Rates of enterovirus D68 have increased significantly across the United States in recent months, based on wastewater data from WastewaterSCAN. The virus is now being detected at medium levels nationally, with the most significant activity seen in the South. Enterovirus D68, a respiratory virus, typically causes mild symptoms resembling a cold, but can lead to a rare and serious complication known as acute flaccid myelitis (AFM) in children. The rise in enterovirus D68 rates is concerning as it often correlates with higher rates of AFM, a neurologic condition that can result in muscle weakness and paralysis.
Since the spring of this year, enterovirus D68 activity has been increasing in all four regions tracked by WastewaterSCAN, including the West, South, Midwest, and Northeast. While the virus is most prevalent in the South, rates are rising nationwide. As of this year, there have been 13 confirmed cases of AFM in 10 states, with a total of 758 cases reported since 2014. The CDC has urged healthcare professionals to be vigilant in identifying symptoms of severe enterovirus infections and AFM in children.
Enterovirus D68 typically spreads through respiratory secretions such as saliva and mucus, with infants, children, and adolescents at the highest risk of contracting the virus. There are no specific treatments for enterovirus D68, so prevention measures such as good hand hygiene, avoiding close contact with sick individuals, and disinfecting high-touch surfaces are recommended. Symptoms of the virus can range from mild cold-like symptoms to more severe respiratory issues, such as wheezing and difficulty breathing. Severe cases may result in muscle weakness, which could indicate the onset of AFM.
AFM is a rare but serious neurologic condition characterized by sudden muscle weakness, loss of reflexes, and loss of muscle tone. More than 90% of AFM cases occur in young children, typically between August and November when enterovirus activity is at its peak. The condition was first identified in 2014 and has seen subsequent spikes in cases in 2016 and 2018, all believed to be linked to enterovirus D68. While the 2022 rise in enterovirus cases did not result in an increase in AFM cases, experts continue to study the connection between the two illnesses.
Patients with AFM should seek medical attention immediately if they experience symptoms such as sudden arm or leg weakness, loss of muscle tone or reflexes, difficulty moving, facial weakness, difficulty swallowing, speech issues, or pain, numbness, or tingling in limbs. Neurologic symptoms of AFM can appear suddenly and progress rapidly, with outcomes ranging from mild weakness to respiratory support being required. There is no specific treatment for AFM, underscoring the importance of prevention measures such as hand hygiene and public mask-wearing to protect against enterovirus D68 and potential complications like AFM.
