Search

Background Nearly 14% of US women report any lifetime infertility which is associated with healthcare costs and psychosocial consequences. Tubal factor infertility (TFI) often occurs as a result of sexually transmitted diseases and subsequent pelvic inflammatory disease. We sought to evaluate for and describe potential racial disparities in TFI and in vitro fertilization (IVF) prevalence. Methods Records of women aged 19-42 years in our retrospective cohort from two US infertility clinics were reviewed. We calculated TFI prevalence, IVF initiation prevalence, and prevalence ratios (PR), with 95% confidence intervals for each estimate, overall and by race. Results Among 660 infertile women, 110 (16.7%; 95% confidence interval [CI] 13.8-19.5%) had TFI which was higher in black compared to white women (30.3% [33/109] vs. 13.9% [68/489]; PR 2.2 [95% CI 1.5-3.1]). For women with TFI, IVF was offered to similar proportions of women by race (51.5% [17/33] versus 52.9% [36/68] for black versus white women); however, fewer black than white women with TFI started IVF (6.7% [1/15] versus 31.0% [9/29]; PR 0.2 [95% CI 0-1.0]), although the difference was not statistically different. Conclusions TFI prevalence was two-fold higher among black than white women seeking care for infertility. Among women with TFI, data suggested a lower likelihood of black women starting IVF than white women. Improved sexually transmitted disease prevention and treatment might ameliorate disparities in TFI.

Background Chlamydia trachomatis (Ct) infection ascending to the upper genital tract can cause infertility. Direct association of genetic variants as contributors is challenging because infertility may not be diagnosed until years after infection. Investigating the intermediate trait of ascension bridges this gap. Methods We identified infertility genome-wide association study (GWAS) loci using deoxyribonucleic acid from Ct-seropositive cisgender women in a tubal factor infertility study and Ct-infected cisgender women from a longitudinal pelvic inflammatory disease cohort with known fertility status. Deoxyribonucleic acid and blood messenger ribonucleic acid from 2 additional female cohorts with active Ct infection and known endometrial infection status were used to investigate the impact of infertility single-nucleotide polymorphisms (SNPs) on Ct ascension. A statistical mediation test examined whether multiple infertility SNPs jointly influenced ascension risk by modulating expression of mediator genes. Results We identified 112 candidate infertility GWAS loci, and 31 associated with Ct ascension. The SNPs altered chlamydial ascension by modulating expression of 40 mediator genes. Mediator genes identified are involved in innate immune responses including type I interferon production, T-cell function, fibrosis, female reproductive tract health, and protein synthesis and degradation. Conclusions We identified Ct-related infertility loci and their potential functional effects on Ct ascension.

BackgroundChlamydial infection is associated with tubal factor infertility (TFI); however, assessment of prior chlamydial infection and TFI is imperfect. We previously evaluated a combination of serological assays for association with TFI. We now describe the chlamydial contribution to TFI using a newer Chlamydia trachomatis Pgp3 enhanced serological (Pgp3) assay.MethodsIn our case-control study of women 19–42 years old with hysterosalpingogram-diagnosed TFI (cases) and non-TFI (controls) in two U.S. infertility clinics, we assessed possible associations and effect modifiers between Pgp3 seropositivity and TFI using adjusted odds ratios (aOR) with 95% confidence intervals (CI) stratified by race. We then estimated the adjusted chlamydia population attributable fraction (aPAF) with 95% CI of TFI.ResultsAll black (n=107) and 618 of 620 non-black women had Pgp3 results. Pgp3 seropositivity was 25.9% (19.3–33.8%) for non-black cases, 15.2% (12.3–18.7%) for non-black controls, 66.0% (95% CI 51.7–77.8%) for black cases, and 71.7% (59.2–81.5%) for black controls. Among 476 non-black women without endometriosis (n=476), Pgp3 was associated with TFI (aOR 2.6 [1.5– 4.4]), adjusting for clinic, age, and income; chlamydia TFI aPAF was 19.8% (95% CI 7.7–32.2%) in these women. Pgp3 positivity was not associated with TFI among non-black women with endometriosis nor among black women (regardless of endometriosis).ConclusionsAmong non-black infertile women without endometriosis in these clinics, 20% of TFI was attributed to chlamydia. Better biomarkers are needed to estimate chlamydia TFI PAF, especially in black women.

Background Acute flaccid myelitis (AFM) is a serious neurologic syndrome that affects mostly children and is characterized by the acute onset of limb weakness or paralysis. Since U.S. surveillance for AFM began in 2014, reported cases have peaked biennially. This report describes the clinical characteristics of AFM patients during 2018, the most recent peak year. Methods Medical records from persons meeting AFM clinical criterion (acute onset of flaccid limb weakness) were submitted to CDC. Patients with confirmed AFM met the clinical criterion and had magnetic resonance imaging indicating spinal cord lesions largely restricted to gray matter and spanning one or more vertebral segments. Symptoms, physical findings, test and imaging results, and hospitalization data were abstracted and described. Results Among 238 patients with confirmed AFM during 2018, median age was 5.3 years. Among the 238 patients, 205 (86%) had onset during August-November. Most (92%) had prodromal fever, respiratory illness, or both beginning a median of 6 days before weakness onset. In addition to weakness, common symptoms at clinical evaluation were gait difficulty (52%), neck or back pain (47%), fever (35%), and limb pain (34%). Among 211 who were outpatients when weakness began, most (76%) sought medical care within 1 day, and 64% first sought treatment at an emergency department. Overall, 98% of patients were hospitalized, 54% were admitted to an intensive care unit, and 23% required endotracheal intubation and mechanical ventilation. Conclusion Clinicians should suspect AFM in children with acute flaccid limb weakness, especially during August-November and when accompanied by neck or back pain and a recent history of febrile respiratory illness. Increasing awareness in frontline settings such as emergency departments should aid rapid recognition and hospitalization for AFM.

Background Chlamydia trachomatis causes pelvic inflammatory disease (PID) and tubal infertility. Plasmid gene protein 3 antibody (Pgp3Ab) detects prior chlamydial infections. We evaluated for an association of high chlamydial seropositivity with sequelae using a Pgp3Ab multiplex bead array (Pgp3AbMBA). Methods We performed chlamydia Pgp3AbMBA on sera from women 18-39 years old participating in the 2013–2016 National Health and Nutrition Examination Survey (NHANES) with urine chlamydia nucleic acid amplification test results. High chlamydial seropositivity was defined as a median fluorescence intensity (MFI ≥ 50 000; low-positive was MFI > 551– Results Of 2339 women aged 18–39 years, 1725 (73.7%) had sera, and 1425 were sexually experienced. Overall, 104 women had high positive Pgp3Ab (5.4% [95% CI 4.0–7.0] of US women); 407 had lowpositive Pgp3Ab (25.1% [95% CI 21.5–29.0]), and 914 had negative Pgp3Ab (69.5% [95% CI 65.5–73.4]). Among women with high Pgp3Ab, infertility prevalence was 2.0 (95% CI 1.1–3.7) times higher than among Pgp3Ab-negative women (19.6% [95% CI 10.5–31.7] versus 9.9% [95% CI 7.7–12.4]). For women with low Pgp3Ab, PID prevalence was 7.9% (95% CI 4.6–12.6) compared to 2.3% (95% CI 1.4–3.6) in negative Pgp3Ab. Conclusions High chlamydial Pgp3Ab seropositivity was associated with infertility although small sample size limited evaluation of an association of high seropositivity with PID. In infertile women, Pgp3Ab may be a marker of prior chlamydial infection.

Pelvic inflammatory disease (PID) is a clinical syndrome that has been associated with a wide range of potential causal pathogens. Three broad groups of organisms have been isolated from the genital tract of people with PID: sexually transmitted organisms such as Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis; bacterial vaginosis (BV)-associated species and genera such as Atopobium vaginae, Sneathia, and Megasphaera; and genera and species usually associated with the gastrointestinal or respiratory tracts such as Bacteroides, Escherichia coli, Streptococcus, or Haemophilus influenza. Although PID is often considered to be synonymous with gonorrhea or chlamydia, these pathogens are found in only one quarter to one third of people with PID, suggesting that broader screening and diagnostic and treatment strategies need to be considered to reduce the burden of PID and its associated sequelae.

Chlamydia trachomatis (CT) causes pelvic inflammatory disease, which may result in tubal factor infertility (TFI) in women. Serologic assays may be used to determine the proportion of women with and without TFI who have had previous CT infection and to generate estimates of infertility attributable to chlamydia. Unfortunately, most existing CT serologic assays are challenged by low sensitivity and sometimes specificity for prior CT infection, however they are currently the only available tests available to detect prior CT infection. Modeling methods such as finite mixture modeling may be a useful adjunct to quantitative serologic data to obtain better estimates of CT-related infertility. In this paper, we review CT serological assays, including the use of antigens preferentially expressed during upper genital tract infection, and suggest future research directions. These methodologic improvements coupled with creation of new biomarkers for previous CT infection should improve our understanding of chlamydia’s contribution to female infertility.Chlamydia trachomatis (CT) is the most common sexually transmitted bacteria in the world[1]. In CT-infected women who go untreated, approximately 17% develop pelvic inflammatory disease (PID), inflammation of upper genital tract structures, and this may result in chronic sequelae, including ectopic pregnancy and tubal factor infertility (TFI)[2]. In the United Kingdom, it has been estimated that CT causes approximately 35% of PID cases in women under 25 years of age and 20% in aged 16-44 years[2, 3]. Other PID-associated pathogens include Neisseria gonorrhoeae, Mycoplasma genitalium, and bacterial vaginosis-associated bacteria [4]. The majority of symptomatic PID cases have no pathogen identified[2, 4, 5]. Further, many PID cases remain undiagnosed due to atypical or absent symptoms [2-4]. There is good evidence from a longitudinal cohort study of 1884 women with PID that the persistence of fallopian tube pathology (adhesions/scarring) can cause infertility in women – tubal factor infertility (TFI)[5]. Only women with PID who have macroscopic fallopian tube inflammation (salpingitis) are at risk of TFI, which is present in some but not all diagnosed PID[2, 5]. A dose response relationship has been observed with more severe macroscopic salpingitis and more PID episodes leading to a greater risk for adverse reproductive outcomes, especially for CT infection[2, 5, 6]. There is also evidence that upper genital tract CT infection may also impair fertility in the absence of tubal pathology, this is reviewed elsewhere in this supplement by Horner et al

Successful baking requires careful measurement, the precise mixing of ingredients and an attentive eye while the mixture is in the oven. However, the environment may have an impact on the final product. Humidity, quality of ingredients, type of oven used and altitude can all mean the difference between a perfect cake and a goopy mess. Although chlamydia control may seem quite different from baking, there are some important parallels, notably the context in which control programmes are developed, implemented and evaluated. The same inputs and approaches applied in different contexts may produce drastically different results. van Bergen et al 1 describe the methods of and conclusions from addressing the question ‘Where to go to in Chlamydia control?’ for the Netherlands in this issue of Sexually Transmitted Infections . The author and colleagues1 convened a panel that met in November 2019 and discussed expert perspectives on chlamydia control. This panel considered the interpretation of available evidence on the impact and/or effectiveness of a variety of testing scenarios: asymptomatic screening including opportunistic testing of asymptomatic patients in routine healthcare settings, syndromic testing, and at-home specimen collection and/or testing. Their paper reports on a problem analysis and the consensus viewpoint that evolved from this expert meeting, which suggested that future strategies should reduce rather than expand the role of widespread testing for asymptomatic chlamydial infections, and therefore the authors conclude that they ‘do not recommend age-based screening and widespread testing for chlamydia in asymptomatic persons in the Netherlands’.1 In this thought-provoking paper, van Bergen et al 1 focus on the assessment of three points: evidence for prevalence reductions, the rate of severe long-term complications caused by chlamydia and the potential harms of overdiagnoses and overtreatment. They find that all three points argue for the need to reassess and question current practices. …

Background Chlamydia trachomatis infection causes reproductive sequelae of pelvic inflammatory disease (PID) and tubal infertility. Previous studies have demonstrated a relationship between levels of chlamydia antibody and these sequelae. We investigated associations of high chlamydial seropositivity with PID and infertility using a Pgp3 antibody (Pgp3Ab) multiplex bead array (Pgp3AbMBA). Methods We performed chlamydia Pgp3AbMBA on sera from women 18–39 years old participating in the 2013–2016 National Health and Nutrition Examination Survey with urine chlamydia nucleic acid amplification test results. High chlamydial seropositivity was defined as a median fluorescence intensity (MFI) ≥ 50,000; low-positive was MFI > 551– Results Sera were available from 1,725 (73.7%) of 2,339 women aged 18–39 years; 1,425 were sexually experienced. Overall, 104 women had high-positive Pgp3Ab (5.4% [95% CI 4.0–7.0] of US women); 407 had low-positive Pgp3Ab (25.1% [95% CI 21.5–29.0]), and 914 were negative (69.5% [95% CI 65.5–73.4]). The prevalence of current chlamydia among women with high seropositivity (10.7% [95% CI 5.4–18.6]) was higher than the prevalence of current chlamydia among seronegative women (0.4% [95% CI 0.1–1.3]). Among women with high-positive Pgp3Ab, infertility prevalence was 2.0 (95% CI 1.1–3.7) times that among Pgp3Ab-negative women (19.6% [95% CI 10.5–31.7] versus 9.9% [95% CI 7.7–12.4]). For women with low-positive Pgp3Ab, PID prevalence was 7.9% (95% CI 4.6–12.6) compared to 2.3% (95% CI 1.4–3.6) in those with negative Pgp3Ab. Conclusions High chlamydial Pgp3Ab seropositivity was associated with infertility. Small sample size limited evaluation of an association of high seropositivity with PID. In infertile women, Pgp3Ab may be a marker of prior chlamydia.

BACKGROUND: Tuberculosis preventive treatment (TPT) reduces the development of tuberculosis (TB) disease and mortality in people living with human immunodeficiency virus (HIV) infection. Despite this known effectiveness, global uptake of TPT has been slow. We aimed to assess current status of TPT implementation in countries supported by the US President's Emergency Plan for AIDS Relief (PEPFAR).METHODS: We surveyed TB-HIV program staff at US Centers for Disease Control and Prevention (CDC) country offices in 42 PEPFAR-supported countries about current TPT policies, practices, and barriers to implementation. Surveys completed from July to December 2017 were analyzed.RESULTS: Of 42 eligible PEPFAR-supported countries, staff from 35 (83%) CDC country offices completed the survey. TPT was included in national guidelines in 33 (94%) countries, but only 21 (60%) reported nationwide programmatic TPT implementation. HIV programs led TPT implementation in 20/32 (63%) countries, but TB programs led drug procurement in 18/32 (56%) countries. Stock outs were frequent, as 21/28 (75%) countries reported at least one isoniazid stock out in the previous year.CONCLUSION: Despite widespread inclusion of TPT in guidelines, programmatic TPT implementation lags. Successful scale-up of TPT requires uninterrupted drug supply chains facilitated by improved leadership and coordination between HIV and TB programs.

Tuberculosis (TB) is the leading cause of death for persons living with HIV (PLHIV). TB preventive therapy (TPT) works synergistically with, and independently of, antiretroviral therapy (ART) to reduce TB morbidity, mortality and incidence among PLHIV. However, although TPT is a crucial and cost-effective component of HIV care for adults and children, and has been strongly recommended as an international standard of care for over a decade, it has remained highly underutilized. If we are to end the global TB epidemic, we must address the significant reservoir of TB infection, especially in those, such as PLHIV, with highest risk of progression to TB disease. In order to do so, we must confront the pervasive perception that barriers to TPT scale-up are insurmountable in resource-limited settings. In this article, we review available evidence to address several commonly stated obstacles to TPT scale-up. These include the need for tuberculin skin testing, limited diagnostic capacity to reliably exclude TB disease, concerns about creating drug resistance, suboptimal patient adherence to therapy, inability to prevent and monitor for adverse events, a “one size fits all” option for TPT regimen and duration, and uncertainty about TPT use in children, adolescents, and pregnant women. We also discuss TPT delivery in the era of differentiated care for PLHIV, how to best tackle advanced planning for drug procurement and supply chain management, and how to create an enabling environment for TPT scale-up success.

Two plasmid gene protein (Pgp3)-based serological assays, the Pgp3-ELISA and multiplex bead assay (Pgp3-MBA), were compared and used to estimate seropositivity of Chlamydia trachomatis (CT) among females 14 to 39 years old participating in the National Health and Nutrition Examination Survey between 2013–2016. Of the 2,201 specimens tested, 502 (29.5%, 95% CI 27.6–31.5) were positive using Pgp3-ELISA and 624 (28.4%, 95% CI 26.5–30.3) were positive using Pgp3-MBA. The overall agreement between the assays was 87.7%. Corresponding nucleic acid amplification test (NAAT) results were available for 1,725 specimens (from women 18–39 years old); of these, 42 (2.4%, 95% CI 1.8–3.3) were CT NAAT-positive. Most of the CT NAAT-positive specimens had corresponding positive serological assay results; 33 (78.6%, 95% CI 62.8–89.2) were Pgp3-ELISA-positive and 36 (85.7%, 95% CI 70.8–94.1) were Pgp3-MBA-positive. Although Pgp3-ELISA and Pgp3-MBA demonstrated equivalent performance in this study, an advantage of the Pgp3-MBA over Pgp3-ELISA is that it is well suited for high sample throughput applications.

Background Our recent case-control study explored the Chlamydia trachomatis population attributable fraction (PAF) for tubal factor infertility (TFI) using an elementary body enzyme-linked immunosorbent serological assay (EB-ELISA) or a commercially available (Medac) major outer membrane protein ELISA to measure prior chlamydial infection. We examined data from this study using a Pgp3 enhanced ELISA (Pgp3). Methods In this study of women with TFI by hysterosalpingogram (cases) and non-TFI infertility (controls) in two U.S. infertility clinics, we assessed anti-C. trachomatis seropositivity by Pgp3. We then assessed the association between chlamydia seropositivity and TFI using adjusted odds ratios (aOR) along with 95% confidence intervals (CI) stratified by race. Finally, the adjusted chlamydia TFI PAF (aPAF) and 95% CI based on the Pgp3 assay were estimated. Results All black (n=107) and 618 of 620 non-black women had Pgp3 results. Seropositivity frequency by Pgp3 was 66% (95% CI 52–80%) for black cases, 72% (60–83%) for black controls, 26% (19–33%) for non-black cases, and 15% (12–18%) for non-black controls. Pgp3 was not associated with TFI among black women (aOR 1.1 [95% CI 0.4–3.3]). Among non-black women, Pgp3 seropositivity was associated with TFI (aOR 1.8 [95% CI 1.1–3.0]) adjusting for clinic, age, income, trichomonas, and endometriosis. Using Pgp3 and adjusting for the same variables, chlamydia TFI aPAF was 12% (95% CI 1–22%) in non-black women. Conclusion Among non-black women, Pgp3 ELISA seropositivity was associated with TFI. Assays to estimate chlamydia TFI PAF merit further investigation, especially in black women. Chlamydial TFI may be prevented in all women by early identification and treatment of chlamydia. Disclosure No significant relationships.

Sexually transmitted diseases, including chlamydia and gonorrhea, cause of pelvic inflammatory disease (PID) and infertility. We estimated the prevalence of infertility and infertility health care seeking.We analyzed self-reported lifetime infertility and infertility health care-seeking in women aged 18 to 49 years in the 2013 and 2015 National Health and Nutrition Examination Surveys. Weighted prevalence of infertility and infertility health care seeking, prevalence ratios (PRs), and 95% confidence intervals (CIs) were calculated.Among 2626 eligible women, 13.8% had self-reported infertility (95% CI, 12.3-15.3) with higher prevalence by age: 960, 18 to 29 years (PR, 6.4%; 95% CI, 4.8-8.0); 799, 30 to 39 years (PR, 14.8%; 95% CI, 12.2-17.3); and 867, 40 to 49 years (PR, 20.8%; 95% CI, 17.2-24.4). Non-Hispanic white women (PR, 15.4%; 95% CI, 13.0-17.8; n = 904) and non-Hispanic black women (PR, 12.9%; 95% CI, 10.3-15.5; n = 575) had the highest infertility prevalences. Women reporting PID treatment (n = 122) had higher infertility prevalence (PR, 24.2%; 95% CI, 16.2-32.2) than women without PID treatment (PR, 13.3%; 95% CI, 11.6-15.0; n = 2,485), especially among 18- to 29-year-old women (PR, 3.8; 95% CI, 1.8-8.0). Of 327 women with infertility, 60.9% (95% CI, 56.1-65.8) sought health care. Women without health care insurance sought care less frequently than women with insurance.In a nationally representative sample, 13.8% of reproductive-age women reported a history of infertility, of whom 40% did not access health care. Self-reported PID was associated with infertility, especially in young women. Annual chlamydia and gonorrhea screening to avert PID may reduce the burden of infertility in the United States.

Background: In 2012, Rwanda introduced a Treat All approach for HIV-infected children younger than 5 years. We compared antiretroviral therapy (ART) initiation, outcomes, and retention, before and after this change. Methods: We conducted a retrospective study of children enrolled into care between June 2009 and December 2011 [Before Treat All (BTA) cohort] and between July 2012 and April 2015 [Treat All (TA) cohort]. Setting: Medical records of a nationally representative sample were abstracted for all eligible aged 18–60 months from 100 Rwandan public health facilities. Results: We abstracted 374 medical records: 227 in the BTA and 147 in the TA cohorts. Mean (SD) age at enrollment was [3 years (1.1)]. Among BTA, 59% initiated ART within 1 year, vs. 89% in the TA cohort. Median time to ART initiation was 68 days (interquartile range 14–494) for BTA and 9 days (interquartile range 0–28) for TA (P < 0.0001), with 9 (5%) undergoing same-day initiation in BTA compared with 50 (37%) in TA (P < 0.0001). Before ART initiation, 59% in the BTA reported at least one health condition compared with 35% in the TA cohort (P < 0.0001). Although overall loss to follow-up was similar between cohorts (BTA: 13%, TA: 8%, P = 0.18), loss to follow-up before ART was significantly higher in the BTA (8%) compared with the TA cohort (2%) (P = 0.02). Conclusions: Nearly 90% of Rwandan children started on ART within 1 year of enrollment, most within 1 month, with greater than 90% retention after implementation of TA. TA was also associated with fewer morbidities.

Background Chlamydia trachomatis (CT) causes pelvic inflammatory disease (PID) and other sequelae; however, these associations are not fully characterized. CT serologic assays including Pgp3 ELISA may detect prior CT infection and may better elucidate these associations. We used a serologic Pgp3 multiplex bead array assay (Pgp3MBA) to measure CT seroprevalence in reproductive-age US women and assess the association with PID. Methods We performed CT Pgp3MBA on sera collected from women 18–39 years old during the 2013–2016 cycles of the National Health and Nutrition Examination Survey (NHANES) who had available urine CT nucleic acid amplification test results. Weighted Pgp3MBA CT seroprevalence and 95% confidence intervals (95% CI) were calculated. We also determined weighted prevalence ratios (PRs) and 95% CIs of self-reported lifetime PID among women with and without detectable Pgp3MBA and other characteristics to estimate these US national statistics. Results Among 2,339 women, 1,725 (73.7%) had available sera. Of these women, 1,425 (or 93.4% of those with data) were sexually experienced and had a CT seroprevalence of 35.9% (95% CI 33.4–38.4). When weighted for US women, CT seroprevalence was 30.5% (95% CI 26.6–34.4%), ranging from 16.9% (95% CI 11.0–22.8%) among non-Hispanic Asian women to 70.2% (95% CI 62.4–78.0%) among non-Hispanic black women. PID was reported by 4.2% (95% CI 3.1–5.2) of 1,413 sexually-experienced women with PID data or an estimated 3.8% (95% CI 2.6–5.0) of US women. Among US women, estimated PID varied by Pgp3MBA status; 7.3% (95% CI 4.3–10.2) of Pgp3MBA-positive women were estimated to report PID versus 2.3% (95% CI 1.3–3.4) of Pgp3MBA-negative women (PR 3.1; 95% CI 1.7–5.9). PID prevalence did not vary by age, nor self-reported recent sexually transmitted disease among US women, but was higher among non-Hispanic black women compared to non-Hispanic white women (PR 2.2; 95% CI 1.4–3.5). Conclusion Nearly one-third of US women have had CT by Pgp3MBA, with differences by race/ethnicity. Women with prior CT had three times the reported PID prevalence of women without CT. Further serologic research may refine the population-level impact of CT prevention activities, such as recommended annual CT screening, on PID incidence, particularly among non-Hispanic black women. Disclosures All Authors: No reported disclosures

Background Acute flaccid myelitis (AFM) is an uncommon but serious condition that causes paralysis in previously healthy children. Multiple viruses can be associated with AFM. In 2018, enteroviruses D68 (EV-D68) and A71 (EV-A71) were the most common viruses detected among patients with confirmed AFM. We described and compared clinical characteristics of cases associated with EV-D68 and EV-A71. Methods Health departments report cases meeting AFM clinical criterion (acute onset of flaccid limb weakness) to the Centers for Disease Control and Prevention along with medical records. Confirmed AFM cases were patients who met clinical criterion and had magnetic resonance imaging (MRI) showing spinal cord lesions largely restricted to gray matter. We abstracted clinical data and laboratory results from records of confirmed case-patients with onset of limb weakness during 2018. EV-D68 and EV-A71 cases were compared using chi-square and Wilcoxan rank sum tests. Results Among 238 confirmed AFM cases, 34 had EV-D68 and 12 had EV-A71 detected in a respiratory, serum, stool, or cerebrospinal fluid specimen. Median age of EV-D68 and EV-A71 cases were 5.9 and 1.6 years, respectively (p< 0.01). EV-D68 cases came from 20 states, while 11/12 EV-A71 cases were from Colorado. Prodromal respiratory illness was more common among EV-D68 (97%) than EV-A71 cases (58%) (p< 0.01). Prodromal rash was more common among EV-A71 (58%) than EV-D68 cases (9%) (p< 0.01). At presentation, the most common symptoms accompanying limb weakness among EV-D68 cases were neck/back pain (59%), gait difficulty (56%), and fever (47%). Among EV-A71 cases, the most common symptoms were fever (67%), ataxia (67%), gait difficulty (50%), and altered consciousness (50%). EV-A71 cases were more likely to have ataxia, altered consciousness, and brainstem (92% vs. 45%) or cerebellar (75% vs. 9%) lesions on MRI (all p< 0.01). EV-D68 cases were more likely to require mechanical ventilation (44% vs. 8%, p 0.03). Conclusion These national data suggest that EV-D68 and EV-A71 are associated with overlapping but different clinical phenotypes. Differences in demographics, prodromal illness, symptoms, and brain MRI findings were identified. Additional research is needed to determine whether pathogenesis and optimal treatment also vary by virus type. Disclosures All Authors: No reported disclosures