Enterovirus D68 on the Rise Among Children, Says CDC Advisory

CDC says there is a rare risk of serious respiratory infection and paralysis associated with the virus.

Father wiping toddler daughters nose
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  • More children are getting sick with enterovirus D68, a virus that usually causes respiratory illness, but can in some cases cause muscle paralysis, the CDC said. 
  • This year’s cases are on the rise, likely because children didn’t come into contact with the virus as much as they otherwise would have with COVID precautions in place, experts said. 
  • People can wash their hands and avoid contact with people who are sick to stop enterovirus from spreading, though experts say the CDC advisory should not be a cause for alarm. 

A health advisory has been issued for pediatricians and parents, warning about a rise in cases of enterovirus D68, a respiratory illness in children that can lead to muscle paralysis.

The advisory, issued by the Centers for Disease Control and Prevention, says pediatric acute respiratory illness surveillance sites are reporting an uptick in children who have enterovirus D68. And while the virus primarily causes acute respiratory illness, it "has been associated with acute flaccid myelitis (AFM), a rare but serious neurologic complication involving limb weakness," according to the CDC advisory.

Here's a closer look at enterovirus and the CDC's current recommendations.

What Is Enterovirus D68?

Enterovirus D68, which was first identified in California in 1962, is related to polio. Both are part of a family of illnesses that largely cause respiratory issues. But while enterovirus D68—or EV-D68—may trigger a cough or runny nose in most people, it can also cause AFM, which is an inflammation of the spinal cord that can lead to serious complications like trouble moving the arms and weakness in the legs.

This complication is rare, but it happens. A large enterovirus D68 outbreak that occurred in the U.S. in 2014 led to about 10% of those infected developing AFM, according to the CDC.

The just issued health advisory notes that healthcare providers and hospitals in several regions of the country notified the CDC in August that they were seeing rises in kids being hospitalized with "severe respiratory illnesses" who tested positive for rhinovirus (one of the main causes of the common cold) and enterovirus.

Testing subsequently showed that some of those children were positive for enterovirus D68, and the CDC noted that there's a "higher proportion" of kids testing positive for enterovirus D68 who have severe respiratory illnesses than in previous years.

Is the CDC Advisory Cause for Concern?

The CDC said the advisory is needed to tip off healthcare providers, laboratories, and public health departments about the increase in "severe respiratory illness requiring hospitalization in children" and to "urge healthcare providers to consider EV-D68 as a possible cause of acute, severe respiratory illness (with or without fever) in children."

The advisory is also designed to let healthcare providers know of the "potential for an increase in AFM cases in the upcoming weeks." Medical professionals say the warning is a good idea.

"I am already seeing a rise in cases of enteroviruses in general," Daniel Ganjian, MD, a pediatrician at Providence Saint John's Health Center in Santa Monica, California, told Health, noting that there are many different types of the virus. That's not unusual this time of year, though, he said.

Enterovirus—and EV-D68—usually peaks in late summer and early fall, the CDC explained. But it tends to cause an increase in cases every other year—which occured in 2014, 2016, 2018, and a bit in 2020, although the pandemic threw things off, Dr. Ganjian said.

"COVID interrupted the cycle," Ian Michelow, MD, division head of pediatric infectious diseases and immunology at Connecticut Children's Medical Center, told Health. "We haven't seen enterovirus as much over the past few years with masking and social distancing."

But that decline in enterovirus outbreaks has prevented people from building up typical immunity that they would get in daycare, preschool, or school, Dr. Michelow said. "People in the community have lost some of that protection and now kids are going back to school without masks," he said, noting that the rise in cases is "not that unexpected."

The warning is "refreshing everyone's memory that, 'Heads up: This is a thing to be aware of," Thomas Russo, MD, professor and chief of infectious disease at the University at Buffalo in New York, told Health.

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Enterovirus D68 symptoms

Enterovirus spreads from person to person when an infected person coughs, sneezes, or touches a surface that is then touched by others, the CDC says. It can cause mild to severe respiratory illness and symptoms including:

  • Runny nose
  • Sneezing
  • Cough
  • Body aches
  • Muscle aches

More severe symptoms can include:

  • Wheezing
  • Trouble breathing

If a child develops AFM, they will have symptoms that can include:

  • Arm or leg weakness
  • Pain in the neck, back, arms, or legs
  • Difficulty swallowing or slurred speech
  • Trouble moving the eyes or drooping eyelids
  • Facial drooping or weakness

How Serious Is Enterovirus D68?

It depends. "Most people that are infected are either asymptomatic or have mild respiratory tract infections," Dr. Russo said. "But the rare child could develop some form of paralysis."

The CDC noted that, in 2018, when enterovirus D68 last circulated at high levels in the U.S., the median age of kids who went to the ER or doctor for care was three. Children with a history of asthma or airway disease may also be more likely to get seriously ill, the CDC said.

"Parents should be aware that this is circulating more now," Dr. Michelow said. "If a child has a respiratory illness and it's getting worse, parents should be aware that it could be enterovirus D68."

How to keep your kids safe from enterovirus D68

While enterovirus spreads easily, doctors say you shouldn't keep your child home over fears they could become paralyzed. "You should not be freaking out," Dr. Michelow said. "This is a very common virus, and the majority of people with it do just fine." Dr. Ganjian agrees. "This is not meant to alarm anybody," he said.

The CDC recommends that you do the following to protect yourself and your family:

  • Wash your hands often with soap and water for 20 seconds.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Avoid close contact like kissing, hugging, and sharing cups or eating utensils with people who are sick, and when you are sick.
  • Cover your coughs and sneezes with a tissue or your upper shirt sleeve, not your hands.
  • Clean and disinfect frequently touched surfaces, like toys and doorknobs, especially if someone is sick.
  • Stay home when you are sick.

"It's all the common advice that is given to protect against other types of respiratory and intestinal viruses," Dr. Michelow said. But, he added, "allow kids to interact. Socialization is important."

Meaning, you don't need to keep your child away from birthday parties over enterovirus D68 fears. "Let kids live," Dr. Ganjian said. "They've already been through so much with the pandemic."

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