Public health agencies, including the Centers for Disease Control and Prevention (CDC), are warning the public about a resurgent virus that causes severe respiratory illness that sometimes includes polio-like symptoms.
In August 2022, the agency was alerted to an increase in pediatric hospitalizations caused by enterovirus D68 (EV-D68), which can cause serious respiratory tract infections and, in rare cases, can cause weakness limbs and progressive paralysis, not unlike polio.
“EV-D68 is back this year and circulating in the US,” Kevin Messacar, a pediatric infectious disease specialist at Children’s Hospital Colorado, told STAT News. “So we want providers, frontline health care providers, pediatricians, EDs to be on the lookout for cases of patients who have weakness, knowing that this is circulating, so that those cases can be quickly diagnosed and managed appropriately”.
EV-D68 is not a new pathogen, it was first identified in 1962, but it has become much more common in the 21st century. The last major outbreak in the US was in 2018, with a record 238 documented cases. After a drop in cases during the COVID pandemic, the virus has made a strong comeback, causing illness in multiple states.
The most common symptoms of EV-D68 include muscle aches, fever, cough, sneezing, blisters or rashes. In severe cases, EV-D68 may cause wheezing or difficulty breathing, which may sometimes require a ventilator. In some cases, the virus can attack the heart or cause damage to the spinal cord, known as acute flaccid myelitis (AFM), which can cause nerve dysfunction and paralysis.
According to the CDC, typical signs of AFM include the sudden onset of arm or leg weakness or loss of muscle tone and reflexes. This may include difficulty moving the eyes or drooping eyelids, drooping of the face, difficulty swallowing or difficulty speaking. Sometimes pain in the arms, legs, neck or back is also reported.
Less common but extremely risky symptoms include respiratory failure and serious neurological complications, such as changes in body temperature and blood pressure instability that can be life-threatening.
If you or your child develop any of these symptoms, you should seek medical attention immediately.
Children are most at risk, but adults can also get it, although the risk of serious illness is much higher in children. This is because most adults have developed immunity from previous exposures to enteroviruses. There are no Food and Drug Administration-approved vaccines or antiviral treatments for EV-D68. Doctors can provide supportive care, but not much else. Severe cases often require hospitalization even as a precaution, because the disease can progress rapidly.
“Children with a history of asthma or reactive airway disease may be more likely to require medical attention, although children with no known history of asthma may also have severe disease,” the CDC warned on 9 September “Adults can also become infected with EV-D68, but it is thought to be more commonly detected in adults with underlying conditions.”
Some children will recover from AFM, but others will not. Some will struggle with neurological complications for the rest of their lives.
So what is the risk to children? Although there are more cases of EV-D68 this summer than the last three years during the same period, they are still relatively rare. However, the consequences can be serious.
So far, the CDC says it has yet to see an increase in associated cases of AFM. That could change, however, as cases of acute flaccid myelitis typically lag behind EV-D68 respiratory illnesses, so monitoring for additional infections in the coming months will be “essential,” the CDC says.
The CDC has offered guidance on how to protect yourself from EV-D68: wash your hands often, avoid touching your eyes, nose, and mouth, and avoid close contact, such as kissing or hugging. Do not share cups or eating utensils with sick people.
You should also clean and disinfect frequently touched surfaces, especially if someone is sick, and cover yourself with a handkerchief or the upper sleeve of your shirt, not your hands. Stay home when you are sick.
It can be difficult to specifically test the EV-D68, which can make outbreak control tricky. There are also more than 100 different strains of enteroviruses, including poliovirus, the pathogen famously responsible for polio, a disease known to paralyze its victims.
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Polio is also currently spreading in parts of the U.S. Last week, New York Governor Kathy Hochul declared a state disaster emergency in response to circulating polio cases. And yesterday, September 13, the CDC announced agreement with the World Health Organization’s assessment that polio is spreading in and around Rockland County, New York. The US has now joined a list of approximately 30 other countries, including Ethiopia, Yemen and Ukraine, where polio outbreaks occur more regularly.
However, unlike EV-D68, there is a poliovirus vaccine. “Polio vaccination is the safest and best way to fight this debilitating disease and it is imperative that people in these communities who are not vaccinated are immediately updated on polio vaccination,” Dr. José R. Romero , director of the National Center for CDC. Immunization and respiratory diseases, he said in a statement. “We cannot stress enough that polio is a dangerous disease for which there is no cure.”
Although vaccines for EV-D68 are in the early stages of development, they are likely to be years away from being available to the general public. In the meantime, health officials will have to continue to monitor the situation, while parents will have to hope their children don’t catch any crippling diseases.