Spike in Enterovirus Cases in Children: What You Need to Know

Hospitals and doctors are seeing a spike in respiratory infections in children linked to a virus called enterovirus D68, which typically causes cold-like symptoms but in rare cases is associated with a type of paralysis.

The Centers for Disease Control and Prevention has issued an alert about the rise in respiratory infections leading to hospitalizations.

While enteroviruses are common and circulate every year, enterovirus D68 was first identified in the 1960s and reemerged in 2014, causing a wave of illness among children.

“Back then we saw an incredible number of children with respiratory disease,” says Claudia Hoyen, MD, director of Pediatric Infection Control at University Hospitals Rainbow Babies & Children's.

“We were seeing tens of children in the hospital, hundreds of children in the ER and many more kids who were sick.”

Enterovirus D68 has appeared every two years since -- in late summer / early fall -- except for 2020, when pandemic restrictions curbed infections, Dr. Hoyen says.

Symptoms of Enterovirus D68

Infected children may have cough, fever and nasal congestion. Some also will have wheezing. Children with asthma are at increased risk of developing more serious breathing problems.

“For most kids, the worst that will happen is they get a bad cold, they may wheeze if they have a history of asthma or even if they don’t have a history of asthma. They usually recover fully and do just fine,” Dr. Hoyen says.

The CDC warned medical providers that enterovirus D68 has been associated with a neurological complication called acute flaccid myelitis (AFM), which causes limb weakness.

“It’s a very rare occurrence,” Dr. Hoyen says. “But there is a small number of children who develop paralysis, more in their limbs than other areas. There may also be issues with facial or eyelid drooping, trouble breathing or swallowing or pain in neck, back or extremities.”

Most of these children recover fully. But there are children who, depending on the severity of the AFM, may be left with some deficits, she says.

A number of children hospitalized with illness linked to enterovirus D68 have also tested positive for rhinovirus, a common cause of colds. Both viruses cause similar symptoms, and the CDC urged medical providers to test specifically for both viruses in cases of serious respiratory illness when the cause isn’t clear.

How to Prevent the Spread of Enterovirus D68

Like other cold viruses, enterovirus D68 spreads mostly through the air from coughing and sneezing, and also spreads through contact with contaminated surfaces.

The CDC recommends these steps to prevent spread of respiratory viruses:

• Wash hands often with soap and water for 20 seconds.
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Avoid close contact such as 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, such as toys and doorknobs, especially if someone is sick.
• Stay home when you are sick.
• Consider wearing a mask around other people if you have respiratory symptoms.
• Contact a medical provider immediately if you or your child has trouble breathing or has a sudden onset of limb weakness, pain or facial and eyelid drooping.
• Ensure you or your child are following an up-to-date asthma action plan if you or your child have asthma.
• Stay up-to-date with all recommended vaccines.

“We all know what to do to keep ourselves and other people safe from respiratory viruses,” Dr. Hoyen says. “A lot of us have become very savvy about infection-control techniques. It’s etiquette we learned over the last few years.”

Dr. Hoyen urges parents to keep symptomatic children home from school, and to have children vaccinated against flu and COVID-19.

“We want to keep people healthy and out of the hospital, as we’re coming into what we think is going to be a normal-to-heavy flu season, with a potential for COVID-19 resurgence on top of that.”

Related Links

University Hospitals Rainbow Babies & Children’s has the region’s largest coordinated network of pediatric primary care providers, committed to delivering the very best care to children of all ages, including routine immunizations. Find a UH Rainbow pediatric practice near you.