Enterovirus D68 (EV-D68), a respiratory virus that can sometimes cause paralysis in children, is spreading across the United States. EV-D68 nucleic acids have been detected in wastewater, signaling a potential increase in cases of acute flaccid myelitis (AFM), a rare neurological condition linked to EV-D68. AFM can result in muscle weakness and, in some cases, permanent paralysis. Although most EV-D68 infections cause mild respiratory symptoms, about 90% of cases occur in children, and there is currently no specific treatment.
Here’s what we know about this virus
What is Enterovirus D68? – Enterovirus D68 is a virus that causes respiratory infections. It is most common in children and adolescents, but adults can also get it.
What is acute flaccid myelitis? – Some people with EV-D68 develop a nervous system disorder called acute flaccid myelitis (AFM). AFM causes sudden, extreme muscle weakness and paralysis.
Enterovirus D68 in 2014 – The Enterovirus D68 strain first became a cause for concern in 2014 in the US, when the country saw a spike in pediatric acute flaccid myelitis for the first time. That year, 120 children were diagnosed with the condition.
Pattern of Enterovirus D68 and AFM – Since 2014, major waves of AFM have followed a biennial pattern, with peaks in 2016 (153 cases) and 2018 (238 cases).
COVID-19 pandemic – The pattern stopped in 2020, when the US went into lockdown due to the COVID-19 pandemic. This dramatically reduced viral spread, and that year, only 32 cases of acute flaccid myelitis (AFM) were recorded.
Post-lockdown – In 2022, the spread of D68 increased again as quarantines were lifted. However, there was no increase in AFM cases. Experts say this could be due to the way the virus itself has changed or that more people in the US have been exposed and now have a level of immunity to D68.
How common is enterovirus D68? – According to scientists, enterovirus D68 is very common in the US, and most people over the age of five show evidence of a previous infection. Fortunately, neurological complications are relatively rare.
Other enteroviruses – Other enteroviruses, including poliovirus and enterovirus 71 (which causes some cases of hand, foot, and mouth disease), can also result in AFM.
Wastewater – According to data from the nonprofit WastewaterSCAN, enterovirus D68 was detected in 207 of 268 samples collected from wastewater treatment sites across the United States.
California Wastewater Treatment Plants – EV-D68 has been detected at medium levels at 17 wastewater treatment plants in California, including facilities in Los Angeles, San Diego, San Francisco, Sacramento, and San Jose.
What are the symptoms of enterovirus D68? – Symptoms of enterovirus D68 are usually mild. They include a stuffy or runny nose, cough, fever, muscle aches, and sore throat. Shortness of breath and wheezing may occur.
What are the symptoms of enterovirus D68? – Within a few days to two weeks after initial symptoms of EV-D68, some people develop symptoms of acute flaccid myelitis (AFM). These include weakness, slurred speech, difficulty swallowing, drooping eyelids, and back, neck, or arm pain.
What causes an enterovirus D68 infection? – EV-D68 is a viral infection that is specifically a non-polio enterovirus. The infection is caused by the virus entering the body through respiratory droplets.
Spinal cord infection – Most people with EV-D68 have symptoms such as a runny nose or cough, but it can also infect the spinal cord, similar to the virus that causes polio. This can damage the nerves, causing temporary or permanent paralysis.
Is enterovirus D68 contagious? – EV-D68 is a contagious virus that spreads through sneezing, coughing, sharing eating utensils, touching contaminated surfaces, or coming into contact with infected feces (such as not washing your hands thoroughly after using the bathroom or changing a diaper).
What are the complications of enterovirus D68? – In addition to acute flaccid myelitis (AFM), EV-D68 can also lead to pneumonia, encephalitis, and meningitis. People with asthma or compromised immune systems are more likely to experience severe respiratory symptoms.
What are the complications of acute flaccid myelitis? – Acute flaccid myelitis (AFM) can affect the muscles used for breathing, which can result in respiratory failure. Approximately one-third of people with AFM require intubation and ventilation.
Neurological complications – AFM can also cause serious neurological complications, including changes in body temperature, unstable blood pressure, and irregular heart rate, which can be fatal.
How is enterovirus D68 diagnosed? – If you have mild, cold-like symptoms, your doctor is unlikely to test you for EV-D68. If you have more severe symptoms and your test is negative for common viruses such as flu and COVID-19, your doctor may suspect EV-D68 if it is spreading in your area.
How is enterovirus D68 diagnosed? – To confirm a diagnosis, your doctor may do a blood test or spinal tap to test your cerebrospinal fluid, particularly if you have nervous system symptoms. An MRI scan may also be used to diagnose and rule out other causes of weakness and paralysis.
How is enterovirus D68 treated? – There is no specific antiviral treatment for EV-D68. Mild symptoms usually improve within a week or two with home care. Severe cases need to be treated in a hospital, where a doctor can give you an intravenous antibody treatment that can help you fight off infection.
How can I prevent an enterovirus D68 infection? – Practicing good hygiene is essential to reducing the risk of contracting EV-D68 and spreading it to others. You should try to sneeze or cough into the crook of your elbow, disinfect high-touch surfaces, wash your hands with soap and water, and keep your children home from work when they are sick.
How long does it take to recover from enterovirus D68? – Mild symptoms of EV-D68 will likely subside after a week or two. However, if your child develops acute flaccid myelitis (AFM), it may take more than a year to recover. Your healthcare provider may recommend physical or occupational therapy.
How long does it take to recover from enterovirus D68? – While most children with acute flaccid myelitis regain some muscle strength and function, some never fully recover. According to research, less than 10% of individuals with AFM make a full recovery.
How can I care for myself or my child at home? – You can relieve mild symptoms by drinking plenty of fluids and getting plenty of rest, taking a warm bath to relieve congestion, and taking over-the-counter medications for fever and pain.
When should you go to the hospital? – Go to the emergency room right away if you or your child develops severe symptoms, such as trouble breathing, blue skin, lips, or nails, or any symptoms of acute flaccid myelitis, such as slurred speech, weakness, or paralysis.
Antiviral medication? – Experts have begun conducting safety studies on a monoclonal antibody designed to block D68. In studies involving mice, it successfully prevented infections that could lead to acute flaccid myelitis (AFM). However, research is expected to take years before the treatment is deemed safe and effective.
Sources: (CNN) (NBC News) (LA Times) (Cleveland Clinic) (Stars Insider)
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