As if colds, the flu, RSV, and COVID-19 weren’t enough to spike parental stress, the Centers for Disease Control and Prevention (CDC) recently issued a health advisory warning about a rise in enterovirus D68 (EV-D68) cases in children, which can cause not only severe respiratory illness, but polio-like muscle weakness. I know that sounds super scary, so the first thing parents should know is that these very-serious enterovirus symptoms are pretty rare. Still, medical professionals are seeing a lot more incidences than they have in the past, So, as we head into sniffles season, it’s good idea to familiarize yourself with the symptoms of enterovirus…as well as how to reduce your family’s risk of catching it. Here are the facts on enterovirus D68.

What is enterovirus?

There are lots of different viruses that fall under the enterovirus umbrella, including polio, hepatitis A, coxsackie, and echovirus. In fact, there are more than 100 non-polio enteroviruses that cause about 10 to 15 million infections in America each year, mostly in the summer and fall. Enterovirus is behind icky illnesses like:

  • Conjunctivitis (pinkeye)

  • Hand, foot, and mouth disease

  • Viral meningitis

  • Viral encephalitis

  • Myocarditis (infection of the heart)

  • Pericarditis (infection of the sac surrounding the heart)

What is enterovirus D68?

Enterovirus D68 (EV-D68) is one type of enterovirus and it’s actually much less common than other enteroviruses. While most of the time enterovirus D68 causes mild, cold-like symptoms, sometimes it causes more severe respiratory complaints. It’s this strain of enterovirus that’s behind a recent surge in severe respiratory illness that have put 260 children and adolescence in the hospital over the past 6 months, according to the CDC.

Enterovirus D68 Symptoms

Enterovirus D68 might not cause a single symptom—or it may bring about mild respiratory symptoms that are often confused with rhinoviruses, like the common cold. Here are some common signs of enterovirus D68:

  • Runny nose

  • Sneezing

  • Cough

  • Body and muscle aches

  • Wheezing and difficulty breathing

    What is acute flaccid myelitis?

    The thing that’s most worrying to experts is that enterovirus D68 has been associated with acute flaccid myelitis (AFM), which is a rare illness that affects the nerve cells in the spinal cord, possibly leading to polio-like paralysis. From August 2014 to date, the CDC has reported 694 total cases of acute flaccid myelitis. However, as of October 12, 2022, there have been 22 new confirmed cases in 2022, with another 53 potential cases under investigation. It’s still unclear why a small number of children develop AFM after having enterovirus D68.

    Acute Flaccid Myelitis Symptoms

    Symptoms of AFM include:

    • Sudden arm or leg weakness

    • Arm, leg, or neck pain before weakness begins

    • Facial droop or weakness

    • Droopy eyelids

    • Difficulty moving eyes

    • Difficulty swallowing

    • Slurred speech

    • Hoarse or weak cry

    Less common symptoms of AFM include numbness or tingling in the arm, legs, and neck. AFM may also trigger breathing difficulties. Most children with AFM had a fever one to two weeks before the onset of weakness in one or more limbs.

    When should you call the doctor about enterovirus?

    Contact your child’s pediatrician immediately if your tyke is having trouble breathing or experiencing any sudden limb weakness. Another reason to ring the doc: a high fever or cold symptoms that last longer than 7 to 10 days.

    If your provider suspects acute flaccid myelitis, they’ll likely take a thorough medical history, do a physical exam, use an MRI to review pictures of the spinal cord, and prompt lab testing of respiratory fluid, blood, stool, and more. Because it takes highly specialized lab tests to detect enterovirus D68, your pediatrician may need to send nasal secretion or blood samples to your state’s health department or the CDC to diagnose EV-D68.

    While there are no specific treatments for children with EV-D68, doctors can offer strategies to control symptoms. And—though rare—for severe respiratory symptoms, hospitalization may be in order. 

    Who’s at risk for enterovirus D68?

    Enterovirus D68 can infect anyone, but tots around age 3 were most affected the last time EV-D68 circulated in 2018. That said, all babies, kids, and teens are especially vulnerable because they’ve yet to build immunity against the virus. Children with asthma or reactive airway disease are at an even higher risk for severe respiratory illness. (Adults and children with weak immune systems are also more susceptible to enterovirus D68.)

    How does enterovirus D68 spread?

    Like other viruses, enterovirus D68 spreads when an infected person sneezes or coughs, releasing virus-laced droplets into the air or on surfaces. So, when a child breathes in those germy particles or touches a contaminated surface—then puts their hands on their eyes, nose, or mouth, they can get infected.

    Is there a way to prevent enterovirus D68?

    Right now, there’s no vaccine against enterovirus D68 and experts aren’t certain what exactly triggers acute flaccid myelitis in children, so there’s no one thing you can do to prevent it. However, there are steps you can do to help reduce the risk of an enterovirus D28 infection, including:

    • Wash hands often. And scrub for 20 seconds! (Have your kiddo sing “Happy Birthday” or their ABC’s as they wash so they lather for long enough.) This is super important after using the bathroom or changing diapers. Don’t forget to clean between your fingers and under your nails, where germs can collect.

    • Don’t touch! Keep your hands off your eyes, nose, and mouth. (Here are some tips for gently reminding your tot to keep their fingers out of their nose.)

    • Cover coughs and sneezes. Teach your tyke to use a tissue or their elbow.

    • Consider wearing a mask in public. If you or your child is at high risk of serious illness from infections, this is especially important. Masks help keep us from breathing in airborne germs!

    • Avoid close contact. Kissing, hugging, and sharing cups or eating utensils with people who are sick is a big no-no.

    • Disinfect frequently touched surfaces. Toys and doorknobs are especially germy.

    • Stay home when sick.

    • Stay up to date with recommended vaccines. Unsure what’s needed, when? Learn what vaccines might be due soon.

    Interestingly, there were fewer enterovirus D68 cases than expected in 2020, likely because of measures put in place to help squash the spread of COVID-19…like wearing face masks, enhanced hand hygiene, and physical distancing. That could mean that as those COVID preventative measures are going away, lots of sickness—including enterovirus—will be on the rise.

    What if my child has asthma?

    Since kids with asthma are more vulnerable to an enterovirus D68 infection, it’s important to take extra steps to keep them safe, like:

    • Review your child’s asthma action plan. Work with your kiddo’s healthcare provider to create a plan that prevents and controls your child’s asthma attacks.

    • Double check meds. Make sure that your child’s long-term control medications or rescue meds (an inhaler or nebulizer) are full, and on hand.

    • Nix smoking. Secondhand smoke is harmful for any child, and this is especially so for kids with asthma.

    • Get the flu shot. According to the American Academy of Pediatrics, your child should get the vaccine as soon as it’s available.

    • Talk to caregivers and teachers. Make sure your child’s caregiver or teachers are aware of your kiddo’s asthma—and that they know how to help if any symptoms arise.

     

    More baby and toddler health need-to-knows:

     

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    REFERENCES

    • Centers for Disease Control and Prevention (CDC): Severe Respiratory Illnesses Associated with Rhinoviruses and/or Enteroviruses Including EV-D68 – Multistate, 2022
    • CDC: Enterovirus D68
    • American Academy of Pediatrics (AAP): Enterovirus D68: What Parents Need to Know
    • Boston Children’s Hospital: What to know about Enterovirus D68
    • Increase in Acute Respiratory Illnesses Among Children and Adolescents Associated with Rhinoviruses and Enteroviruses, Including Enterovirus D68 — United States, July–September 2022, Morbidity and Mortality Weekly,  October 7, 2022
    • Rutgers Today: CDC Reports Rise in Hospitalizations of Children With Respiratory Virus Associated With Rare Polio-Like Illness 
    • CDC: AFM Cases and Outbreaks
    • CDC: Acute Flaccid Myelitis in Children, A Parent Fact Sheet
    • CDC: Diagnosis & Treatment of AFM
    • Cleveland Clinic: Enterovirus D68

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    Disclaimer: The information on our site is NOT medical advice for any specific person or condition. It is only meant as general information. If you have any medical questions and concerns about your child or yourself, please contact your health provider.