In recent months, thousands of children have been exposed to an unusual outbreak of enterovirus D68, or EV-D68. Typically a mild virus that leads to the common cold, many of the recent cases have caused patients to develop respiratory symptoms requiring hospitalization. Now, 10 children in Colorado are being treated for mysterious muscle weakness that may be connected to the outbreak.
Children’s Hospital Colorado reports that they have treated over 4,000 children with the unusual respiratory symptoms in their clinics since August 18. This figure is reportedly 10% above the usual rate, straining the medical provider’s resources. However, physicians say that similar situations are occurring across the country, proof of the virus’s transference from coast to coast. But of the thousands of children who have or are suspected to have been affected by EV-D68, only 10 have displayed a curious muscle weakness, which affects the arms, neck, and occasionally the skeletal muscles used for swallowing. Only four out of eight of the children displaying these symptoms tested positive for EV-D68. Given the strangeness of the recent outbreak, however, the Centers for Disease Control and Prevention (CDC) are reportedly investigating these cases and asking doctors across the country to watch out for similar symptoms.
It is not unheard of for viruses to cause paralysis or muscle weaknesses, and EV-D68 is known to be a distant relative of polio, a well-known cause of paralysis. Despite this, doctors at Children’s Hospital Colorado have stressed that they do not suspect polio is involved, as all of the affected children had been fully immunized against the disorder. Additionally, none of the latest victims have actually been paralyzed, and six been able to return home, although their symptoms have not completely abated. Tests of the 10 children’s spinal fluid found no evidence of the virus at the site, and at least one theory speculates that whatever is causing the symptoms may be attacking nerves elsewhere in the body.
Surprisingly, this recent cluster of cases is not the first time these unusual symptoms have emerged, though they are still incredibly rare: in 2012, Stanford doctors identified more than 20 cases of paralysis-like symptoms following a respiratory illness. The children in this case had also been fully immunized against polio. Similar cases have also been reported recently in Boston. But despite the similarities, the cases in California occurred over a longer span of time and also included adults. Moreover, the Colorado cluster seems to be more severe.
Currently, the CDC reports it has confirmed 443 cases of EV-D68 in 40 states and Washington, D.C. If this figure seems low, it is because very few health departments can perform the specialized test for enterovirus infections. Instead, most tests healthcare providers use identify a category of viruses, and many stop testing when a certain virus is known to be circulating. But even if every suspected case was tested for EV-D68, it likely wouldn’t affect the way patients are treated; because there is no antiviral drug that treats the specific strain, patients are generally given fluids and medication for their symptoms. As a result, the majority of cases, which would not be characterized by respiratory difficulties or muscle weakness, are likely being treated at clinics, such as urgent care centers, 70% of which are open by 8 AM for patient convenience.
Doctors are stressing that parents should not panic; most children who contract the virus won’t have anything worse than a runny nose. However, as the outbreak continues, a number of questions remain unanswered: for example, why are these symptoms developing? And is Enterovirus D68 really to blame?