Rising instances of a virus potentially causing paralysis in children have sparked concerns among parents. What level of uneasiness is appropriate?
What is Enterovirus D68 and how does it spread? How prevalent is it, and how are we seeing an increase in cases? What are its symptoms, and what are the chances of it leading to acute flaccid myelitis? How worried should parents be, and what measures can families take to lessen their risk of contracting this virus?
To help us answer these questions, I spoke with CNN health expert Dr. Leana Wen. Wen is an emergency physician and professor at George Washington University, and she was previously the health commissioner of Baltimore and now has two school-aged children.
CNN: What is Enterovirus D68? How frequently does it occur, and how can we determine that cases are increasing?
Dr. Leana Wen: Enterovirus D68 is one of over 100 non-polio enteroviruses. Many people who contract it have no symptoms or only mild cold-like symptoms. Most people are unaware they have an enterovirus infection.
This is why wastewater testing is useful. Testing sewage for viruses provides an early warning of virus activity in a specific area. It's especially useful for diseases that are often asymptomatic or rarely tested. Recent data shows that enterovirus activity is now at the medium level and has seen a significant increase since July.
CNN: How does Enterovirus D68 spread, and who is most susceptible to infection?
Wen: Enterovirus D68 is a respiratory virus that spreads when someone with the infection sneezes or coughs, and droplets land on someone else's nose, mouth, or eyes. These droplets can also land on surfaces or objects, and someone can become infected by touching those areas and then their nose, mouth, or eyes.
Children are more likely to get infected and exhibit symptoms. This is because children are in close contact with one another at school and daycare, and they may not always practice good hygiene. Adults can also get infected, but they are less likely to have symptoms, and if infected, they may only show mild symptoms in comparison to children.
CNN: What are the symptoms of Enterovirus D68 infection?
Wen: Many people will have mild cold-like symptoms, such as a runny nose, sneezing, fever, and a cough. Some may experience more severe symptoms, such as difficulty breathing, fatigue, and body aches. Less commonly, enteroviruses can cause inflammation of the brain and heart. Asymptomatic infection is also possible, making this virus harder to contain.
CNN: Can you tell us about acute flaccid myelitis, the rare but potentially dangerous complication that can develop from Enterovirus D68 infection?
Wen: Acute flaccid myelitis is a recently identified condition, first recognized in 2014. It shares some similarities with polio. Individuals first experience a viral infection, and then, a few weeks later, they develop sudden onset of arm or leg weakness. Other symptoms include loss of muscle tone and reflexes, facial droop, and slurred speech.
The condition can be life-threatening when respiratory muscles are involved; patients may require machines to help them breathe. It could also lead to problems with regulating blood pressure, body temperature, and heart rate.
There is no specific treatment for acute flaccid myelitis. Patients receive supportive care, such as hospitalization, fluids, anti-inflammatory medications, breathing support, and physical and occupational therapy. While some can recover completely, the majority have lasting symptoms and disability as a result of this disease.
CNN: How likely is it that Enterovirus D68 infection will result in acute flaccid myelitis? Should parents be concerned?
Wen: It's unlikely. Enterovirus infections are common, and the vast majority of cases are never diagnosed. Since acute flaccid myelitis was first identified in 2014, there have been 758 confirmed cases in the US. As of September 3, according to the CDC, there have been 13 confirmed cases in 10 states.
Though the number of affected individuals is low, I understand why parents are concerned about acute flaccid myelitis given its severity and the lack of a cure.
CNN: Are there steps families can take to reduce their risk of contracting this virus?
Wen: Everyone should wash their hands regularly and thoroughly with soap and water. Children should wash their hands when they return from school and after playing with their friends. Regular hand washing is especially important when soap and water are not readily available, in which case hand sanitizer should be used.
Older children can be taught to avoid touching their faces with unwashed hands, to cover their coughs and sneezes, and to use hand sanitizer or wash their hands after touching high-touch surfaces like doorknobs.
People ought to be vigilant for signs of severe difficulties that may suggest acute flaccid myelitis. Besides experiencing an abrupt loss of strength in the limbs or speech impairment, manifestations of this condition can include drooping eyelids, trouble swallowing, and fresh discomfort in the neck, arms, and back. Any occurrence of these symptoms necessitates immediate medical attention.
Although there isn't a specific vaccine for this enterovirus, there are vaccines available that safeguard against numerous other diseases. Parents and caregivers should ensure their children have received their necessary immunizations for childhood and that adults get the recommended vaccinations.
To maintain overall health and wellness during this time, regular hand washing is essential, as Enterovirus D68 spreads through droplets from an infected person's sneeze or cough. Washing hands often and thoroughly, especially after interacting with high-touch surfaces, can help reduce the risk of contracting the virus. Additionally, practicing good hygiene habits, such as covering coughs and sneezes and avoiding touching the face with unwashed hands, can further minimize the chance of transmission.
