Explaining enterovirus D68

Hospitals across the country have reported a spike in cases of enterovirus D68 (EV-D68) in children, according to a recent alert issued by the Centers for Disease Control and Prevention (CDC). The virus typically leads to respiratory illness but can develop into something more serious.

Mobeen Rathore, MD, chief of Pediatric Infectious Disease and Immunology at Wolfson Children's Hospital, said it's common for children to get enterovirus infections, but this particular strain can, in rare cases, cause a serious condition known as acute flaccid myelitis (AFM). Similar to polio, which also falls in the enterovirus family, AFM can cause weakness in the muscles or paralysis of the arms and legs.

While AFM is rare, EV-D68 has been around for decades and outbreaks tend to happen every other year, though experts aren't sure why. There were significant numbers of cases in 2014, 2016 and 2018. The virus didn't show up as much in 2020, which was likely due to extra precautions brought on by the COVID-19 pandemic such as masking and social distancing.

"Now it's 2022, so not surprisingly we're seeing an outbreak and we may see a much worse one because children who were not previously exposed to this virus may be at risk," said Dr. Rathore.

Symptoms, spread and prevention

There have been less than 700 cases of acute flaccid myelitis since the CDC began tracking the condition in 2014, but 90% have been in children.

"Pain can occur in the neck, back, arms and legs, and those aren't symptoms you'll see very often in any other situation," Dr. Rathore said. "Other signs can include difficulty swallowing, slurred speech, facial weakness or sleepy eyelids. All of those things need immediate medical attention."

Enterovirus D68 presents itself much like the common cold, which can make it harder to identify.

"You might have what you call a summer cold. You could have a fever or feel run down. There isn't a specific symptom that would identify this virus," Dr. Rathore said.

Since EV-D68 affects the respiratory system, it can also cause difficulty breathing. Children who have asthma or a weakened immune system are at greater risk for severe illness if infected with EV-D68, Dr. Rathore said.

Also like a cold or COVID-19, EV-D68 is spread through contact with respiratory droplets.

"Even sharing cups, which kids do all the time, can cause the virus to spread," Dr. Rathore said.

Proper handwashing, mask-wearing and social distancing from those who might be sick are the best ways to prevent infection.

"I think it's the same things that we've learned from coronavirus, like cover your cough, clean and disinfect surfaces, and stay home if you're sick," Dr. Rathore said.

When to seek medical attention

Hospitals and doctors' offices can test for illnesses that fall within the enterovirus family, but not specifically for EV-D68. Instead, a special test must be ordered and sent to the CDC or state health department for an official diagnosis, Dr. Rathore said.

"Kids could have mild symptoms like a runny nose, sneezing, cough or body aches and have EV-D68. In other cases, they could have more severe symptoms like wheezing or difficulty breathing, but not have EV-D68," he said.

Because the virus is tricky and often hard to distinguish from a cold, Dr. Rathore said the best advice is to use your parental instincts.

"When your child is ill, make sure he or she is practicing good hygiene and nutrition. Try to avoid sick people and don't delay in contacting their pediatrician," Dr. Rathore said.

If symptoms progress or you notice any sign of muscle weakness, you should seek immediate medical attention.

"Acute flaccid myelitis is uncommon, but a serious neurological condition," Dr. Rathore said. "If you think your child is having muscle weakness or you notice he or she is not walking correctly, you should take him or her to the emergency department immediately."

If your child is experiencing cold- or flu-like symptoms, call your pediatrician. For symptoms that require immediate care, take him or her to the nearest Children's Emergency Center or call 911.

Source: Centers for Disease Control and Prevention