Investigation of Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children, Fall 2014

The Centers for Disease Control and Prevention (CDC) is working closely with the Colorado Department of Public Health and Environment (CDPHE) and Children’s Hospital Colorado to investigate a cluster of pediatric patients hospitalized with acute neurologic illness of undetermined etiology characterized by focal limb weakness and abnormalities of the spinal cord gray matter on MRI.

On September 26, CDC issued a request to all states to look for and report other similar neurologic illnesses. We are receiving reports and will update this website with new available data every Thursday.

Update

As of October 29, CDC has verified reports of 64 cases in 28 states that meet our case definition below. We are working with healthcare professionals and state and local officials to investigate all of these cases.

We are also in the process of verifying about half a dozen additional reports. These investigations take time. Therefore, the number of cases will likely increase further as we update these numbers weekly on Thursday, but the increase will not necessarily reflect changes in occurrence of cases in real time.

Case Definition

Persons who meet the case definition should be reported to state and local health departments.

To be considered a case, a patient must meet ALL 4 of the following criteria:

Patient ≤21 years of age,
Acute onset of focal limb weakness,
On or after August 1, 2014, AND
An MRI showing a spinal cord lesion largely restricted to gray matter

Patient Summary Form

CDC requests that state and local health departments report persons meeting the case definition to CDC using the patient summary form below. Ideally, for cases that meet the CDC case definition (see above), the patient summary form and available clinical specimens should be submitted to CDC as soon as possible after case identification, so that CDC can monitor these cases 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 still under investigation (e.g., polio vaccination history) should still be submitted as soon as possible, and the pending results can then be provided to CDC when they become available.

UPDATED October 10, 2014

Acute Neurologic Illness with Limb Weakness in Children: Patient Summary Form Word[v 2.0, 6 pages]
Acute Neurologic Illness with Limb Weakness in Children: Patient Summary Form PDF[v 2.0, 6 pages]

State health departments should send completed investigation forms to CDC by email at limbweakness@cdc.gov or via secure fax at 404-471-8442.

Specimen Collection Instructions

Providers should follow these Specimen Collection Instructions for collecting specimens from patients that meet all 4 criteria of the case definition.

Health departments may contact CDC for further laboratory and epidemiologic support by phone through the CDC Emergency Operations Center (770-488-7100), or by email at limbweakness@cdc.gov. Confirmation of the presence of EV-D68 currently requires typing by molecular sequencing.

Also see CDC Health Advisory Network: Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children.

Parent Information

Many parents are concerned to hear about these sick children in Colorado. For a description of the investigation, see Unexplained Paralysis Hospitalizes Children.