Job Aid for Clinicians
How to send information about a suspected AFM case to the VIDOH
Ensure that patient meets confirmed or probable case definition for acute flaccid myelitis (AFM).
Confirmed: 
Patient with acute onset of focal limb weakness 
and an MRI showing a spinal cord lesion largely 
restricted to gray matter and spanning one or 
more spinal segments.
OR
Probable:
Patient with acute onset of focal limb weakness 
and cerebrospinal fluid (CSF) with pleocytosis 
[white blood cell (WBC) count >5 cells/mm3]
CSF
WBC>5mm3
AND
SPECIMEN COLLECTION
Collect specimens as close to onset of limb 
weakness as possible and store as directed  
(see table on reverse side)
CSF
Serum
Whole
blood
Stool
NP swab
Work with VIDOH-EPID to coordinate 
specimen pick-up for testing at CDC.
‚ Specimens should be shipped overnight 
to arrive at CDC Tuesday through Friday.
 ‚ Specimens should be shipped within 
24–48 hours of collection, if possible. 
INFORMATION SHARING
Assist VIDOH staff in completing AFM Patient 
Summary Form available at: https://
www.cdc.gov/acute-flaccid-myelitis/hcp/
data.html
VIDOH sends copies of 
Patient Summary Form, 
specimens and other clinical 
information (e.g., MRI scans) 
to CDC.
TO
Contact VIDOH-EPID when you identify a suspect case of AFM.
EMERGENCY NOTIFICATION
Call Dr. Esther Ellis at (340) 626-1654 or 
Dr. Tai Hunte at (240) 472-4466
Direct general questions/requests to 
Dr. Irene Guendel at irene.guendel@doh.vi.gov 
or (340) 774-7477 x5646
Revised October 2018
Job Aid for Clinicians  |  Guidance for specimen collection and storage
Specimens to collect and send to CDC for testing for suspect AFM cases
SAMPLE
AMOUNT
TUBE TYPE
PROCESSING
STORAGE
SHIPPING**
CSF
1mL  
(collect at same time 
or within 24hrs of 
whole blood)
Cryovial
Spun and CSF 
removed to 
cryovial
Freeze at -20⁰C
Ship on dry ice
CSF
2 mL  
(collect at same time 
or within 24hrs of 
whole blood)
Cryovial
Unspun
Refrigerate at 4⁰C Ship overnight on 
cold packs within 
24–48 hours of 
collection*
Serum
≥0.4mL
Tiger/red top
Spun and serum 
removed to 
tiger/red top
Freeze at -20⁰C
Ship on dry ice
Whole blood
3 to 5mL  
(collect at same  
time or within  
24hrs of CSF)
EDTA/
heparin tube 
(lavender or 
green top)
Unspun
Refrigerate at 4⁰C Ship overnight on 
cold packs within 
24–48 hours of 
collection*
Stool
≥1 gram  
(2 samples collected 
24hrs apart)
Sterile  
container
n/a
Freeze at -20⁰C
Ship on dry ice
Rectal swab
≥1 gram  
(2 samples collected 
24hrs apart)
n/a
Store in viral 
transport 
medium 
Freeze at -20°C
Ship on dry ice
Respiratory NP or 
nasal (mid-turbinate 
[MT]+OP) swab
1ml 
(minimum amount)
n/a
Store in viral 
transport 
medium
Freeze at -20°C
Ship on dry ice; 
send ONLY if EV/RV 
positive for typing
Dr. Will Weldon
Centers for Disease Control and Prevention
1600 Clifton Road, NE
Building 17, Room 6124
Atlanta, GA 30329
Office: 404-639-5485
Mobile: 404-216-6183
Email: wweldon@cdc.gov
www.cdc.gov/acute-flaccid-myelitis
National Center for Immunization and Respiratory Diseases (NCIRD)
Division of Viral Diseases
U.S. Department of 
Health and Human Services 
Centers for Disease 
Control and Prevention 
NCIRDig-608 | 03/03/17
*If specimens cannot be shipped within 24-48 hours of collection, consider repeat collection, if feasible.
**Shipping instructions for VIDOH-EPID staff only.
Include a DASH form with each specimen
(https://www.cdc.gov/laboratory/specimen-submission/form.html) 
‚ Select Test Order Name = ‘Picornavirus Special Study’
VIDOH-EPID ship specimens to: