August 7, 2020 Dr. Robert Redfield Director Centers for Disease Control and Prevention 1600 Clifton Road Atlanta, GA, 30329 Dear Director Redfield, I write to express my concern about a potential outbreak of acute flaccid myelitis (AFM) infections this year and to request more information about the steps the Centers for Disease Control and Prevention (CDC) is taking to prepare for such an outbreak. As you know, AFM is a severe disease that causes patients’ muscles to weaken. Symptoms can include sudden muscle weakness in the arms or legs, neck weakness or stiffness, drooping eyelids or a facial droop, difficulty swallowing, and slurred speech. Because AFM affects mostly children and has no known cure, it is critical that the CDC continue to prepare for future outbreaks of this disease. The CDC recently acknowledged that the third and largest peak of AFM occurred in 2018, with 238 cases in 42 states. In light of the recent pattern of AFM infections—which tend to spike in alternating years—the CDC has warned that cases could spike again later this year, with the highest number of cases anticipated between August and November. 1 This timing is especially concerning because it would indicate that the next AFM outbreak may coincide with the both the upcoming flu season and the continued spread of the coronavirus throughout the United States. I appreciate that the CDC has taken some steps to warn families and health care providers about a potential outbreak of AFM infections this year. Given the severity of this disease, I respectfully request your response to the following questions to better understand the CDC’s efforts to prepare for and respond to a potential AFM outbreak: 1. During a recent briefing, you indicated that some preclinical work has begun on the development of a prototype vaccine candidate for enterovirus-D68, the virus most likely 1 Centers for Disease Control and Prevention. CDC Expects 2020 Outbreak of Life-Threatening Acute Flaccid Myelitis. (August 4, 2020). Retrieved from: https://www.cdc.gov/media/releases/2020/p0803-acute-flaccid-myelitisoutbreak.html responsible for the recent increases in AFM cases. 2 What information can you share regarding the development status of that vaccine candidate? 2. During the 2018 outbreak of AFM infections, some states – such as Minnesota – reported a disproportionate number of AFM cases. Does the CDC have any estimate as to why certain areas may be more susceptible to AFM outbreaks than others? If there is an AFM outbreak in 2020, does the CDC predict that certain areas are more likely to experience an outbreak than others? 3. Does the CDC believe that the upcoming 2020 flu season, as well as the coronavirus pandemic, could have any impact on a potential AFM outbreak or affect the severity of AFM cases? 4. Are there any additional authorities or funding that the CDC needs from Congress to prepare for and respond to a potential AFM outbreak? Thank you for your time and attention to this important matter. I look forward to working with you to protect Americans from this deadly disease. Sincerely, Amy Klobuchar United States Senator 2 Centers for Disease Control and Prevention. CDC Expects 2020 Outbreak of Life-Threatening Acute Flaccid Myelitis: Transcript. (August 4, 2020). Retrieved from https://www.cdc.gov/media/releases/2020/t0804-acuteflaccid-myelitis-outbreak.html