How To Reduce Your Child’s Risk Of The Enterovirus Infection (EV-D68) That Is Causing Paralysis

The CDC issued a health alert Friday (9/9/22) warning of a surge in enterovirus-D68 (EV-D68) cases, which can rarely lead to severe muscle weakness [the technical name is acute flaccid myelitis (AFM), a polio-like illness].

They also noted an increase in hospitalizations of children with severe respiratory disease who tested positive for rhinovirus (RV) and/or enterovirus (EV). The two viruses can have similar symptoms. Commonly used laboratory tests may not distinguish the two infections. special tests are required. Further testing has confirmed that many of the laboratory samples are from children with EV-D68 diseases.

There are also “Sentinel Surveillance Sites” called the New Vaccine Surveillance Network – in Pittsburgh, Rochester (NY), Nashville, Cincinnati, Kansas City (MO), Houston and Seattle. They have more sophisticated diagnostic labs.

These sentinel sites also report higher levels of EV-D68. The CDC warns that this virus can cause a polio-like disease. The CDC would like to caution parents and physicians who would not normally expect EV-D68 to be matched to the possibility.

Non-polio enteroviruses can cause respiratory symptoms (and thus confusion with rhinoviruses). They can also cause a range of other symptoms, including skin rash or hand, foot, and mouth disease (HFMD), heart inflammation (myocarditis), and viral meningitis or encephalitis. Children hospitalized with EV-D68 may experience respiratory symptoms, including coughing, shortness of breath, and wheezing. However, in rare cases, children can develop sudden limb weakness known as acute flaccid myelitis (AFM). They rarely recover muscle strength.

Enteroviruses tend to peak in late summer and early fall. As of 2014, few EV-D68 cases have been diagnosed in the United States. Then EV-D68 caused a large nationwide severe respiratory disease outbreak in 2014 and smaller spikes in fall 2016 and 2018. AFM cases also increased, following the same two-year pattern. There was no increase in 2020 and other respiratory infections were also far less common, likely due to Covid precautions. So far, at least 650 children out of hundreds of thousands who have been infected have developed paralysis from the virus. It’s rare but scary when it happens because of its devastating effects.

With the seven Sentinel sites reporting an increase in EV-D68, there is concern that cases of AFM will soon follow. There is additional concern that this outbreak will be larger as the 2020 wave was small and the population lacks immunity.

Should children develop sudden limb weakness or AFM, the CDC wants to collect blood, stool, spinal fluid (if obtained), and throat or nasal swabs to investigate whether polio or EV-D68 is the cause. Other viruses — enterovirus A71, coxsackievirus A16, West Nile virus, and adenovirus — can also cause AFM, but EV-D68 is getting all the attention. They all require specific tests to diagnose.

There is no specific treatment for AFM – or polio. While only one case of polio has been reported in upstate New York to date, there is a risk of more polio cases due to poor immunization rates, particularly in the Hasidic community. Most cases of polio are asymptomatic, so the only case of paralysis is probably the canary in the coal mine. We also know that poliovirus has been detected in wastewater from New York City and four nearby counties.

What can you do to reduce your child’s risk?

For respiratory infections such as rhinovirus and EV-D68, the focus remains on good hygiene and frequent hand washing. We’ve seen mask-wearing significantly reduce flu and colds, as well as Covid, leaving many wondering why the CDC and many public health officials abandoned these sensible precautions. Some are calling for more emphasis on improving ventilation in schools, businesses and homes.

It’s also important not to touch your eyes, nose, and mouth with unwashed hands, as these mucosal surfaces are easily susceptible to infection. Avoid sharing cups or dishes.

Catch coughs and sneezes with a tissue or sleeve, then wash or use hand sanitizer.

Disinfect frequently touched surfaces such as doorknobs and handles. Bonus points if you use a paper towel to turn off taps and open doors in public spaces – you’ll be amazed at how much less sick you get!

It’s important to be up to date on your vaccinations – including any child shots, too many of which have expired since the start of Covid. Polio vaccinations are crucial. Measles is also increasing in many areas and can be fatal.

Unfortunately, there is probably no vaccine against these enteroviruses. Columbia virologist Vincent Racaniello told me, “EV-68 is making headlines, but there are a dozen other enteroviruses out there that can also cause paralysis. And they do it in different countries – like in Asia, it’s enterovirus 71. In Europe, it’s different enteroviruses. So it’s not just one, and they’re different, so you can’t make a vaccine to meet them.” Because muscle weakness comes on quickly and medications are likely to stop working once paralysis has set in, Racaniello doesn’t think antivirals are a good thing or monoclonal antibodies are effective against these enteroviruses.

That leaves us with public health and common sense measures that often seem to be lacking.