Health officials are warning doctors about another contagious virus that, in rare cases, can send children to the hospital or lead to permanent paralysis.
In an advisory, the U.S. Centers for Disease Control and Prevention noted an increase last month in the number of children hospitalized for severe respiratory illness — including enterovirus D68, or EV-D68.
First identified in California in 1962, EV-D68 is worrisome because, in rare cases, it can harm the spinal cord and cause a condition known as acute flaccid myelitis — which causes muscles to become weak and can sometimes cause paralysis.
In general, more than 90% of cases of acute flaccid myelitis have been in young children.
In response to the CDC notice, the Los Angeles County Department of Public Health issued its own advisory stating that if paralysis or other symptoms of acute flaccid myelitis are suspected in a patient, clinicians should report the case to their agency within 24 hours.
Orange County also issued an advisory, with Health Officer Dr. Regina Chinsio-Kwong saying the county “is seeing a lot of respiratory illnesses affecting our community right now, both in children and adults … resulting in hospitalizations.”
There are no vaccines available to protect against EV-D68.
But health officials suggested residents take steps to guard against other viral illnesses such as getting their flu shots and staying up to date on COVID-19 vaccines and boosters.
EV-D68 can transmit through an infected person’s saliva and mucus and likely spreads “when an infected person coughs, sneezes or touches a surface that is then touched by others,” the CDC said.
“In general, infants, children and teenagers are most likely to get infected with enteroviruses and become ill. That’s because they do not yet have immunity (protection) from previous exposures to these viruses,” the CDC says. “Adults can get infected with enteroviruses, but they are more likely to have no symptoms or mild symptoms.”
Most EV-D68 cases cause no or only mild symptoms, according to the CDC. Mild symptoms include a runny nose, sneezing, a cough and aches. Fever is reported in about half of known EV-D68 cases.
More severe symptoms, including unusual shortness of breath and difficulty breathing, are signs that a person needs to get immediate medical care.
Children with asthma might be at higher risk for severe illness if infected with EV-D68, the CDC said. Asthma patients who are seeing their symptoms exacerbated should seek medical care early, the agency said.
Small numbers of EV-D68 cases have been reported in the United States since 1987. But a nationwide outbreak of respiratory illness in late 2014 began to raise awareness of severe associated sicknesses.
Accompanying observed growth in EV-D68 cases in 2014, 2016 and 2018 has led to increases in instances of acute flaccid myelitis each respective summer and autumn, according to the CDC.
There also was an increase in EV-D68 cases, though to a lesser extent, in 2020. Spread of the virus was likely limited by the stay-at-home and masking requirements in place because of the COVID-19 pandemic; there was no significant increase in acute flaccid myelitis that year.
There were 120 cases of acute flaccid myelitis nationally in 2014; 153 in 2016; 238 in 2018; and 33 in 2020. In California, there were 24 cases in 2014; 28 in 2016; 15 in 2018; and four in 2020.
In 2018, the last year EV-D68 was documented in relatively high levels, the median age of children needing care in emergency rooms or hospitals was about 3. “However, all ages of children and adolescents can be affected,” the CDC said.
The agency issued its recent advisory in light of data that cases of EV-D68 in July and August were higher than the same period in each of the last three years. However, there were no increased reports of acute flaccid myelitis or related paralysis as of Aug. 30.
But because increases in EV-D68 cases typically foreshadow increased cases of acute flaccid myelitis, officials say it’s essential to be extra vigilant in the coming weeks.
Another possible cause of acute flaccid myelitis and paralysis can be polio. There has been one case of polio-caused paralysis in New York this year, and the polio virus has been found in the wastewater in New York City and in several suburban counties northwest of the city as well as in Nassau County on Long Island.
On Friday, New York Gov. Kathy Hochul declared a state disaster emergency related to the rise in polio in wastewater, allowing more types of workers to administer polio vaccines and requiring healthcare providers to send polio immunization data to state officials.
People should seek medical attention for themselves or their child at once if they notice symptoms of weakness in the arm or legs; pain in the neck, back, arms or legs; difficulty swallowing; slurred speech; difficulty moving the eyes, drooping eyelids or facial droop; or weakness.
Tracking EV-D68 is difficult because most hospitals and doctor’s offices don’t do the kind of testing needed to identify the specific type of enterovirus.
The CDC recommends doctors consider EV-D68 as a potential reason for illness — particularly during summer and fall — “as a possible cause of acute, unexplained severe acute respiratory illness, even if the patient does not have fever.”
Dr. Robert Kim-Farley, an epidemiologist and infectious diseases expert with the UCLA Fielding School of Public Health, said tactics to protect against EV-D68 infection are common sense: washing hands and staying at home if sick.
“If the child gets sicker than a normal cold, they should be seen” by a healthcare provider, Kim-Farley said.
In addition, doctors and other clinicians should keep EV-D68 in their minds as a possible cause for a severe respiratory illness or sudden onset of muscle weakness and consider ordering specialized testing to confirm a suspected diagnosis, Kim-Farley said.