Enterovirus D68

You may have heard about recent spikes in cases of enterovirus D68, a respiratory virus that typically causes mild cold-like symptoms. However, the concern is about rare cases where it has been linked to a more serious condition– acute flaccid myelitis (AFM), which can cause paralysis. While this connection may seem alarming and with mainstream media using scary headlines, it’s important to stay informed and take practical steps without letting fear take over.

What is enterovirus D68?

Enterovirus D68 (EV-D68) is one of over 100 types of non-polio enteroviruses that typically cause mild respiratory illness. Like many common viruses, EV-D68 spreads through respiratory droplets when an infected person coughs or sneezes and through touching contaminated surfaces. It’s a common virus– if you’ve ever had a cold, you’ve likely encountered an enterovirus.

Most cases of EV-D68 cause symptoms similar to a common cold, such as a runny nose, coughing, sneezing, and body aches. In some cases, particularly in children with asthma or underlying respiratory conditions, the virus can lead to more severe symptoms like wheezing or difficulty breathing.

While EV-D68 is a common virus, it has gained attention in recent years because of its rare link to the neurological condition AFM. It’s important to remember that while EV-D68 outbreaks occur periodically, the majority of children infected typically experience mild cold-like symptoms without any long-term complications.

What is Acute Flaccid Myelitis (AFM)?

AFM is a rare but serious condition that affects the nervous system, specifically the spinal cord. Since 2014, there have been 758 cases in the USA (the last 10 years). It leads to muscle weakness and, in some cases, paralysis. Although the exact cause isn’t fully understood, enteroviruses like EV-D68 have been linked to outbreaks of AFM.

AFM often begins with cold-like symptoms, such as a fever, cough, and congestion. However, over the next few days, more serious signs may appear. The most common symptom is sudden weakness in the arms or legs, along with a loss of muscle tone and reflexes. Some children may also experience drooping eyelids, facial weakness, difficulty swallowing, or pain in the arms, legs, back, or neck. If you notice any of these signs, it’s necessary to seek medical care immediately.

There is still much we don’t fully understand about AFM, but researchers are actively working to uncover why only a small number of people develop it after a viral infection like EV-D68. Future studies aim to uncover who is most at risk and whether factors like genetics play a role. Because so much is still unknown, developing a targeted treatment has been challenging.

There is no specific treatment for AFM at this time, but medical teams focus on managing symptoms and helping children recover as much as possible. Care often includes physical and occupational therapy and a team of specialists, including neurologists. Ongoing research is exploring new treatments, including antivirals and monoclonal antibodies, with the hope of preventing the virus from leading to AFM. As more is understood about AFM, there is hope that additional treatments will be developed.

What are the current trends for AFM?

Although AFM can sound alarming, it’s important to keep in mind that it remains extremely rare. As I mentioned, according to the CDC, there have been 758 confirmed cases since tracking AFM in August of 2014. There have been a total of 13 confirmed cases in 2024, as of September 3rd.

AFM cases tend to spike every two years, typically in the summer and fall, often aligning with outbreasks of EV- D68. There was a noticeable dip in cases (see image) in 2020, when people were taking caution for Covid-19, and the virus didn’t have the opportunity to spread.

The image below from the CDC shows the cases in each state and cases by month since 2014 (click to follow the link for an interactive breakdown).

In addition to monitoring outbreaks through traditional public health measures, researchers are now using a new method to track viruses like EV-D68– wastewater surveillance. By testing municipal wastewater, scientists can detect the presence of various infectious diseases, including respiratory viruses, before they become widespread in the community.

One initiative is the WastewaterSCAN project, which collaborates with local governments to monitor viral activity in wastewater from across the U.S. This testing provides insight into trends in virus transmission, which can reveal what may be circulating in the population– often before people even show symptoms. This allows us to take preventative action and inform local healthcare providers and residents about increased risks.

Recent data from the WastewaterSCAN Dashboard shows that EV-D68 has been detected in 300 out of 416 samples in the past 10 days. This reflects an increase in viral circulation in some communities. This information provides real-time data, helping track viral loads rise and fall in specific areas. By knowing when the virus is circulating in your community, you can take extra precautions to protect your family. Although the presence of enterovirus in wastewater doesn’t guarantee an outbreak, but it can give us the information we need to be proactive and prevent an outbreak– it’s an indicator to be more vigilant with good hygiene and keeping an eye out for symptoms.

What can you do with this information?

As parents and caregivers, it’s understandable to feel concerned when you hear about spikes in viruses like EV-D68, especially when there’s a connection to something as serious as AFM. The key takeaway is that while AFM is rare, staying informed and focusing on practical steps will help ease worries and keep you proactive. So what can you do?

Practice good hygiene

The best way to protect your family is by reinforcing good hygiene habits. This includes frequent handwashing, especially after coughing, sneezing, or touching surfaces in public spaces. Avoid close contact with people who are sick can help limit the spread of respiratory viruses.

Monitor symptoms

If your child develops cold-like symptoms, watch for any signs of muscle weakness or difficulty breathing, especially if they have underlying respiratory conditions like asthma. Recognizing symptoms early and seeking medical care can make a difference.

Stay informed and maintain a balanced perspective

Keep an eye on public health udpates and seek information from reliable sources. For example, the wastewater surveillance data can give you a sense of what’s circulating in your community. While it’s important to be informed, remember that severe complications from EV-D68, including AFM, are rare. Keeping a balanced perspective can help you be proactive and avoid unnecessary fear.

How I approach these rare conditions as a pediatrician mother

This information doesn’t change how I live or how I encourage my kids to enjoy life. As parents, it’s only natural to feel a bit anxious when we hear about conditions like AFM. But here’s the good news: AFM is incredibly rare. Staying informed and aware is important, but so is remembering that those scary headlines don’t tell the full story (and yes, turning off the news sometimes helps!). We should focus on being cautious, not fearful– simple hygiene steps go a long way, and there’s no need to avoid all the fun that makes childhood special. What really matters is knowing when to seek help, so you can get the right care if needed. Make sure to subscribe to our YouTube channel, follow us on Instagram, and stay connected through our newsletter for helpful updates. My goal is always to provide support and reassurance—because as parents, we’re in this together.

If you find yourself worrying about health-related issues, you might find the PedsDocTalk podcast episode on health anxiety helpful in learning how to manage those concerns.

On The Podcast

October is ADHD awareness month and I invited Lori Long and Katie Severson founders of The Childhood Collective, an online resource to help parents of children with ADHD. Whether you or your child has ADHD or not, we discuss some very important parenting strategies that you may find useful even if your child does not have ADHD. We discuss:

• What to remember about the ADHD brain and how to better approach your child with ADHD

• Why some parenting discipline strategies like gentle parenting may not work with children with ADHD and what they may need instead

• How to approach ADHD parenting with prevention versus consequences

On YouTube

This video tackles constipation in children, explaining its causes, symptoms, and prevention strategies. Constipation can manifest as difficulty passing stool, pain during bowel movements, or even a psychological reluctance to poop. Children may become backed up, leading to a cycle of discomfort where they become scared to poop due to previous pain. I address the triggers that cause constipation and address natural solutions that you can try before medication.

This video includes

• What is constipation? How does it happen?

• Symptoms of constipation

• Step-by-step guide to preventing constipation

• When to seek help for your child’s constipation

Ask Dr. Mona

An opportunity for YOU to ask Dr. Mona your parenting questions!

Dr. Mona will answer these questions in a future Sunday Morning Q&A email. Chances are if you have a parenting concern or question, another parent can relate. So let's figure this out together!