Data Collection

Acute flaccid myelitis (AFM) is not nationally notifiable, but a standardized case definition for AFM was published by the Council of State and Territorial Epidemiologists in 2015, allowing a system for consistent collection of clinical and laboratory data.

Clinicians

Clinicians should send information to their state or local health department for all patients who meet the clinical clinical case definition for AFM using the following Patient Summary Form. Clinicians should send information for patients who meet the case definition regardless of any laboratory results.

The form should be completed by, or in conjunction with, a clinician who provided care to the patient during the neurologic illness, and sent to the state or local health department as soon as possible after case identification, so that these cases can be monitored in as real time as possible.

A form that is largely complete but has some information pending (e.g., hospital or health department laboratory results) or under investigation (e.g., polio vaccination history) should still be sent as soon as possible, and the pending results can then be provided to CDC when they become available.

Health Departments

CDC advises state and local health departments to send completed Patient Summary Forms to CDC by email at limbweakness@cdc.gov or via secure fax at 404-471-8442 for each patient that meets the clinical case definition for AFM. Health departments should send information for patients who meet the clinical case definition regardless of any laboratory results.

Patient Summary Form

• Acute Flaccid Myelitis: Patient Summary Form Word [v 4.0, 5 pages] UPDATED SEP 2015
• Acute Flaccid Myelitis: Patient Summary Form PDF [v 4.0, 5 pages] UPDATED SEP 2015
• Instructions for completing the AFM Patient Summary Form [5 pages] NEW JAN 2016