CDC warns of enterovirus in children — and the risk of rare paralysis that can follow

After virtually disappearing for several years amid measures to curb the spread of COVID-19[feminine]the Centers for Disease Control and Prevention is now urging doctors to be vigilant for a new wave of enterovirus D68, or EV-D68 – a viral infection in children that can cause rare form of paralysis.

In July and August, the CDC reports that hospitals detected an increase in infections caused by enterovirus D68. The number is now the highest seen since 2018, when the agency tracked the latest wave of summer and fall infections caused by the virus.

Many children are infected with enterovirus D68 early in life and will only experience a range of mild colds symptoms at worst, like a runny nose and cough. A study in Missouri from 2012 to 2013 found antibodies from a previous infection in every child tested.

But some children, especially those with underlying conditions like asthmaare at higher risk for severe symptoms that can cause breathing problems and require hospitalization.

A small fraction of infected children also develop a rare complication known as acute flaccid myelitis (AFM), which can cause muscle weakness and paralysis similar, but probably rarer, to the paralysis caused by polio.

In 2018, there were 238 reports of acute flaccid myelitis at the CDC, which would be largely caused by spikes in the virus. There has been no increase in this paralysis seen so far this year, according to the agency. But as the virus spreads, there are growing fears that it is only a matter of time.

“The increase in EV-D68 respiratory disease has generally preceded AFM cases, indicating that increased vigilance for AFM in the coming weeks will be essential,” the CDC warned.

AFM remains “a bit of a mystery” for researchers


A CDC spokesperson said reports can take up to a month to be added to the agency’s acute flaccid myelitis. score, taking into account the time required to review each patient’s medical file. The agency is now working on weekly count updates, starting this Friday.

The federal alertdistributed Friday to doctors and health departments across the country, echoes a similar warning earlier this summer about an increase in case of parechovirus in infants across the country.

Both viruses tend to spread in waves that fill children’s hospital beds every two years. It was supposed to happen in 2020, until the COVID-19 pandemic caught up with them and disrupted the pattern.

“We wrote articles about how we should expect it to come back in 2020, and we were preparing for it and preparing for it, and lo and behold the whole world is changing with COVID,” recalls Dr Kevin Messacar from Children’s Hospital Colorado.

Modeling suggests a “immunity hole” in children who have never been exposed before may now increase the risk of a large outbreak of enterovirus D68.

“You have four years of children who haven’t seen these viruses and you wouldn’t expect them to be immune to them,” Messacar said.

Last year, scientists in Europe also expressed concern over the re-emergence of enterovirus D68 infections following the easing of COVID-19 related containment measures across the continent.

Several reports of acute flaccid myelitis associated with the virus have since been reported in Europe, the study’s corresponding author, Kimberley Benschop of the Netherlands National Institute for Public Health and the Environment, told CBS News.

“However, as seen in previous peak years of EV-D68, where several cases of AFM associated with EV-D68 were also reported, we have not seen a major upsurge in these AFM cases in 2021,” Benschop wrote in an email.

She added that health authorities were again alerting their doctors to be vigilant about a possible increase in cases this year.

Enteroviruses are in the same family of infectious pathogens as poliovirus and parechovirus, as well as rhinovirus – a close relative that is also one of the most common causes of the common cold.

Enteroviruses are so closely related to rhinoviruses that they are “indistinguishable from each other” on most tests performed by doctors, the CDC warns, and can be confused with each other.

“When EV-D68 is there, we need pediatricians, emergency physicians, urgent care providers, to be on the lookout for this rare paralytic disease that may be associated with it,” Messacar said.

Classes since 2014

Enterovirus D68 has been known to health authorities since the 1960s, when doctors discovered it to be the culprit of a group of hospitalized children in California.

Efforts to track the virus rise in power after an epidemic in 2014 led to the hospitalization of hundreds of children in the United States, as well as cases of paralysis and dead. Previous case acute flaccid myelitis and deaths in children are now also linked to the virus.

This epidemic of 2014 also started with hospitals notifying the CDC in mid-August of an “increase in admissions of children with severe respiratory illnesses” that have ultimately been linked to the virus.

Study finds possible link between enterovirus D68 and infantile paralysis


“Very similar to previous waves, it feels a lot like 2014 in children’s hospitals right now,” Messacar said.

Messacar, who is also an associate professor at the University of Colorado, was working on research studies in 2014 when the outbreak began to swell.

He now helps lead A pilot study for the National Institutes of Health, launched last year, which hopes to study the virus as it spreads this year, in hopes of accelerating responses to the disease.

Although no specific drug is currently licensed to treat acute flaccid myelitis caused by the virus, doctors have several possibilities for drugs and techniques that could help improve patients’ lives, especially if started early.

“Having seen these waves pass since 2014, for every case that we see coming from the onset of paralysis, we still see a few that come weeks or months later with other diagnoses,” Messacar said.

There are also no vaccines or treatments approved specifically to target enterovirus D68, although early data suggests monoclonal antibodies could work to prevent and treat the disease.

“It’s not 2014. We know more about what this virus does, how it does it, how to detect it, how to take better care of these children,” Messacar said.

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