Using the Acute Flaccid Paralysis Surveillance System to Identify Cases of Acute Flaccid Myelitis, Australia, 2000-2018

Since 2012, the United States has reported a distinct syndrome of acute fl accid paralysis (AFP) with anterior myelitis, predominantly in children. This polio-like syndrome was termed acute fl accid myelitis (AFM). Australia routinely conducts AFP surveillance to exclude poliomyelitis. We reviewed 915 AFP cases in Australia for children <15 years of age during 2000-2018 and reclassifi ed a subset to AFM by using the US Council of State and Territorial Epidemiologists case defi nition. We confi rmed 37 AFM cases by using magnetic resonance imaging fi ndings and 4 probable AFM cases on the basis of cerebrospinal fl uid pleocytosis. Nonpolio enteroviruses were detected in 33% of AFM cases from which stool samples were tested. Average annual AFM incidence was 0.07 cases/100,000 person-years in children <15 years of age. AFM occurred sporadically in Australia before 2010 but regularly since then, indicating sustained, albeit rare, clinical manifestation in children. The AFP surveillance system in Australia is well-positioned to identify future AFM cases.