Don’t Panic if Your Child Has Enterovirus

Investigations continue on the causes of enterovirus flu cases.

Summer and fall are cold season — and in 2014, many children needed hospitalization after one especially rough respiratory ailment. Some parents are worrying that there’s a dangerous virus due to return.

Don’t panic. New, better testing tools have been developed, and evidence is emerging that last year’s flurry of seemingly related scary cases may, in fact, have more than one cause.  

Beginning in mid-August, hospitals saw a surge of children who had trouble breathing during a flu. Usually, the children had a history of wheezing or asthma. They turned out to be infected with an enterovirus known as “EV-D68,” which took days to identify by testing. The Centers for Disease Control and Prevention (CDC) had been hearing reports of “EV-D68” since 1987, but not in these numbers. The agency recorded more than a 1,000 cases.

A much smaller number of children around the country also showed up in hospitals with symptoms of paralysis. For example, the parents of a 6-year-old girl brought her to University of Virginia’s (UVA) Children’s Hospital in October after her right shoulder began to droop. She had trouble using her right hand. Before that, she’d had a cough, a slight fever, and headache.

Many suspected that “EV-D68” was causing both the respiratory and neurological cases. However, the girl’s test results later showed that she did not have an “EV-D68” infection. Instead, a sample from her respiratory tract showed an infection with a different virus, “EV-C105.” This virus was so rare that her doctor had never heard of it at the time. In a study of the case, a team from UVA note that “EV-D68” was detected in few of the children tested for it in 2014. They suggest that the outbreak of “EV-D68” at the same time as the neurological outbreak may have been a misleading coincidence.

The CDC reports that 118 children developed “acute flaccid myelitis” from August last year through this past April, with sudden weakness in one or more arms or legs and inflammation of nerve cells in the spinal cord that showed up on a MRI. The agency continues to collect reports and test specimens from patients. The median age of the children was about 7 years. Almost all of them were hospitalized; some were put on breathing machines. Most had a fever or cold-like symptoms before the paralysis showed up. Only two of the children have fully recovered.

The cause could be any number of viruses, including herpes — or other ailments. To sort this out and help patients, researchers have developed faster, and more sensitive tests for “EV-D68.” Many hospitals and some doctor’s offices can test ill patients to see if they have enterovirus infection, but most can’t pinpoint the virus. The CDC and some state health departments can. To prove a connection between a virus and neurological symptoms, the infection would have to show up in tests of cerebrospinal fluid. That has reportedly happened twice so far, according to the CDC.

Children develop neurological problems every year and often it goes unexplained. The possible causes also include environmental toxins, genetic disorders, and Guillain-Barre syndrome, an immune disorder.

“EV-D68” seems to spread as other viruses do, when an infected person coughs, sneezes, or touches a surface that is then touched by others. Children are more susceptible than adults. There is no medication to combat it, but you can take simple steps to avoid it.

“EV-C105” was first reported in 2012 in children from Peru and the Republic of Congo with respiratory and neurological symptoms, and seems to be circulating worldwide.