What Parents Should Know About the Latest Enterovirus Spike

By Catherine Pearson 

The Centers for Disease Control and Prevention has issued an advisory to health care providers about a recent increase in severe respiratory illnesses requiring hospitalization in children, urging them to consider the type of enterovirus as a possible cause.

In July and August, hospitals and doctors in several parts of the United States reported an increase in infections caused by enterovirus D68, or EV-D68, which often causes mild cold-like symptoms but can also lead to more serious respiratory illnesses. The number of detected cases is now the highest since a wave of seasonal infections in 2018. A representative for the C.D.C. confirmed that 84 cases of EV-D68 were recorded from March to August 4.

The recent warning was aimed at doctors and hospitals because — in addition to causing respiratory symptoms — EV-D68 has been linked to acute flaccid myelitis, or A.F.M., a rare but serious neurological complication that can lead to permanent paralysis or death. More than 90 percent of A.F.M. the cases in the United States were in young children.

CDC did not receive an increased number of reports on A.F.M. cases so far this year, but because spikes in EV-D68 infections tend to precede A.F.M. cases, the agency hopes to put pediatricians and other front-line health care providers across the country on alert. It is important that diagnostic tests are performed as soon as possible after the child develops symptoms.

“Increased vigilance towards A.F.M. will be critical in the coming weeks," the C.D.C. warned.

What are non-polio enteroviruses?

Non-polio enteroviruses such as EV-D68 are very common and cause up to 15 million infections annually in the United States. There are more than 100 known types and they tend to spread in late summer and early fall, although infection occurs year-round.

"They cycle every year," said Dr. Alejandro Jordan Villegas, a pediatric infectious disease physician at Orlando Health Arnold Palmer Hospital for Children. "Some years we see more cases than other years, but that's nothing new."

Most infected people are asymptomatic or have mild cold-like symptoms such as fever, runny nose, cough, sneezing, or body aches. Two of the better-known enteroviruses — enterovirus A71 and Coxsackie virus A6 — can cause hand, foot, and mouth disease, a mild, contagious infection that is very common in children under 5 years of age.

CDC The Alert also notes that some patients recently hospitalized with respiratory illness have tested positive for rhinovirus, which most commonly causes the common cold.

What should parents know about EV-D68 and the risk of paralysis?

EV-D68 was first identified in 1962, although the C.D.C. it has only been closely monitored since 2014, when it caused a nationwide outbreak of respiratory diseases. That year, the agency confirmed 1,395 cases in 49 states and the District of Columbia, although it believes there were likely many thousands more unconfirmed mild cases.

“For most people, this is an acute viral illness that comes and goes without incident; in a select few it can cause neurological symptoms like this acute flaccid myelitis," said Dr. Amy Arrington, medical director of the special isolation unit and section chief of global biopreparedness at Texas Children's Hospital. “But it's very rare.

There were 693 confirmed cases of A.F.M. because the C.D.C. began tracking the virus in 2014, including 120 this year. About 10 percent of EV-D68 cases in 2014 were caused by A.F.M., although this may be an overestimate given that many enterovirus infections are believed to go unreported. Since then there have been further leaps in the A.F.M. cases in 2016 and 2018 — increases the C.D.C. believe they were caused by EV-D68, although experts are still investigating how the virus affects the nervous system and why a small number of people develop A.F.M. after a viral infection.

There were 14 confirmed cases of A.F.M. this year in the United States.

The most common symptoms of A.F.M. are sudden weakness of arms or legs, loss of muscle tone and loss of reflexes. In addition to those warning signs, the C.D.C. also tells parents to seek medical attention if children develop symptoms such as difficulty swallowing or slurred speech, droopy eyelids or facial weakness, especially after they've had a respiratory illness.

How parents can keep their children safe

Non-polio enteroviruses are spread when an infected person coughs, sneezes, or touches a surface that is then touched by others. So the best practices that many families, schools and child care centers relied on during the Covid-19 pandemic can also help prevent the spread of common seasonal viruses, including EV-D68, this fall.

"The main, main, main thing is to wash your hands," said Dr. Villegas, noting that soap and water are generally considered better than hand sanitizer when it comes to infection control.

He also stressed the importance of "respiratory etiquette". "If you're sick, try not to expose yourself to others," urged Dr. Villegas. Children with asthma may have a higher risk of severe symptoms from EV-D68.

Parents should watch for signs of serious illness in their children, but they should also remember that the purpose of these types of C.D.C. health alerts — which the agency issues regularly and are sometimes picked up by major news outlets — is to put pediatricians and other front-line health care providers on alert. There is no specific treatment for A.F.M., but doctors may recommend physical or occupational therapy.

"It's incredibly rare, but it's something you don't want to miss when a child comes to you with these neurological symptoms, because getting that child checked out and treated and rehabilitated as soon as possible is really important." said Dr. Arrington.