{"id":10372,"date":"2025-03-01T14:07:49","date_gmt":"2025-03-01T19:07:49","guid":{"rendered":"https:\/\/www-test.dhss.delaware.gov\/dph\/dhan395\/"},"modified":"2025-03-02T00:54:32","modified_gmt":"2025-03-02T05:54:32","slug":"dhan395","status":"publish","type":"page","link":"https:\/\/www-test.dhss.delaware.gov\/dph\/php\/alerts\/dhan395\/","title":{"rendered":"php\/alerts\/dhan395 ~  Division of Public Health &#8211; Health Alert  &#8211; Delaware Health and Social Services &#8211; State of Delaware"},"content":{"rendered":"<div data-swiftype-index=\"true\">\n\n\n\n\n\n  <br>\n\n\n\n\n\n  <div class=\"container\" id=\"main_header\"> \n\n\n    <!-- BEGIN readspeaker div -->\n\n\n    <div class=\"rs_skip rsbtn rs_preserve\" id=\"readspeaker_button1\">\n\n\n      <a accesskey=\"L\" class=\"rsbtn_play\" href=\"https:\/\/app-na.readspeaker.com\/cgi-bin\/rsent?customerid=7262&#038;lang=en_us&#038;readid=main_content&#038;url=https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan395.html\" title=\"Listen to this page using ReadSpeaker\">\n\n\n        <span class=\"rsbtn_left rsimg rspart\"><span class=\"rsbtn_text\"><span>Listen<\/span><\/span><\/span>\n\n\n        <span class=\"rsbtn_right rsimg rsplay rspart\"><\/span>\n\n\n      <\/a>\n\n\n    <\/div>\n\n\n    <!-- END readspeaker div -->\n\n\n\n\n\n    \n\n\n    <header class=\"pull-left\">\n\n\n      <h1>Delaware Health Alert Network #<!--[type=EDIT name=\"DHAN Number\"]-->395 <!--[END]--> <\/h1>\n\n\n      <h2> <!--[type=EDIT name=\"DHAN Date\"]-->October 19, 2018 12:13 pm <!--[END]--> <\/h2>\n\n\n    <\/header>\n\n\n  <\/div><br>\n\n\n \n\n\n  <div class=\"container\">\n\n\n    <div class=\"row\">\n\n\n      <div class=\"col-md-3\" id=\"leftCol\">\n\n\n        <div class=\"panel-group\" id=\"accordion\">\n\n\n          <div class=\"panel sectionmenu_panel\">\n\n\n            <div class=\"panel-heading\">\n\n\n              <p class=\"panel-title\"><a class=\"agency_nav\" data-parent=\"#accordion\" data-toggle=\"collapse\" href=\"#collapseOne\"><strong><i class=\"fa fa-align-justify fa-fw\"><\/i> Public Health Menu<\/strong><\/a><\/p>\n\n\n            <\/div>\n\n\n\n\n\n            <div class=\"panel-collapse collapse in\" id=\"collapseOne\">\n\n\n              <div class=\"panel-body\" id=\"clf_nav\">\n\n\n                  <ul class=\"nav nav-stacked nav-pills-clf\" id=\"agency_sidebar\">\n    <li><a href=\"\/dph\/\"><h2>Home <i class=\"fa fa-home fa-fw\"><\/i><\/h2><\/a><\/li>\n    <li class=\"toplevel\"><a data-parent=\"#agency_sidebar\" data-toggle=\"collapse\" href=\"#HomeMenu\"><h2>About <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"HomeMenu\">\n        <li><a href=\"\/dph\/about.html\">About DPH<\/a><\/li>\n        <li><a href=\"\/dph\/sections.html\">Sections &#038; Programs<\/a><\/li>\n        <li><a href=\"\/dph\/ofclocations.html\">Office Locations<\/a><\/li>\n        <li><a href=\"\/dph\/contact.html\">Contact Info<\/a><\/li>\n      \n        <li><a href=\"\/calendars.html\" target=\"_blank\">Calendar<\/a><\/li>\n      <\/ul>\n    <\/li>\n    <li class=\"toplevel\"><a data-parent=\"#sidebar\" data-toggle=\"collapse\" href=\"#ServicesMenu\"><h2>Services <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"ServicesMenu\">\n        <li><a href=\"\/dph\/servicesaz.html\">A-Z Services<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/environmental.html\">Air &#038; Water Quality<\/a><\/li>\n        <li><a href=\"\/dph\/ss\/vitalstats.html\">Birth, Death, &#038; Marriage Records<\/a><\/li>\n        <li><a href=\"\/dph\/clinics.html\">Clinics<\/a><\/li>\n        <li><a href=\"\/dph\/healthdatastats.html\">Health Data &#038; Statistics<\/a><\/li>\n        <li><a href=\"\/dph\/php\/emsps.html\">Emergency Preparedness<\/a><\/li>\n        <li><a href=\"\/dph\/healthandwellness.html\">Health &#038; Wellness<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/healthyhomes.html\">Healthy Homes<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/healthywp.html\">Healthy Workplaces<\/a><\/li>\n        <li><a href=\"\/dph\/lab\/labs.html\">Laboratory<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/feir.html\">Restaurant Inspections<\/a><\/li>\n        <li><a href=\"\/dph\/screen.html\">Screening and Testing<\/a><\/li>\n        <li><a href=\"\/dph\/chca\/dphwichominf01.html\">WIC<\/a><\/li>\n        <li><a href=\"\/dph\/servicesadd.html\">Additional Services<\/a><\/li><li>\n      <\/li><\/ul>\n    <\/li>\n    <li class=\"toplevel\"><a data-parent=\"#sidebar\" data-toggle=\"collapse\" href=\"#InformationMenu\"><h2>Information <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n        <ul class=\"panel-collapse collapse\" id=\"InformationMenu\">\n        <li><a href=\"\/dph\/factsheetsaz.html\">A-Z Fact Sheets<\/a><\/li>\n        <li><a href=\"\/dph\/pubreportsaz.html\">A-Z Publications &#038; Reports<\/a><\/li>\n        <li><a href=\"\/dph\/diseasesandconditions.html\">Diseases &#038; Conditions<\/a><\/li>\n        <li><a href=\"\/dph\/faq.html\">FAQ&#8217;s<\/a><\/li>\n        <li><a href=\"\/dph\/php\/alerts.html\">Health Alerts<\/a><\/li>\n        <li><a href=\"\/dph\/healthylifestyles.html\">Healthy Lifestyles<\/a><\/li>\n        <li><a href=\"\/dph\/hipaa.html\">HIPAA<\/a><\/li>\n        <li><a href=\"\/dph\/regs.html\">Regulations<\/a><\/li>\n        <li><a href=\"\/dph\/forms.html\">Request Forms<\/a><\/li>\n        <li><a href=\"\/dph\/links.html\">Links &#038; Resources<\/a><\/li>\n        <li><a href=\"http:\/\/delaware.gov\/help\/foia_request.shtml\">FOIA Request Form<\/a><\/li>\n      <\/ul>\n    <\/li>\n    <li><a id=\"SocialMenuHeader\"><h2>Connect <i class=\"fa fa-thumbs-o-up fa-fw\"><\/i><\/h2><\/a>\n      <ul id=\"SocialMenu\">\n        <li class=\"facebook\"><a href=\"https:\/\/www.facebook.com\/DEPublicHealth\" target=\"_blank\" title=\"Division of Public Health Facebook Page\"><i class=\"fa fa-facebook-square fa-lg\"><\/i> Facebook<\/a><\/li>\n        <li class=\"twitter\"><a href=\"https:\/\/twitter.com\/Delaware_DHSS\" target=\"_blank\" title=\"Delaware Health and Social Services Twitter Account\"><i class=\"fa fa-twitter-square fa-lg\"><\/i> Twitter<\/a><\/li>\n        <!-- <li class=\"googleplus\"><a href=\"#\"><i class=\"fa fa-google-plus-square fa-lg\"><\/i> Google +<\/a><\/li>\n        <li class=\"flickr\"><a href=\"#\"><i class=\"fa fa-flickr fa-lg\"><\/i> Flickr<\/a><\/li>\n        <li class=\"youtube\"><a href=\"#\"><i class=\"fa fa-youtube-square fa-lg\"><\/i> Youtube<\/a><\/li>\n        <li class=\"instagram\"><a href=\"#\"><i class=\"fa fa-instagram fa-lg\"><\/i> Instagram<\/a><\/li>\n        <li class=\"linkedin\"><a href=\"#\"><i class=\"fa fa-linkedin-square fa-lg\"><\/i> Linkedin<\/a><\/li>\n        <li class=\"pinterest\"><a href=\"#\"><i class=\"fa fa-pinterest-square fa-lg\"><\/i> Pinterest<\/a><\/li> -->\n      <\/ul>\n    <\/li>\n  <\/ul>\n\n\n              <\/div>\n\n\n            <\/div>\n\n\n          <\/div>\n\n\n        <\/div><br>\n\n\n      <\/div>\n\n\n\n\n\n      <div class=\"col-md-9\" id=\"main_content\"> \n\n\n  \n\n\n<h2 class=\"center\">Health\n\n\n<!--[type=EDIT name=\"DHANType\"]-->\n\n\n\n\n\n\n\n\n\nAlert<!--[END]-->\n\n\n<br>\n\n\n<!--[type=EDIT name=\"DHAN Heading\"]-->\n\n\n\n\n\n\n\n\n\nACUTE FLACCID MYELITIS: CLINICAL REMINDERS AND REPORTING REQUIREMENTS<!--[END]-->\n\n\n<\/h2>\n\n\n\n\n\n<!--[type=HTMLEDIT name=\"Content\"]-->\n\n\n\n\n\n\n\n\n\n<p>The Delaware Division of Public Health (DPH) is issuing this health advisory regarding clinical \n\n\n\n\n\nreminders and reporting requirements related to acute flaccid myelitis.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<h2>Summary<\/h2>\n\n\n\n\n\n<p>An increased number of acute flaccid myelitis (AFM) cases have been reported nationally in 2018. \n\n\n\n\n\nHealth care providers should report any suspect cases of AFM to DPH by calling 302-744-4990 or \n\n\n\n\n\n1-888-295-5156 (24\/7). Cerebrospinal fluid (CSF), blood, stool, and respiratory specimens should be \n\n\n\n\n\ncollected as close to illness onset as possible for laboratory testing. DPH can facilitate testing of \n\n\n\n\n\nclinical specimens.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<h2>Background<\/h2>\n\n\n\n\n\n<p>During the summer, the Centers for Disease Control and Prevention (CDC) began receiving an increasing \n\n\n\n\n\nnumber of suspected acute flaccid myelitis (AFM) cases. Since January 1, 2018, CDC has had 127 patients \n\n\n\n\n\nunder investigation and 62 cases have been confirmed in 22 states. Ninety percent of cases are in patients \n\n\n\n\n\n18 years or younger with the average age about 4 years old. In 2014 and 2016, increases in AFM cases that \n\n\n\n\n\npeaked seasonally from August through October were documented. Given this biennial trend, an increase in \n\n\n\n\n\nAFM cases during 2018 is anticipated.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<p><strong>Clinical Syndrome:<\/strong> AFM generally presents with a prodromal respiratory or gastrointestinal illness for \n\n\n\n\n\none week, and neck or back pain followed by onset of weakness of one or more limbs. Other neurologic symptoms \n\n\n\n\n\ninclude cranial nerve findings such as slurred speech, difficulty swallowing, eyelid or facial droop, poor \n\n\n\n\n\ntone, and diminished reflexes. Weakness can also affect respiratory muscles, leading to respiratory failure. \n\n\n\n\n\nCerebrospinal fluid may show a lymphocytic pleocytosis and elevated protein, and MRI findings include lesions \n\n\n\n\n\nin the central or gray matter of the spinal cord. There is no specific treatment for AFM. Most patients recover \n\n\n\n\n\nwith supportive care and physical and occupational therapy but severe neurologic complications can result in death.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<h2>Reporting<\/h2>\n\n\n\n\n\n<p>Although AFM is not a mandatory reportable condition in Delaware, clinicians are strongly encouraged to notify \n\n\n\n\n\nthe DPH Office of Infectious Disease Epidemiology of any patient you are evaluating for AFM by calling 302-744-4990 \n\n\n\n\n\nor 1-888-295-5156 (24\/7). <strong>Approval from DPH is required for specimen testing.<\/strong> To receive approval, clinicians \n\n\n\n\n\nmust complete the Patient Summary Form (https:\/\/www.cdc.gov\/acute-flaccid-myelitis\/hcp\/data.html) and include \n\n\n\n\n\n(if available) admission and discharge notes, neurology and infectious diseases consults, magnetic resonance imaging \n\n\n\n\n\n(MRI) images and reports, and vaccination history. Laboratory results including initial hospital or commercial \n\n\n\n\n\nlaboratory testing for enteroviruses, arboviruses, and adenoviruses should also be provided. <strong>Information should be \n\n\n\n\n\nsubmitted to DPH regardless of any laboratory or MRI results.<\/strong> AFM neurology experts at CDC will review all case \n\n\n\n\n\ninformation and lab results to determine case classification.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<h2>Recommendations<\/h2>\n\n\n\n\n\n<p>Although enteroviruses, West Nile virus, other flaviviruses, and adenoviruses can cause AFM, surveillance efforts \n\n\n\n\n\naim to explore and identify all possible etiologies for this illness. DPH advises collecting specimens from patients \n\n\n\n\n\nas early as possible after symptom onset, preferably on the day that limb weakness develops. Specimens to collect for \n\n\n\n\n\nsubmission to CDC include: <strong>CSF, Serum, Stool, and nasopharyngeal (NP) or oropharyngeal (OP) swabs. All specimens must \n\n\n\n\n\nbe accompanied by the CDC Form 50.34<\/strong> <a href=\"https:\/\/www.cdc.gov\/laboratory\/specimen-submission\/form.html\">https:\/\/www.cdc.gov\/laboratory\/specimen-submission\/form.html<\/a>. &#8220;Picornavirus Special Study&#8221; must be selected for test order name. Additional instructions regarding specimen collection and shipping to CDC \n\n\n\n\n\nare available at <a href=\"https:\/\/www.cdc.gov\/acute-flaccid-myelitis\/hcp\/instructions.html\">https:\/\/www.cdc.gov\/acute-flaccid-myelitis\/hcp\/instructions.html<\/a>.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<h2>Additional information<\/h2>\n\n\n\n\n\n<ul>\n\n\n\n\n\n<li>CDC Acute Flaccid Myelitis website: <a href=\"https:\/\/www.cdc.gov\/acute-flaccid-myelitis\/index.html\">https:\/\/www.cdc.gov\/acute-flaccid-myelitis\/index.html<\/a><\/li>\n\n\n\n\n\n<li>AFM Surveillance in the US: <a href=\"https:\/\/www.cdc.gov\/acute-flaccid-myelitis\/afm-surveillance.html\">https:\/\/www.cdc.gov\/acute-flaccid-myelitis\/afm-surveillance.html<\/a><\/li>\n\n\n\n\n\n<li>Materials for Clinicians and Health Departments: <a href=\"https:\/\/www.cdc.gov\/acute-flaccid-myelitis\/hcp\/index.html\">https:\/\/www.cdc.gov\/acute-flaccid-myelitis\/hcp\/index.html<\/a><\/li>\n\n\n\n\n\n<li>Job Aid for Clinicians: <a href=\"https:\/\/www.cdc.gov\/acute-flaccid-myelitis\/downloads\/job-aid-for-clinicians-508.pdf\">https:\/\/www.cdc.gov\/acute-flaccid-myelitis\/downloads\/job-aid-for-clinicians-508.pdf<\/a><\/li>\n\n\n\n\n\n<li>References: <a href=\"https:\/\/www.cdc.gov\/acute-flaccid-myelitis\/references.html\">https:\/\/www.cdc.gov\/acute-flaccid-myelitis\/references.html<\/a><\/li>\n\n\n\n\n\n<\/ul>\n\n\n\n\n\n<br>\n\n\n\n\n\n<p>************************************<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<p>You are receiving this email because you are a registered member of the Delaware Health Alert Network.\n\n\n\n\n\nIf you are not a member and would like to subscribe, please register at <a href=\"https:\/\/healthalertde.org\">https:\/\/healthalertde.org<\/a><\/p>\n\n\n\n\n\n\n\n\n\n\n\n<br>\n\n\n\n\n\n<br>\n\n\n\n\n\n<p class=\"smalltext\"><a href=\"http:\/\/www.adobe.com\/products\/acrobat\/readstep2.html\"><img loading=\"lazy\" decoding=\"async\" alt=\"Download Adobe Acrobat Reader\" height=\"21\" src=\"\/wp-content\/uploads\/dhss\/img\/getacro60.gif\" width=\"60\"><\/a> Please note: Some of the files available on this page are in Adobe PDF format which requires Adobe Acrobat Reader.  A free copy of Adobe Acrobat Reader can be downloaded directly from <a href=\"http:\/\/www.adobe.com\/products\/acrobat\/readstep2.html\">Adobe <\/a>. If you are using an assistive technology unable to read Adobe PDF, please either view the corresponding text only version (if available) or visit Adobe&#8217;s <a href=\"http:\/\/access.adobe.com\">Accessibility Tools page<\/a>.<\/p>\n<!--[END]-->\n\n\n  \n\n\n        <div class=\"panel panel-danger\">\n\n\n          <div class=\"panel-heading\">    \n\n\n      <h2>Categories of Health Alert messages:<\/h2>\n\n\n       <\/div>\n\n\n       <div class=\"panel-body\">\n\n\n      <ul>\n\n\n        <li><strong>Health Alert:<\/strong> Conveys the highest level of importance; warrants immediate action or attention.<\/li>\n\n\n        <li><strong>Health Advisory:<\/strong> Provides important information for a specific incident or situation; may not require immediate action.<\/li>\n\n\n        <li><strong>Health Update:<\/strong> Provides updated information regarding an incident or situation; unlikely to require immediate action.<\/li>\n\n\n            <\/ul>\n\n\n         <div><strong>NOTE: This page is for informational purposes only and dated material (e.g. temporary websites) may not be available.<\/strong><\/div>\n\n\n          <\/div> \n\n\n        <\/div><br>  \n\n\n\n\n\n      <\/div>\n\n\n    <\/div>\n\n\n  <\/div><!-- \/container -->\n\n\n  <\/div>","protected":false},"excerpt":{"rendered":"<p>Listen Delaware Health Alert Network #395 October 19, 2018 12:13 pm Public Health Menu Home About About DPH Sections &#038; Programs Office Locations Contact Info Calendar Services A-Z Services Air &#038; Water Quality Birth, Death, &#038; Marriage Records Clinics Health Data &#038; Statistics Emergency Preparedness Health &#038; Wellness Healthy Homes Healthy Workplaces Laboratory Restaurant Inspections [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"parent":9294,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-10372","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10372","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/comments?post=10372"}],"version-history":[{"count":1,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10372\/revisions"}],"predecessor-version":[{"id":11548,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10372\/revisions\/11548"}],"up":[{"embeddable":true,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9294"}],"wp:attachment":[{"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/media?parent=10372"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}