CDC Warns of Increased Respiratory Virus Among Children That Can Cause Polio-Like Paralysis
Enterovirus EV-D68 cases typically have mild cold-like symptoms that can lead to severe neurologic complications.
The Centers for Disease Control and Prevention (CDC) has issued an official advisory warning of a recent rise in the number of children hospitalized with a respiratory illness that can cause a serious neurologic condition that weakens muscles and reflexes.
According to reports to the CDC in August from healthcare providers and hospitals from around the United States, these pediatric patients tested positive for rhinovirus or enterovirus, including enterovirus D68 (EV-D68). Pediatric acute respiratory illness sentinel surveillance sites have also reported a higher proportion of children with EV-D68 positivity compared with previous years.
Data analysis from NBC News found that there were 84 EV-D68 cases from March through August 4. By comparison, the CDC identified six such cases in 2019, 30 in 2020, and 16 in 2021. EV-D68 has been reported in 40 states and the District of Columbia. The CDC suggests that relative lower case counts in the past couple years may have been due to protective measures taken during the pandemic, such as mask-wearing.
Typically, EV-D68 causes respiratory illness with mild cold-like symptoms — although sickness from the virus can sometimes be more severe. Common symptoms among hospitalized children with EV-D68 include cough, shortness of breath, and wheezing. Fever is reported in roughly half of known cases.
In some instances, the infection can lead to acute flaccid myelitis (AFM), a rare but serious neurologic complication involving disabling limb weakness, per the CDC. The condition has similarities with polio, such as lesions in the area of the spinal cord called gray matter that create inflammation and sometimes produce permanent paralysis.
As of September 2, researchers have confirmed 13 AFM cases in the United States so far this year out of 33 reports of patients under investigation.
“Enterovirus D68 is much like the rhinovirus where it typically starts with common cold-type symptoms,” said Matthew Vogt, MD, assistant professor in the division of pediatric infectious diseases at the University of North Carolina School of Medicine in a press release. “Right when those symptoms start to get better, within five days or so, then weakness will begin to appear. It’s highly variable. The weakness can range from subtle to paralysis of every muscle in the body.”
In addition to arm and leg weakness, symptoms that indicate a child needs immediate medical attention include pain in the neck, back, arms, or legs; difficulty swallowing or slurred speech; difficulty moving the eyes or drooping eyelids; and facial droop or weakness.
In summer and fall of 2014, nearly 1,400 Americans, almost all of whom were children, were confirmed to have EV-D68. Many had asthma or a history of wheezing. The outbreak raised awareness of EV-D68-associated illness, and national surveillance expanded.
The CDC is urging healthcare providers to consider EV-D68 as a possible cause of any acute, severe respiratory illness (with or without fever) in children, and make sure those cases are reported to the federal government. (The health agency notes that adults may also become infected with EV-D68, but it is thought to be more commonly detected in adults with underlying conditions.) EV-D68 can only be diagnosed by doing specific lab tests on specimens from a person’s nose and throat, or blood.
No vaccines or specific treatments are available for rhinovirus or enterovirus, including EV-D68. A doctor can recommend supportive care to alleviate symptoms, such as taking over-the-counter medication to reduce pain and fever. Intensive care is needed in more severe cases.
As with the flu and most respiratory illnesses, good hand hygiene is one of the best defenses against getting infected with enterovirus. To prevent getting the disease in the first place, Connecticut health officials recommend:
- Washing hands often with soap and water for 20 seconds, especially after changing diapers
- Avoiding touching eyes, nose and mouth with unwashed hands
- Avoiding kissing, hugging, and sharing cups or eating utensils with people who are sick
- Disinfecting frequently touched surfaces, such as toys and doorknobs, especially if someone is sick