Public health agencies including the Centers for Disease Control and Prevention (CDC) are warning the public about a resurgent virus causing severe respiratory illness that sometimes comes with polio-like symptoms.
In August 2022, the agency was alerted about an uptick in pediatric hospitalizations caused by enterovirus D68 (EV-D68), which can cause severe respiratory tract infections, and in rare cases, it can cause limb weakness and progressive paralysis, not unlike polio.
"EV-D68 is back this year and circulating in the U.S.," Kevin Messacar, a pediatric infectious diseases specialist at Children's Hospital Colorado, told STAT News. "So we want providers, first-line health care workers, pediatricians, ER docs to be on the lookout for cases of patients presenting with weakness, knowing that this is circulating, so that those cases can be diagnosed quickly and managed appropriately."
EV-D68 isn't a new pathogen — it was first identified in 1962 — but it has become far more common in the 21st century. The last major outbreak in the U.S was in 2018, with a record 238 documented cases. Following a dip in cases during the COVID pandemic, the virus has returned in force, generating illness in multiple states.
The most common symptoms of EV-D68 include muscle aches, fever, coughing, sneezing, blisters or rashes. In severe cases, EV-D68 can trigger wheezing or difficulty breathing, which can sometimes require a ventilator. In some cases, the virus can attack the heart or cause lesions on the spinal cord, known as acute flaccid myelitis (AFM), which can produce nerve dysfunctions and paralysis.
According to the CDC, typical signs of AFM include a sudden onset of arm or leg weakness or loss of muscle tone and reflexes. That can include difficulty moving the eyes or drooping eyelids, drooping of the face, difficulty with swallowing or slurred speech. Pain in the arms, legs, neck or back is also sometimes reported.
Less common but extremely risky symptoms include respiratory failure and serious neurologic complications such as body temperature changes and blood pressure instability that could be life threatening.
If you or your child develops any of these symptoms, you should seek medical care immediately.
Children are most at risk, but adults can catch it, too, although the risk of severe illness is far greater in kids. That's because most adults have developed immunity from previous exposures to enteroviruses. There are no vaccines or antiviral treatments for EV-D68 approved by the Food and Drug Administration. Doctors can give supportive care, but not much else. Severe cases often require hospitalization even as a precaution, because the disease can progress rapidly.
Acute flaccid myelitis cases typically lag behind EV-D68 respiratory illnesses, so monitoring for additional infections in the coming months will be "essential," the CDC says.
"Children with a history of asthma or reactive airway disease may be more likely to require medical care, though children without a known history of asthma can also present with severe illness," the CDC warned on September 9th. "Adults may also become infected with EV-D68, but it is thought to be more commonly detected in adults with underlying conditions."
Some kids will recover from AFM, but others won't. Some will struggle with neurological complications for the rest of their lives.
So how at-risk are kids? Even though 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 severe.
So far, the CDC says it hasn't seen an uptick in associated AFM cases yet. That could change, however, as acute flaccid myelitis cases 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. Don't share cups or eating utensils with people who are sick.
You should also clean and disinfect frequently touched surfaces, especially if someone is sick and cover your coughs and sneezes with a tissue or your upper shirt sleeve, not your hands. Stay home when you are sick.
It can be difficult to test specifically for EV-D68, which can make monitoring the outbreak cumbersome. There are also over 100 different strains of enteroviruses, including poliovirus, the pathogen famously responsible for polio, a disease notorious for paralyzing its victims.
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Polio is currently spreading as well in parts of the U.S. Last week, New York Gov. Kathy Hochul declared a state disaster emergency in response to circulating polio cases. And yesterday, September 13th, the CDC announced agreement with the World Health Organization's assessment that polio is spreading in Rockland County, New York and surrounding areas. The U.S. has now been added to a list of approximately 30 other countries, including Ethiopia, Yemen and Ukraine, where polio outbreaks more regularly occur.
However, unlike EV-D68, there is a vaccine for poliovirus. "Polio vaccination is the safest and best way to fight this debilitating disease and it is imperative that people in these communities who are unvaccinated get up to date on polio vaccination right away," Dr. José R. Romero, director of CDC's National Center for Immunization and Respiratory Diseases, said in a statement. "We cannot emphasize enough that polio is a dangerous disease for which there is no cure."
While vaccines for EV-D68 are in early stages of development, they are still likely years away from becoming available to the general public. In the meantime, health officials will need to continue monitoring the situation while parents will have to hope their kids don't catch a child-paralyzing disease.
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