Infectious Disease

CDC reports increased circulation of enterovirus linked to AFM

September 28, 2022

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Surveillance data show increased circulation of enterovirus D68 — or EV-D68 — over the summer in the United States after a period of low circulation during the COVID-19 pandemic, researchers reported this week in MMWR.

The report also noted an increase in detection of rhinovirus (RV) this past summer.

Enterovirus D68 returned in children this summer. Source: CDC

Circulation of EV-D68 in even-numbered years has been linked to spikes in cases of acute flaccid myelitis (AFM) in children.

co-author Kevin C Ma, PhDan Epidemic Intelligence Service officer in the CDC’s Division of Viral Diseases, said that after a peak in 2018, enterovirus levels fell off during the COVID-19 pandemic.

Kevin C Ma

“Increases in EV-D68 detections and AFM occurred in 2016 and 2018 as well, but detections were lower than expected in 2020, likely due to COVID-19 mitigation measures,” Ma told Healio. “In August 2022, clinicians in several geographic areas notified CDC of an increase in hospitalizations of pediatric patients with severe respiratory illness and positive RV/EV test results, potentially indicating a return of EV-D68 circulation.”

Ma and colleagues analyzed surveillance data from multiple national sources for their study to compare trends in 2022 to past years.

During a period lasting from March 1 to Sept. 20, 2022, the New Vaccine Surveillance Network enrolled 5,633 children and adolescents with acute respiratory illness (ARI) in need of emergency care or hospitalization. As of Sept. 20, RV/EV was detected in 1,492 (26.4%) of these patients, among whom 260 (17.4%) had a positive EV-D68 test result.

The authors also noted that the percentage of positive EV-D68 test results among children and adolescents with ARI and positive RV/EV test results increased to 56% during the week ending Aug. 13.

The percentage of positive EV-D68 test results during July and August 2022 was higher than during the same months in 2017 and 2019 to 2021 and similar to peak levels observed in 2018, Ma said.

Ma added that health care providers should consider EV-D68 as a possible cause of severe respiratory illness in children, particularly among children who wheeze or require respiratory support.

“Providers should have high clinical suspicion for AFM in children and adolescents with acute flaccid limb weakness, neurologic symptoms, or neck/back pain with a recent history of respiratory illness or fever,” Ma said. “Patients with AFM can experience rapid progression of muscle weakness and should be promptly hospitalized and referred to specialty care. Parents should contact a health care provider immediately if their child has trouble breathing or has a sudden onset of limb weakness. Parents should also ensure that their child is following an up-to-date asthma action plan if they have asthma.”

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