27Jul / 2020

AFM is Serious: Know the Symptoms. Act Fast.

Acute flaccid myelitis (AFM)

Acute flaccid myelitis (AFM) is a serious neurologic condition that causes limb weakness and paralysis. While uncommon, AFM affects mostly children, and can have devastating, long-term effects for patients and their families.

There have been three AFM outbreaks in the United States—in 2014, 2016, and 2018. If this biennial pattern continues, another outbreak might occur in 2020.

What AFM Might Look Like

Little boy doing physical therapy — Braden, who was diagnosed with AFM in 2016, doing his physical therapy. Braden needed a breathing tube for 3 years and was initially paralyzed from the neck down. Now Braden can walk short distances, and his breathing tube has been removed. Braden’s mom Rachel is a co-founder of the Acute Flaccid Myelitis Association.

Imagine your 5-year-old son, who is usually very excited to get up and get going in the morning, complains that his neck hurts, and he can’t move his left arm. You think nothing of it. Maybe he just slept wrong and his arm “fell asleep” and it will go away shortly.

You fix his favorite cereal and call him to come eat, but he doesn’t. It’s been almost half an hour since he woke up. Any other morning, he’d be running around, talking about this and that, and demanding his breakfast. You check on him again. He is still lying in bed and still complaining about his neck and arm.

You check his temperature, which seems fine. What could this be? You don’t think he’s making it up, especially since he was excited about an art project happening today.

You call the doctor’s office and get the nurse on the line. She asks you a series of questions, and you remember that his older sister was sick last week with a mild fever, but your son only had some sniffles. Your pediatrician wants to see your son right away, and after examining his reflexes and strength, he tells you to bring your son immediately to the nearest children’s hospital’s emergency department (ED). The pediatrician suspects your son may have a serious neurologic condition. Scared and worried, you rush to the ED.

AFM is a Medical Emergency

AFM can progress quickly to respiratory failure. Patients who develop AFM symptoms need immediate medical care. That’s why it’s very important that parents call their child’s pediatrician right away or go to the ED, and that clinicians recognize the symptoms of AFM early and hospitalize patients for further evaluation and monitoring.

When to Suspect AFM

You should suspect AFM when a person has sudden onset of arm or leg weakness. Also, did the person have a recent respiratory illness or fever? If so, this should heighten your suspicion for AFM.

Also, look for other signs and symptoms such as:

Loss of muscle tone and reflexes in the affected extremities.
Difficulty moving the eyes or drooping eye lids.
Facial droop or weakness.
Difficulty with swallowing or slurred speech.
Pain in arms or legs.
Pain in neck or back.

AFM & the COVID-19 Pandemic

View Printable Poster: How to Spot Symptoms of AFM in Your Child.

COVID-19 is likely on everyone’s minds and causing concern, uncertainty, and challenges for communities across the country.

It is not known how the COVID-19 pandemic and social distancing may affect AFM this year, or the health care system’s ability to promptly recognize and respond to it. However, even in communities with high COVID-19 activity:

Parents should act and get medical attention immediately if their child develops sudden arm or leg weakness. It may be AFM, which is serious and requires urgent care. It is very likely that the assessment of your child will require hospitalization if clinicians think your child might have AFM.

Clinicians should not “wait and see.” They should refer patients suspected to have AFM to the ED immediately. They should reference CDC resources on AFM symptoms, provide optimal medical management, collect specimens, and report cases to health departments. Clinicians can also contact an AFM expert for a clinical consult through the AFM Physician Consult and Support Portal.

Clinicians may consider reassuring parents about going to the ED during the COVID-19 pandemic for serious health problems. Clinicians can let parents know that hospitals are taking precautions to prevent exposures to COVID-19, such as providing separate entrances and rooms for those with respiratory symptoms, requiring hospital staff to wear appropriate protective equipment like face coverings and shields for all encounters with patients, and increasing access to hand sanitizer and disinfecting surfaces frequently.

AFM remains a public health priority for CDC. CDC is committed to investigating AFM, working with partners, supporting affected families, and responding to outbreaks. Clinicians are encouraged to review CDC’s AFM website, stay alert for AFM in late summer through fall, and promptly evaluate and hospitalize AFM patients.

Resources for Parents:

Resources for Health Care Professionals:

CDC’s AFM webpages for clinicians and health departments
Watch CDC’s Public Health Grand Rounds about AFM released on July 21, 2020, and earn free continuing education.

If you have questions, you may send them to AFMQuestions@cdc.gov.

Thanks in advance for your questions and comments on this Public Health Matters post. Please note that the CDC does not give personal medical advice. If you are concerned you have a disease or condition, talk to your doctor.

Have a question for CDC? CDC-INFO (http://www.cdc.gov/cdc-info/index.html) offers live agents by phone and email to help you find the latest, reliable, and science-based health information on more than 750 health topics.

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05Nov / 2018

Partnerships Help Save Lives When Disaster Strikes

Emergency responders gathered in a circle.

Public health emergencies occur every day across the United States. Tornadoes, hurricanes, wildfires, floods, infectious disease outbreaks, terrorist attacks, and other emergencies have all occurred within the past few years and likely will happen again. Communities must be ready in the event of a public health emergency – both those they expect and those that come without warning.

Since 2002, CDC’s Public Health Emergency Preparedness (PHEP) program has provided funding and guidance to 50 states, four cities, and eight territorial health departments across the nation to protect communities. Planning and exercising plans help ensure that health departments are ready to respond and save lives when emergencies occur.

While we all hope that emergencies never happen, they are inevitable and the true test of any preparedness system. The following stories are examples of how CDC’s PHEP program works with states and local communities to ensure they are ready to respond to any emergency. Some of CDC’s partners include health departments, community organizations, national public health organizations, and private companies.

Restoring California Communities after Devastating Wildfires

A fire truck responds to a brush fire. In 2017, nearly 9,000 fires, almost double the average annual number, burned 1.2 million acres in California. The fires destroyed more than 10,800 structures and killed at least 46 people. However, thanks to years of planning for such events and building a public health infrastructure through the PHEP program, state and local health departments were ready to respond immediately and help their communities recover over the following months.

Through partnerships and support provided by the PHEP program in and around Sonoma County, local officials evacuated more than 1,160 patients from area hospitals and many other healthcare facilities. Additionally, because of the relationship the state built with the California National Guard through the PHEP program, more than 100 volunteer troops cleaned the Sonoma Developmental Center in one day. More than 200 patients with disabilities were then able to return safely to the facility.

Ensuring Access to Medication during an Influenza Outbreak in Maine

Package of Oseltamivir (i.e., Tamiflu) capsules In March 2017, an influenza outbreak on Vinylhaven, a remote island off the coast of Maine with a population of about 1,165, sickened half of the island’s residents. The outbreak depleted the medical center’s Tamiflu® supply. Tamiflu® can greatly lessen the severity of influenza but it must be taken early in treatment.

Because of a partnership agreement established under PHEP with the Northern New England Poison Center, local pharmacies, and other organizations, and the Maine Department of Health staff quickly delivered 100 treatment courses of Tamiflu®. As a result, the state successfully reduced the impact of the influenza outbreak on the island.

Responding to a Water Contamination Incident in Illinois

Bottles of water on a conveyor belt. On May 2017, a water main break under a river contaminated water in Cumberland County, Illinois, and left some residents without water entirely. Health department staff funded through PHEP established water distribution sites with bottled water donated by private partners such as Walmart, Coca-Cola, and Anheuser-Busch. Staff also went door-to-door to check on residents and distribute materials about safe water.

The PHEP program ensures public health emergency management systems and experts are ready to respond when emergencies occur. Preparedness efforts throughout the years have saved lives and helped communities return to normal operations as quickly as possible.

From natural disasters to infectious diseases, the PHEP program protects America’s health, safety, and security to save lives. Check out the PHEP Stories from the Field to find out more about how the PHEP program has helped communities prepare for, respond to, and recover from public health emergencies.

16Apr / 2018

Moving the Dial on Preparedness: CDC’s 2018 National Snapshot

Photo of a flooded apartment complex and office building during Hurricane Harvey.

Every year, CDC’s Office of Public Health Preparedness and Response publishes the Public Health Preparedness and Response National Snapshot, an annual report that highlights the work of CDC and our partners. No matter the type, size, or cause of a public health emergency, we must work together to respond to the best of our ability.

Photo of the cover of the Public Health Preparedness and Response 2018 National Snapshot report. — Read the full 2018 National Snapshot Report.

The Snapshot includes two sections:

The Narrative describes CDC preparedness and response activities in 2016 and 2017 and demonstrates how investments in preparedness enhance the nation’s ability to respond to public health threats and emergencies.
The Public Health Emergency Preparedness (PHEP) Program Fact sheets provide information on PHEP funding from 2015 to 2017 and trends and progress related to the 15 public health preparedness capabilities defined in the PHEP Cooperative Agreement. They also feature a short story that demonstrates the impact of the PHEP program.

Here are some highlights from the Snapshot that showcase how CDC’s Office of Public Health Preparedness and Emergency Response worked to keep people safer in 2017.

Hurricane Response and Recovery

In late summer 2017, three major hurricanes—Harvey, Irma, and Maria—made landfall in the United States and territories. This was the first time the United States experienced three Category 4 or greater hurricanes during a single hurricane season. CDC activated its Emergency Operations Center (EOC) on August 31, 2017 and the response is ongoing. CDC epidemiologists, environmental health specialists, emergency managers, health communicators, and scientists with expertise in waterborne and vector-borne diseases continue to work together to monitor and address public health threats in the aftermath of the storms.

Learn more about CDC’s role in the hurricane response.

The Opioid Epidemic

From 2000 – 2015, drug overdoses killed more than half a million people in the U.S. Six out of 10 of these deaths involved an opioid. CDC’s National Center for Injury Prevention and Control and the PHEP Program work together to support communities responding to the opioid epidemic. State health departments are using PHEP funds to identify communities hardest hit by the epidemic and to support the distribution of naloxone, a medical treatment to prevent death from opioid overdose.

Learn more about what states are doing to fight the opioid epidemic.

State and Local Readiness

Between 2017 and 2019, CDC and Public Health Emergency Preparedness (PHEP) program recipients will conduct nearly 500 medical countermeasure operational readiness reviews nationwide. Nearly 60% of the U.S. population resides in 72 metropolitan areas that are included in the reviews of 400 local jurisdictions. The reviews evaluate a jurisdiction’s ability to execute a large response that requires the rapid distribution and dispensing of life-saving medicines and medical supplies.

Learn more about the role of the PHEP program in state and local readiness.

Cutting-Edge Science to Find and Stop Disease

In 2017, CDC’s Federal Select Agent Program (FSAP) developed a new electronic information system to improve the efficiency of information sharing and exchange between FSAP and registered entities.

Learn more about how CDC safeguards lifesaving research with deadly pathogens and poisons through the Select Agent Program.

Full Report: Public Health Preparedness and Response 2018 National Snapshot
Public Health Preparedness Capabilities: Public Health Emergency Preparedness Map
Infographic: Preparedness and Response – By the Numbers

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If you have any feedback about the 2018 National Snapshot, please email us at preparednessreport@cdc.gov. We welcome your suggestions and will use your feedback to improve future editions of the Snapshot.

18Sep / 2017

Preparedness and Response in Action: Stories from the States

Celebrating 15 Years of PHEP

CDC’s Public Health Emergency Preparedness (PHEP) cooperative agreement is a critical source of funding, guidance, and technical assistance for state, local, tribal, and territorial public health departments to strengthen their public health preparedness capabilities. Since 9/11, the PHEP program has saved lives by building and maintaining a nationwide public health emergency management system that enables communities to rapidly respond to public health threats.

The following stories are examples of how PHEP has equipped states for each of the four stages of preparedness: Ready. Steady. Show. Go!

READY: Planning for the inevitable

Often the emergency managers and public health professionals who respond to an emergency are personally impacted by the same event. The ability of emergency response staff to take action during a disaster is limited when they are stranded in their homes due to an ice storm, without power, or unable to make it into the office.

The Connecticut State Department of Health, led by Jonathan Best, took on the challenge to ensure that operations can run smoothly even when their own staff are directly impacted by an emergency. They developed the Red Sheet Program, which trains three people for every key position in the emergency management structure – a primary contact with two back-ups. This means the health department can be fully staffed and ready to respond to a crisis within 20 minutes.

STEADY: Solving two problems at once

As the saying goes, even the best laid plans often go awry. Planning is an essential part of any preparedness program, but it is often difficult to imagine every scenario and obstacle that may arise during an emergency. But we also know that practice is the best way to identify and address those gaps– and practice is exactly what the Oklahoma State Department of Health does to improve its preparedness programs.

In September 2016, the Oklahoma Strategic National Stockpile team prepared to conduct a full-scale exercise of its ability to distribute medical countermeasures – medications and other products used to prevent and treat health conditions that may arise during a public health emergency. Before the exercise began, the state realized they had shipments of flu vaccines that they needed to distribute around the state and the team distributed the vaccines as part of their regularly scheduled exercise. The team transported 11,960 doses of vaccine to eight local health departments while simultaneously completing this practice exercise.

SHOW: Creating a culture of preparedness

Emergencies impact all sectors of health, and experts from across departments are often asked to weigh in, from epidemiologists, to laboratorians, to mental health experts. However, public health staff in these positions may not often consider their roles in an emergency situation.

To build a culture of preparedness across the entire Oregon Health Authority, the Emergency Operations Division provided all staff with a 72-hour emergency kit, worked to enroll staff in the Health Alert Network, and trained staff on the Incident Management System. Since this initiative, staff personally feel more prepared for an emergency, and more staff are now prepared to respond should the need arise. “The culture has shifted. People are now talking in the elevator about what they would do in the event of a large-scale disaster,” acting PHEP director Akiko Saito said. “If we can build this culture of preparedness here, then we’re better equipped to build community resiliency on a larger scale.”

GO! Putting plans into action

While we all hope that emergencies never occur, they are inevitable and the true test of any preparedness system. Washington experienced an outbreak of mumps that affected more than 800 people of all ages in late 2016 and early 2017.

During this outbreak, the state and local health departments in Washington investigated new cases, advised local school districts on prevention measures, and developed culturally appropriate risk communication materials. Due to a robust preparedness system and the efforts of the health department staff and partners, more than 5,000 more people were vaccinated for measles, mumps, and rubella compared to previous years.

For 15 years, PHEP has been there, from Katrina to SARS; Joplin to H1N1 influenza. To find out more about how the PHEP program has equipped jurisdictions to prepare for, respond to, and recover from public health emergencies, check out our Stories from Field.

Read our other National Preparedness Month blogs: