Los Angeles Health Departments and OC Warn of EV-D68 Respiratory Virus

Health officials are warning doctors of another contagious virus that could in rare cases send children to the hospital or lead to permanent paralysis.

In an advisory report, the US Centers for Disease Control and Prevention noted an increase last month in the number of children hospitalized with acute respiratory illnesses — including enterovirus D68 or EV-D68.

First identified in California in 1962, EV-D68 is worrisome because, in rare cases, it can damage the spinal cord and cause a condition known as acute flaccid myelitis — which leads to muscle weakness and can sometimes cause paralysis.

Overall, more than 90% of acute flaccid myelitis cases were in young children.

In response to the CDC’s notice, the Los Angeles County Department of Public Health issued its own guidelines that state that if paralysis or other symptoms of acute flaccid myelitis are suspected in a patient, physicians must report the case to their agency within 24 hours.

Orange County also issued an advisory, with Health Officer Dr. Regina Chinseo-Kwong saying the county is “experiencing a lot of respiratory illnesses affecting our community right now, both in children and adults … leading to hospitalizations.”

There are no vaccines available to protect against EV-D68.

But health officials have suggested that residents take steps to protect against other viral illnesses such as getting flu shots and staying up to date on COVID-19 vaccines and boosters.

EV-D68 can be transmitted through the saliva and mucus of an infected person and is likely to be spread “when an infected person coughs, sneezes, or touches a surface that others then touch,” the CDC said.

In general, infants, children, and teens are more likely to get enteroviruses and get sick. This is because they do not yet have immunity (protection) from previous exposure to these viruses,” the CDC says. “Adults can be infected with enteroviruses, but they are likely to have no or mild symptoms.”

According to the CDC, most cases of EV-D68 cause no symptoms or only mild symptoms. Mild symptoms include a runny nose, sneezing, coughing, and aches. Fever has been reported in about half of all known EV-D68 cases.

More severe symptoms, including unusual shortness of breath and difficulty breathing, are signs that a person needs immediate medical attention.

The Centers for Disease Control and Prevention said that children with asthma may be more likely to develop serious illness if they are infected with EV-D68. Asthma patients who see their symptoms worsen should seek medical care early, the agency said.

Small numbers of EV-D68 cases have been reported in the United States since 1987. But the nationwide outbreak of respiratory illness in late 2014 began raising awareness of associated acute illnesses.

The marked growth associated with EV-D68 cases in 2014, 2016 and 2018 led to an increase in acute flaccid myelitis cases each summer and fall, according to the CDC.

There was also an increase in cases of EV-D68, albeit to a lesser degree, in 2020. The spread of the virus is likely to be limited by the stay-at-home and concealment requirements in place due to the COVID-19 pandemic; There was no significant increase in acute flaccid myelitis that year.

There were 120 cases of acute flaccid myelitis nationwide in 2014; 153 in 2016; 238 in 2018; and 33 cases in 2020. In California, there were 24 cases in 2014; 28 in 2016; 15 in 2018; and four in 2020.

In 2018, EV-D68 was documented last year at relatively high levels, and the average age of children requiring care in emergency rooms or hospitals was about 3 years. “However, all ages of children and teens can be affected,” the CDC said.

The agency issued its latest advisory in light of data that EV-D68 cases in July and August were higher than the same period in each of the past three years. However, there were no increasing reports of acute flaccid myelitis or associated paralysis as of August 30.

But because increases in EV-D68 cases typically portend an increase in acute flaccid myelitis cases, officials say extra vigilance is necessary in the coming weeks.

Another possible cause of acute flaccid myelitis and paralysis is poliomyelitis. There has been one case of paralysis caused by polio in New York this year, and the polio virus has been found in wastewater in New York City and in several suburban counties northwest of the city as well as in Nassau County on Long Island.

On Friday, New York Governor Cathy Hochhol declared a catastrophic emergency related to the rise in polio in wastewater, allowing more types of workers to give polio vaccines and requiring health care providers to send polio immunization data to state officials.

People should seek medical attention for themselves or their children at once if they notice symptoms of weakness in the arm or legs; Pain in the neck, back, arms or legs. difficulty swallowing slurred speech; difficulty moving the eyes, drooping eyelids, or drooping face; or weakness.

Tracing EV-D68 is difficult because most hospitals and doctors’ offices do not perform the type of tests needed to determine the specific type of enterovirus.

The CDC recommends that clinicians consider EV-D68 as a possible cause of illness—particularly during the summer and fall—”as a possible cause of acute, unexplained acute respiratory illness, even if the patient does not have a fever.”

Dr. Robert Kim Farley, an epidemiologist and infectious disease expert at the University of California’s Fielding School of Public Health, said tactics to protect against EV-D68 infection are common sense: wash hands and stay home if you’re sick.

“If a child gets sicker than a normal cold, they should be seen by their health care provider,” Kim Farley said.

In addition, physicians and other clinicians should keep EV-D68 in mind as a possible cause of acute respiratory illness or sudden onset of muscle weakness and consider ordering specialized tests to confirm a suspected diagnosis.

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