CDC: Increase of severe respiratory illness in kids may lead to rare neurologic condition with limb weakness

This photo shows an electron micrograph of a thin section of numerous, spherical EV-D68 viral particles. (Photo: Cynthia S. Goldsmith and Yiting Zhang, CDC)

Pediatricians and hospitals across the U.S. are reporting an increase in children being hospitalized with a severe respiratory illness that, in rare cases, can lead to serious neurologic complications involving limb weakness.

The Centers for Disease Control and Prevention issued a health advisory about Enterovirus D68, or EV-D68, after doctors reported the uptick in pediatric hospitalizations during the month of August.

The virus typically causes respiratory illness with mild symptoms including runny nose, sneezing, cough, body aches and muscle aches. However, it can also produce more severe symptoms such as wheezing and difficulty breathing.

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In rare cases, the CDC says EV-D68 can also cause acute flaccid myelitis, or AFM, a serious neurologic condition that mostly affects children and causes the muscles and reflexes in the body to suddenly become weak.

What are the symptoms?

Parents are warned to seek immediate medical attention if their child develops any of the following symptoms of AFM, especially if they come after a respiratory illness:

  • arm or leg weakness
  • pain in the neck, back, arms, or legs
  • difficulty swallowing or slurred speech
  • difficulty moving the eyes or drooping eyelids
  • facial droop or weakness

2014 outbreak, other increased activity

This is not the first time health officials have seen an uptick in EV-D68 cases.

The CDC said during the summer and fall of 2014, the U.S. experienced an outbreak of EV-D68 cases. From mid-August 2014 to January 15, 2015, CDC or state public health laboratories reported that 1,395 people contracted the illness. Almost all of the cases involved children. 

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Increased activity was also reported in 2016 and 2018, with lower levels in 2015, 2017, and 2019. They noted the lower circulation in 2020 was likely due to the use of COVID-19 pandemic infection mitigation measures in place at the time, which are known to have interrupted the circulation of other viruses as well.

While there have not yet been any increased reports of AFM cases in 2022, the CDC noted that in previous years, "increases in EV-D68 respiratory illnesses have typically preceded cases of AFM, indicating that increased vigilance for AFM in the coming weeks will be essential."