NBC News reports that the Centers for Disease Control and Prevention (CDC) is warning about the spread of a common childhood virus that can cause muscle weakness or paralysis in rare cases.
According to their report released just last week, the CDC recorded 260 cases of “enterovirus D68,” aka EV-D68, which most commonly leads to respiratory illness among kids, from March 1 to September 20. That’s more than in the last three years combined. The CDC identified six cases in 2019, 30 in 2020 and 16 in 2021.
Kids who have gotten EV-D68 this year are under 3 years old, on average. Cases been detected across seven pediatric medical centers affiliated with the CDC’s New Vaccine Surveillance Network — in Nashville, Tennessee; Houston; Kansas City, Missouri; Cincinnati; Seattle; Pittsburgh; and Rochester, New York. During the week of August 8, 56% of children and adolescents who required emergency care or hospitalization for acute respiratory illness at those seven sites tested positive for EV-D68.
According to NBC News, polio falls within the rather large enterovirus umbrella; both EV-D68 and poliovirus can invade the nervous system and cause muscle weakness. Occasionally, EV-D68 can result in a condition called acute flaccid myelitis, or AFM, which is characterized by inflammation in the neck region of the spinal cord. Some people who experience AFM have difficulty moving their arms, while others experience weakness in all four extremities.
During a large outbreak in the U.S. in 2014, around 10% of people diagnosed with EV-D68 went on to develop AFM, but the condition is likely rarer than that, since not everyone gets tested for EV-D68. Full recovery from AFM is uncommon. Most patients improve to some extent, but the process is often difficult and requires rehabilitation.
As of September 21, 15 cases of AFM had been confirmed this year across 10 states, according to the CDC. The agency is investigating 30 additional cases.
So, why are EV-D68 cases rising this year? According to NBC News, in the past, the CDC has recorded spikes in EV-D68 cases every other year. Before the coronavirus pandemic, that was in 2014, 2016 and 2018. Dr. Benjamin Greenberg, a neurologist at UT Southwestern’s O’Donnell Brain Institute who treats patients at Children’s Health in Dallas, said the pattern most likely appears because kids develop immunity to the enterovirus when it spreads, leading to “off” years with higher population immunity. Once the immunity wanes, case numbers tick up again.
Dr. Sarah Hopkins, a pediatric neurologist at Children’s Hospital of Philadelphia, said experts thought there would be a spike in 2020, following the pattern. “But then with mask-wearing and social distancing and all those things that limit the spread of a respiratory virus, we didn’t have that expected spike,” she said.
Greenberg said cases are most likely rising again this year because children are back in school and other public spaces. “We have a group of kids now who’ve never seen the virus, because they weren’t having school exposures. So we think the at-risk population is bigger than in 2020,” he said.
The CDC is asking health care providers to be on the lookout for EV-D68 cases among kids and to strongly consider AFM as a potential diagnosis for patients with limb weakness. However, it can be hard to distinguish EV-D68 symptoms from those of other respiratory viruses, Greenberg said. Like the common cold, EV-D68 can cause a runny nose, sneezing, body aches or muscle aches. Children who require hospitalization tend to have coughs, shortness of breath, wheezing and — in about half of cases — fever.
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