC PHL.

For courier services to LAC PHL, call 562-658-1460. For assistance with form completion, laboratory specimens and courier services, contact the ACDC AFM team during business hours on 213-240-7941.