How To Reduce Your Child’s Risk Of The Enterovirus Infection

The CDC issued a health advisory on Friday (9/9/22) warning about a rise in enterovirus D68 (EV-D68) cases, which can rarely cause severe muscle weakness [the technical name is acute flaccid myelitis (AFM), a polio-like illness].

They also noted increases in hospitalizations of children with severe respiratory illness who tested positive for rhinovirus (RV) and/or enterovirus (EV). The two viruses can have similar symptoms. Commonly used lab tests may not be able to tell the two infections apart; specialized tests are required. Further testing has confirmed that many of the lab samples are from children with illnesses from EV-D68.

There are also “sentinel surveillance sites” called the New Vaccine Surveillance Network — in Pittsburgh, Rochester (NY), Nashville, Cincinnati, Kansas City (MO), Houston, and Seattle. They have more sophisticated diagnostic labs.

These sentinel sites are also reporting a higher proportion of EV-D68. The CDC’s alert is because this virus can cause a polio-like illness. The CDC wants to warn parents and physicians who would not ordinarily be expecting EV-D68 to be attuned to the possibility.

Non-polio enteroviruses can cause respiratory symptoms (and thus confusion with rhinovirus). They can also cause an array of other symptoms, including rash or hand-foot-mouth disease (HFMD), heart inflammation (myocarditis), and viral meningitis or encephalitis. Children hospitalized with EV-D68 may have respiratory symptoms, including cough, shortness of breath, and wheezing. Rarely, however, kids can develop sudden limb weakness, known as acute flaccid myelitis (AFM). They rarely recover muscle strength.

Enteroviruses tend to peak in late summer and early fall. Until 2014, few EV-D68 cases were diagnosed in the US. Then EV-D68 caused a large nationwide outbreak of severe respiratory illness in 2014 and lesser spikes in the fall of 2016 and 2018. AFM cases also rose, following the same biennial pattern. There was no spike in 2020, and other respiratory infections were also far less, likely due to Covid precautions. So far, at least 650 children have developed paralysis from the virus, among hundreds of thousands who have been infected. It is rare, but scary when it happens because of its devastating effects.

Because the seven sentinel sites are reporting increases in EV-D68, there is concern that cases of AFM will soon follow. There is added worry that this outbreak will be larger because the 2020 wave was small, and the population lacks immunity.

Should children develop sudden limb weakness, or AFM, the CDC would like to collect blood, stool, spinal fluid (if obtained), and throat or nasal swabs for study to determine if polio or EV-D68 is the cause. Other viruses—enterovirus A71, Coxsackievirus A16, West Nile virus, and adenovirus—can also cause AFM, but EV-D68 gets all the attention. They all require specialized testing to diagnose.

There is no specific treatment for AFM—or polio. While there is only one case of polio reported thus far in New York state, we are at risk for more polio cases because of the poor vaccination rates, particularly in the Hasidic community. Most cases of polio are asymptomatic, so the one case of paralysis is likely to be the canary in the coal mine. We also know that poliovirus has been detected in the wastewater of New York City and four nearby counties.

What can you do to reduce your kid’s risk?

For respiratory infections like rhinovirus and EV-D68, the emphasis remains on good hygiene and frequent handwashing. We’ve seen that wearing masks markedly reduced influenza and colds, as well as Covid, so many question why the CDC and many public health officials have abandoned these common-sense precautions. Some urge a greater emphasis on improving ventilation in schools, businesses, and homes.

It’s also important to avoid touching your eyes, nose, and mouth with unwashed hands, as those mucosal surfaces are ready routes to infection. Avoid sharing cups or eating utensils.

Catch your coughs and sneezes with a tissue or sleeve, and then wash or use hand sanitizer.

Disinfect frequently touched surfaces such as door knobs and handles. Bonus points if you use a paper towel to turn off faucets and open doors in public spaces—you’ll be amazed at how much less frequently you will become ill!

It’s essential to be up to date on your vaccinations—including all the childhood immunizations which have lapsed for too many since Covid began. Polio vaccinations are critically important. Measles is also surging in many areas and can be deadly.

Unfortunately, there is not likely to be any vaccine for these enteroviruses. As Columbia virologist Vincent Racaniello told me, “EV-68 is getting the headlines, but there are a dozen other enteroviruses out there that can also cause paralysis. And they do so in different countries—like in Asia, it’s enterovirus 71. In Europe, it’s different enteroviruses. So it’s not just one, and they’re different, so you can’t make one vaccine to hit them.” Similarly, because the muscle weakness comes on quickly and medicines are not likely to be effective once the paralysis has occurred, Racaniello does not believe that antivirals or monoclonal antibodies will be effective for these enteroviruses.

That leaves us with public health and common sense measures…which often seem to be lacking.