With the eradication of poliomyelitis from most countries, acute flaccid myelitis (AFM) due to non-polio enteroviruses and other viruses is an emerging disease. Besides the vaccine-associated paralytic polio, AFM outbreaks due to other viruses are also a hazard. AFM comprises of patients with acute flaccid paralysis (AFP), characteristically asymmetric limb weakness, with MRI suggestive of a spinal cord lesion in grey matter and spanning one or more vertebral segments [1]. Over the last decade, multiple outbreaks have been reported from countries such as USA, European countries, and Japan [1]. Two outbreaks have already been reported from India [2,3]. However, the pathogen testing was limited and inconclusive in both the cohorts. Even with ongoing AFP surveillance, AFM has not been frequently reported from India. Similar to Australia, we believe that there is misdiagnosis and under-recognition of AFM. During the initial disease course, AFM is frequently misdiagnosed as transverse myelitis due to an often extensive involvement of the spinal cord, not classically limited to the grey matter of the spinal cord [5]. Hence, there is a need for creating awareness regarding this evolving entity.

With many viruses involved such as EVD68, EVA71, etc. and poor yield of pathogen testing, it is often difficult to establish causality for AFM [1-3]. Therefore, it is time that patients with AFP should also be tested for other viruses beyond the poliovirus. This can later help in strengthening the AFP surveillance system. Survey studies for non-polio AFM throughout the country may be an initial step in this aspect, in the absence of active ongoing surveillance. However, the surveys need to be more robust to capture the epidemiological aspects of both AFM and associated respiratory/ gastrointestinal illnesses. The key epidemiological parameters should include the whereabouts of patients (for source identification), age group, details of neuroimaging, and virological studies, contact tracing, etc. for patients in both the groups. Besides, AFM clusters and outbreaks need to be investigated meticulously to avoid an epidemic staring at us.

1. Hardy D, Hopkins S. Update on acute flaccid myelitis: Recognition, reporting, aetiology, and outcomes. Arch Dis Child. 2020;105:842-47.

2. Sarmast SN, Gowda VK, Ahmed M, Gv B, Saini J, Benakappa A. Acute flaccid myelitis – Clustering of polio-like illness in the tertiary care centre in Southern India. J Trop Pediatr. 2019;65:309-31.

3. Madaan P, Saini L. Nerve transfers in acute flaccid myelitis: A beacon of hope. Pediatr Neurol. 2019;93:68.

4. Madaan P, Keshavan S, Saini L. Poor clinico-radiological correlation: A hallmark of acute flaccid myelitis. Brain Dev. 2019;41:480-81.