A virus that can rarely cause polio-like paralysis in children has resurfaced in the United States after mostly disappearing during the covid-19 pandemic. Reports from the Centers for Disease Control and Prevention that he isas spotted an upsurge in cases linked to enterovirus D-68. Based on recent past outbreaks, officials expect a small percentage of these cases to develop a serious neurological condition known as acute flaccid myelitis.
Over the weekend, the CDC Published a health advisory regarding EV-D68. Since August 2022, doctors and hospitals in several regions of the country have notified the agency of an increase in cases of serious respiratory illnesses and hospitalizations in children caused by two groups of viruses: rhinoviruses and enteroviruses. Additional testing showed that some of those cases were caused by EV-D68, and the CDC’s own surveillance data showed a higher proportion of respiratory illnesses linked to the virus. this summer compared to the last three years.
EV-D68 is one of many viruses that commonly cause mild colds, primarily in children. However, it is become apparent in recent years that infection can sometimes trigger AFM. The virus is a cousin of poliovirus, which has long been known to cause a similar paralytic state in about 0.1% of victims. And his suspected that EV-D68 has recently mutated in a way that makes it more similar to poliomyelitis and therefore more likely to cause AFM, although this is still a rare complication.
The main symptoms of AFM are sudden limb weakness, and some will also experience facial weakness, slurred speech, and pain along the limbs and back. In the most severe cases, people can develop life-threatening paralysis that causes respiratory failure, while others can develop permanent paralysis.
There are likely multiple causes of AFM, including other enteroviruses, but the spike in cases seen since at least 2014 is closely linked to outbreaks of EV-D68 in particular. These outbreaks of EV-D68 and AFM had occurred every two years as predicted for the past decade, likely due to declines in population immunity small enough that large groups of children catch it at the same time. But this pattern, which would have predicted another outbreak of AFM in 2020, changed once the covid-19 pandemic arrived.
While nearly everyone has already contracted covid-19, much of the world took precautions in the early years of the pandemic to avoid unnecessary social and physical contact. These efforts may have only slowed the spread of the highly contagious coronavirus, but they have been more effective in curbing the transmission of many others, less-contagious infections, EV-D68 included. It is only recently that many garden variety sprouts have begun to return storm in frequency, and experts have warned that the EV-D68 will eventually follow as well. The virus tends to be seasonal, arriving in the summer, as it is now.
There have been nearly 700 confirmed cases of AFM documented by the CDC since 2014, when the agency began officially tracking it. In recent epidemic years, there have been about 150 to 200 cases of AFM. So far only 13 cases have been reported in 2022. But the condition usually appears weeks after the first symptoms of a cold appear, and past outbreaks of AFM have also followed outbreaks of EV-D68. In its advisory, the CDC calls on physicians to be on the lookout for the disease and notes that “increased vigilance for AFM in the coming weeks will be essential.”
The the actual poliovirus did something of a unwelcome return in the United States this summer. In July, a young New York resident developed paralytic polio, and the virus has since been found in the state’s sewage, indicating potential for further spread. The virus may not spread very far, thanks to a very effective vaccine and a high vaccination rate (over 92% nationally), but there is still a danger for the unvaccinated, and its return could jeopardize the global effort to eradicate poliomyelitis as a human disease.
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