A virus associated with a neurologic condition that causes paralysis is spreading more in the U.S. this year than it has in previous years, according to a warning issued Friday by the Centers for Disease Control and Prevention.
This virus, EV-D68, is an enterovirus that primarily causes acute respiratory illness. It has also been linked to acute flaccid myelitis (AFM), a rare but serious neurologic complication.
AFM is a “a polio-like illness that affects the nerve cells (motor neurons) in the gray matter of the spinal cord. It is thought to be due to a viral infection,” according to the Children’s Hospital of Philadelphia. Children who develop AFM have a rapid onset of “floppy” paralysis, typically in an arm or leg.
Last month, healthcare providers and hospitals in several regions of the U.S. notified the CDC about an increase in pediatric hospitalizations for patients who tested positive for enterovirus and rhinovirus, which can present with similar symptoms. Some of these cases led to positive diagnosis of EV-D68.
So far, no cases of AFM onset have been reported related to the current EV-D68 case spread.
“However, increases in EV-D68 respiratory illnesses have typically preceded cases of AFM, indicating that increased vigilance for AFM in the coming weeks will be essential,” said the CDC. It recommends that healthcare providers “strongly consider AFM in patients with acute flaccid limb weakness, especially after respiratory illness or fever, and between the months of August and November.”
Enterovirus is also associated with symptoms that include febrile rash and neurologic illness such as aseptic meningitis and encephalitis in addition to AFM. More common symptoms of EV-D68 are cough, shortness of breath and wheezing. Fever is reported in approximately half of known cases, according to the CDC.
Currently there are no treatments for EV-D68.
“People with mild illness caused by non-polio enterovirus infection typically only need to treat their symptoms. This includes drinking enough water to stay hydrated and taking over-the-counter cold medications as needed,” said the CDC. “Most people recover completely. However, some illnesses caused by non-polio enteroviruses can be severe enough to require hospitalization.”
Cases of EV-D68 in the U.S. usually peak in late summer and early fall. Since the virus caused a nationwide outbreak in 2014, the CDC expanded surveillance. Increased activity was previously detected in 2016, 2018 and “to a lesser degree” in 2020. This years’ spread is estimated to be greater than the previous three years.
“The relatively lower circulation in 2020 may reflect the use of COVID-19 pandemic infection mitigation measures, which are known to have interrupted the circulation of other respiratory viruses,” the CDC explained.
Children and adults with underlying infections are diagnosed with the virus more often than others. When it was spreading in 2018, the median age of children seeking emergency treatment for EV-D68 was 3 years old.
According to the CDC, the public can work to prevent EV-D68 infection by: washing hands often with soap and water for 20 seconds; avoiding touching their eyes, nose, and mouth with unwashed hands; avoiding close contact or sharing of cups with people who are sick; covering coughs and sneezes with sleeves rather than hands; maintaining clean and frequently disinfected surfaces; staying at home when sick; wearing a mask around others if they have respiratory symptoms and staying up to date on vaccinations.
Parents are advised to contact a healthcare provider immediately if they or their child has trouble breathing or has a sudden onset of limb weakness.
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