Alabama Department of Public Health
Alabama Emergency Response Technology (ALERT) 
Health Alert Network (HAN)
October 14, 2025
Remain Vigilant for Acute Flaccid Myelitis in Fall 2025
 
Acute Flaccid Myelitis (AFM) is a rare, serious paralytic disease that mainly affects children. As we enter the fall season, seasonal increases in the circulation of respiratory pathogens, including enteroviruses, is to be expected. Enterovirus D-68 (EV-D68) is believed to be the main enterovirus responsible for the increases in AFM cases observed during 2014, 2016, and 2018. 

Although we are seeing increases in EV-D68 detections in the United States this year, the number of reported cases of AFM has remained relatively low to date.  AFM became reportable in Alabama in 2018 and since then we have had 7 cases. As of August 5, 2025, CDC has received 17 reports of suspected AFM, with 7 confirmed cases in 5 states. In past years, increases in EV-D68 respiratory disease have preceded cases of AFM by about 2 weeks. Therefore, vigilance for possible increases in EV-D68 respiratory disease and AFM is important as we move into the fall season. 

Additionally, the identification of a paralytic polio case in an unvaccinated person in New York in 2022 reinforced the need to also consider polio in the differential diagnosis of patients with sudden onset of limb weakness. Clinicians should obtain whole stool samples from all patients with suspected AFM to rule out poliovirus infection. This is particularly important if the patient is under-vaccinated or unvaccinated against polio.

Clinicians play a critical role in recognizing AFM symptoms and assessing patients quickly. Suspected cases that present with acute onset of flaccid limb weakness AND at least some gray matter lesions in the spinal cord are required to be reported to the health department via the REPORT Card for Reportable Diseases/Conditions.

For more information

AFM

• AFM: https://www.cdc.gov/acute-flaccid-myelitis/index.html  
• AFM reporting procedures for clinicians: https://www.alabamapublichealth.gov/infectiousdiseases/assets/afm_flyer_providers.pdf
• AFM physician consult and support portal: https://wearesrna.org/living-with-myelitis/resources/afm-physician-support-portal/  
• For healthcare providers: https://www.cdc.gov/acute-flaccid-myelitis/hcp/clinical-overview/index.html
• For health departments: https://www.cdc.gov/acute-flaccid-myelitis/php/laboratories/index.html

POLIO

• Poliomyelitis: For Healthcare Providers: https://www.cdc.gov/polio/us/hcp/index.html
• Polio vaccine recommendations: https://www.cdc.gov/vaccines/vpd/polio/hcp/index.html
• Resources for polio: https://www.cdc.gov/polio/about/index.html