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Enterovirus, which can cause paralysis in kids, on the rise in US: What parents should know

This summer, there was an increase in kids being hospitalized with severe respiratory illness, in particular enterovirus D86. Know the symptoms and when to seek medical attention.

The U.S. saw increased rates of emergency department visits in children and adolescents due to acute respiratory illness in the summer of 2022. The increase since the beginning of the pandemic has prompted the Centers for Disease Control and Prevention to ask health care providers to be on alert for cases of acute flaccid myelitis (AFM), a polio-like condition that can lead to paralysis in kids and is believed to be caused by respiratory and other viruses.

In a report issued earlier this week, the CDC warned about increased circulation of enterovirus D68, a common virus that usually results in no symptoms or mild illness but may also lead to AFM, according to Children's Hospital of Philadelphia. The CDC report noted that a 2014 outbreak of enterovirus D68 coincided with an increase in AFM cases; about 10% of patients who tested positive for the virus developed AFM, NBC News reported.

According to Tuesday's report, between March 1 and Sept. 20, 2022, the CDC recorded 260 cases of enterovirus D68 in children seeking emergency care or hospitalization — more than the past three years combined, NBC News reported. On average, the children with the virus were 2.6 years old. Cases were detected around the country, including in Rochester, New York; Nashville, Tennessee; Cincinnati; Seattle; Pittsburgh; Houston; and Kansas City, Missouri.

As of Sept. 28, there have been 19 confirmed cases of AFM in 13 states this year, according to the CDC. In all of 2021, there were 28 confirmed cases in 15 states.

Experts believe that rates of enterovirus D68 are rising because kids are back in school and interacting more in person. “We have a group of kids now who’ve never seen the virus, because they weren’t having school exposures. So we think the at-risk population is bigger than in 2020,” Dr. Benjamin Greenberg, a neurologist at Children’s Health in Dallas, told NBC News.

The CDC report advised medical facilities to prepare for more cases of severe illness due to enterovirus D68 and recommended health care providers look for AFM in patients with limb weakness, especially if they recently had a respiratory illness or fever.

What to know about enterovirus D68

Enterovirus D68, believed to be pretty common, usually causes respiratory illness, which can range from mild, like a common cold, to more severe, according to the CDC. In many cases, the virus doesn't cause any symptoms. In the U.S., the risk of infection is greatest in the summer and fall, but it's possible year-round.

Infants, children and adolescents have the highest risk of getting ill from the virus.

The enterovirus D68 spreads through respiratory secretions, namely saliva and mucus, when an infected person coughs, sneezes or touches a surface that another person then touches.

There are no specific treatments for enterovirus D68. To prevent contracting the virus, practice good hand hygiene, avoid touching your face with unwashed hands, avoid close contact with others when sick, cover your coughs and sneezes and disinfect high-touch surfaces, like door knobs and toys.

What are the symptoms of enterovirus?

Mild symptoms of enterovirus D68 include runny nose, sneezing, cough, body aches and muscle aches. Severe symptoms often include wheezing and difficulty breathing. According to the CDC report, patients' most common symptoms were: shortness of breath, rapid or shallow breathing, wheezing, cough and nasal congestion.

If your child develops any limb or muscle weakness following a respiratory illness, seek medical attention immediately as it could be a sign of AFM.

What to know about AFM

Over the past several years, the CDC has recorded three spikes in rates of AFM — the first in 2014, followed by others in 2016 and 2018 — all of which are believed to be caused by enterovirus D68.

“AFM is an uncommon but serious neurologic condition,” the CDC explained. “Sudden onset of arm or leg weakness, loss of muscle tone, and loss of reflexes are the most common symptoms.”

AFM is most common between August and November, when enteroviruses are also most common. More than 90% of AFM cases are in young children.

What are the symptoms of AFM?

Seek medical attention right away if your child develops any of the following symptoms, especially after a respiratory illness, as patients with AFM should be hospitalized right away:

  • Sudden arm or leg weakness
  • Sudden loss of muscle tone or reflexes
  • Difficulty moving or dropping eyelids
  • Facial drooping or weakness
  • Difficulty swallowing or slurred speech
  • Pain in arms, legs, neck or back
  • Numbness or tingling in arms or legs

It takes between one and four weeks for a case of enterovirus D68 to progress to AFM; usually the patient has recovered from their respiratory symptoms before neurologic symptoms begin, according to NBC News.

“The outcomes are everything from just a little bit of slight shoulder weakness to difficulty moving all extremities and sometimes even needing prolonged respiratory support,” Dr. Sarah Hopkins, a pediatric neurologist at Children’s Hospital of Philadelphia, told NBC News.

The neurologic symptoms usually appear suddenly and can progress quickly, often peaking in just a few hours. There is no specific treatment, so the best way to protect your family is to practice good hand hygiene and wear a mask in public.