Incidence, Risk Factors and Outcomes Among Children With Acute Flaccid Myelitis: A Population-based Cohort Study in a California Health Network Between 2011 and 2016

Pediatr Infect Dis J. 2019 Jul;38(7):667-672. doi: 10.1097/INF.0000000000002276.


Background: Acute flaccid myelitis (AFM) is defined as an acute onset of limb weakness with longitudinal spinal gray matter lesions. Reporting bias and misdiagnosis confound epidemiologic studies of AFM. We mitigated these confounders by using a large data set to assess AFM incidence, risk factors and outcomes in a fixed population.

Methods: A retrospective cohort study was conducted within Kaiser Permanente Northern California population among children 1-18 years. Cases met radiographic and clinical criteria for AFM and were confirmed by two clinicians. Clinical and demographic data were assessed.

Results: A total of 28 patients met study criteria for AFM between January 1, 2011 and December 31, 2016, an overall rate of 1.46 per 100,000 person-years. Incidence increased from 0.30 to 1.43 cases/per 100,000 person-years between 2011 and 2016, respectively. Median age was 9 years. Risk factors included male sex, Asian ancestry and history of asthma, atopic dermatitis or head injury. Risk factors associated with poliomyelitis were absent. Prodromal illness was common; enterovirus was the most common pathogen detected (n = 5). Among the 27 patients with 12-month follow-up, most demonstrated some improvement, 11 (41.0%) had full recovery, but several had significant deficits with one death reported after the study period.

Conclusions: We employed a closed-population study to generate AFM incidence, risk and outcome data. Our findings support previous reports of male sex and atopy as risk factors. Interval increase in incidence, predisposing Asian ancestry and history of head injury were unique findings to this study. Overall prognosis was better than prior reports, but recovery was incomplete in several patients.

MeSH terms

  • Adolescent
  • California / epidemiology
  • Central Nervous System Viral Diseases / epidemiology*
  • Central Nervous System Viral Diseases / pathology*
  • Child
  • Child, Preschool
  • Enterovirus / classification
  • Enterovirus / isolation & purification*
  • Enterovirus Infections / epidemiology*
  • Enterovirus Infections / pathology*
  • Female
  • Humans
  • Incidence
  • Infant
  • Male
  • Myelitis / epidemiology*
  • Myelitis / pathology*
  • Neuromuscular Diseases / epidemiology*
  • Neuromuscular Diseases / pathology*
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome

Supplementary concepts

  • acute flaccid myelitis