September 12, 2022
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An influx of Enterovirus D68 could cause a spike in acute flaccid myelitis cases among children, the CDC says. The virus typically causes the common cold but, in rare cases, it can lead to AFM, a polio-like neurological condition that causes paralysis.
Due to an uptick in child hospitalizations attributed to a virus that generally cause the common cold, federal health officials are asking providers to watch for a related – but rare – polio-like syndrome.
Hospitals in several regions of the United States have reported more cases of severe respiratory illnesses caused by enteroviruses, the Centers for Disease Control and Prevention said in a health alert issued Friday. Enteroviruses typically cause mild symptoms, with transmission peaking during the fall. But in rare cases, a particular strain, EV-D68, can lead to a progressive form of paralysis called acute flaccid myelitis, or AFM.
Children with AFM rapidly develop limb weakness. Some also will experience droopy eyelids, facial weakness, difficulty swallowing or pains in the arms, legs, neck or back. AFM affects the nervous system, specifically the area of the spinal cord called gray matter, which causes the muscles and reflexes in the body to become weak.
Symptoms can progress within just a few days. Though some children recover completely from the syndrome, others never fully regain motor control and require long-term rehabilitation.
In previous years, AFM cases generally have spiked about a month after a new surge of enterovirus infections. Infectious disease experts are concerned about the possibility of a large wave this fall because very few enterovirus cases were reported during the height of the COVID-19 pandemic. That means there is a large number of children who have never been exposed to the virus, making them more vulnerable to severe illness, including AFM.
EV-D68 waves, and the resultant spikes in AFM, typically occur every two years, the CDC says. There were 120 AFM cases in 2014, 153 cases in 2016 and 238 cases in 2018. There was no wave in 2020, because of the preventive measures put in place to reduce the spread of COVID-19. That year, there were only 33 AFM cases.
There is no specific treatment or cure for AFM, but when it is diagnosed early, doctors can offer supportive care more quickly. Some doctors have found success with antiviral drugs combined with an anti-inflammatory medication.
Researchers haven't been able to determine why AFM occurs or who is most at risk.
The CDC is asking pediatricians and emergency department physicians to be on the lookout for patients presenting with limb weakness. Parents are urged to call a pediatrician if their children complain of limbs not working properly after they recovered from a respiratory illness.
