Mystery paralysis in children is perplexing parents — and researchers

BALTIMORE — Johns Hopkins Bloomberg School of Public Health researchers Aaron Milstone and Priya Duggal are leading a study to help children who have been paralyzed after contracting enterovirus. (Linda Davidson/The Washington Post) But then there was this mystery: More than 100 kids suffered an unexplained, polio-like paralysis that struck quickly but even now continues to stump researchers and upend the lives of the families across the country. For Priya Duggal and her colleagues at Johns Hopkins University, the biggest puzzle is why those children became paralyzed while their brothers and sisters, who also were exposed to the virus, escaped largely unscathed. [What is Enterovirus 68?] Many of the children with paralysis also got the virus, but initially they weren’t any sicker than their siblings or peers — until they experienced sudden muscle weakness days later. Some of the children, whose average age is a little younger than 8, have lost the use of an arm or a leg. Some have ended up in wheelchairs or on breathing machines. Although some have improved, according to the Centers for Disease Control and Prevention, almost none have fully recovered. When viruses mutate, scientists try to stay one step ahead. Columbia University virologist Vincent Racaniello explains the different ways that viruses like Enterovirus D68 can change. Doctors flummoxed Recently, as part of the Hopkins genetic study, Duggal sent DNA kits to some of the families wrestling with their new reality. One of the kits arrived at the Sheehan residence in Welches, Ore., a hamlet near Mount Hood. Bailey Sheehan, then 7, had woken up Oct. 21 with a headache and pain in her neck and back. She soon developed a respiratory infection. The rest of the family — her parents; brother Caleb, 5; and sister Andi, 4 months — also came down with flu-like symptoms. Everyone but Bailey recovered. Her respiratory problems cleared up, but the nerve pain got worse. One morning she had trouble lifting her arms. She later collapsed while trying to get up from the couch. “Mom,” she shouted, “my leg’s not working!” Mikell Sheehan rushed her daughter to Randall Children’s Hospital in Portland, an hour’s drive away. Bailey’s right arm had grown weak from shoulder to elbow; her right leg was numb from ankle to knee. She underwent tests, including for West Nile virus and Guillain-Barré syndrome. Physicians determined that Bailey had been infected by enterovirus D68, but they

BALTIMORE —
Johns Hopkins Bloomberg School of Public Health researchers Aaron Milstone and Priya Duggal are leading a study to help children who have been paralyzed after contracting enterovirus. (Linda Davidson/The Washington Post)
But then there was this mystery: More than 100 kids suffered an unexplained, polio-like paralysis that struck quickly but even now continues to stump researchers and upend the lives of the families across the country.
For Priya Duggal and her colleagues at Johns Hopkins University, the biggest puzzle is why those children became paralyzed while their brothers and sisters, who also were exposed to the virus, escaped largely unscathed.
“Is there something in these [paralyzed] kids that is different than the kids that are fine?” said Duggal, a genetic epidemiologist. “Maybe it’s the host, and the virus is a trigger that sets off the paralysis. . . . Maybe it’s something in their genetic makeup.”
Duggal and fellow researchers Aaron Milstone and David Thomas, who are gathering DNA from patients around country, are among the experts trying to find answers for families affected by the paralysis.
Doctors believe the condition, known as “acute flaccid myelitis,” is linked to last year’s nationwide outbreak of enterovirus D68, or EV-D68 — part of a family of viruses that appears in summer and fall — but they haven’t proved a connection. The outbreak probably sickened millions of children and sent thousands to doctors’ offices and emergency rooms with severe respiratory problems.
[What is Enterovirus 68?]
Many of the children with paralysis also got the virus, but initially they weren’t any sicker than their siblings or peers — until they experienced sudden muscle weakness days later.
Some of the children, whose average age is a little younger than 8, have lost the use of an arm or a leg. Some have ended up in wheelchairs or on breathing machines. Although some have improved, according to the Centers for Disease Control and Prevention, almost none have fully recovered.
When viruses mutate, scientists try to stay one step ahead. Columbia University virologist Vincent Racaniello explains the different ways that viruses like Enterovirus D68 can change.
Doctors flummoxed
Recently, as part of the Hopkins genetic study, Duggal sent DNA kits to some of the families wrestling with their new reality. One of the kits arrived at the Sheehan residence in Welches, Ore., a hamlet near Mount Hood.
Bailey Sheehan, then 7, had woken up Oct. 21 with a headache and pain in her neck and back. She soon developed a respiratory infection. The rest of the family — her parents; brother Caleb, 5; and sister Andi, 4 months — also came down with flu-like symptoms.
Everyone but Bailey recovered. Her respiratory problems cleared up, but the nerve pain got worse. One morning she had trouble lifting her arms. She later collapsed while trying to get up from the couch. “Mom,” she shouted, “my leg’s not working!”
Mikell Sheehan rushed her daughter to Randall Children’s Hospital in Portland, an hour’s drive away. Bailey’s right arm had grown weak from shoulder to elbow; her right leg was numb from ankle to knee. She underwent tests, including for West Nile virus and Guillain-Barré syndrome. Physicians determined that Bailey had been infected by enterovirus D68, but they couldn’t say for sure whether that caused the paralysis.
[How virus sleuths and officials are tracking the mysterious illness]
“The doctors just tell us they don’t know [the cause],” Sheehan said. “It’s the most terrible feeling to have to tell your little girl, who’s in so much pain and whose leg won’t work, ‘I don’t know how to fix it and neither do the doctors.’ ”
In her hunt for answers, Sheehan has scoured medical literature, called experts at the CDC and traded information online with other parents whose children have been affected. She has written to President Obama and other elected officials, talked to reporters, and enrolled her daughter in studies like the one at Johns Hopkins.
Nearly four months after her ordeal began, Bailey, now 8, still undergoes intense physical therapy six days a week. She’s learning to ride a bike again; her paralyzed foot must be strapped to the pedals. She recently returned to second grade but still uses a leg brace and a walker.
Other children are having similar struggles.
Thirteen-year-old Billy Sticklen of Joplin, Mo., developed polio-like paralysis this summer during an outbreak of the respiratory virus EV-D68. Billy's family moved from Joplin to Kansas City, Mo., to access physical therapy at Children's Mercy Hospital. Occupational therapist Kelly Grabendike works with Billy in the therapy pool on Jan. 28. (Jill Toyoshiba/The Kansas City Star)
A 13-year-old boy from Joplin, Mo., spent months in a wheelchair after he became paralyzed in September; he still uses a cane to walk. A first-grade boy in Tennessee lost the use of his right arm. Another girl in Oregon was almost completely paralyzed from the neck down.
In Seabrook, N.H., Dan Dugan, 13, spent nearly 50 days in Boston hospitals last fall after he had paralysis in his left arm and leg. Friends and businesses organized fundraisers. A store posted a sign saying, “Pray for Danny.” After months of rehabilitation, Dan, the youngest of six children, was able to move from a wheelchair to a walker and he recently began using special crutches.
“He’s got a good attitude,” said his father, Patrick Dugan, a mechanic who owns Pat’s Towing in Seabrook. “He’s not down about what happened. He has kind of accepted everything.”
No direct link to virus found
Mary Anne Jackson, chief of infectious diseases at Children’s Mercy Hospital in Kansas City, Mo., is one of the researchers trying to explain the inexplicable condition.
When several cases surfaced at her hospital last year in children between the ages of 4 and 13, she and other doctors suspected that enterovirus was the culprit.
“We looked at blood, spinal fluid, stool — thinking we’d find [the EV-D68] virus,” Jackson said. “It just wasn’t there.”
They also saw on MRIs what other doctors nationwide were noticing: distinctive damage to a specific part of the spinal cord. “That’s the classic feature of polio,” Jackson said. “On the scan, it looks like polio.”
Doctors in Kansas City and at other children’s hospitals are examining hundreds of old MRIs of children who had suffered from limb weakness to see if the same pattern on the images may have been overlooked in the past.
Researchers at the CDC are equally perplexed.
In any given year, it’s not uncommon for several cases of acute flaccid paralysis to occur, said Jim Sejvar, a CDC neuroepidemiologist. But when the agency queried doctors around the country, he said, “almost unanimously, you get a response that they’ve really never seen anything like this.”
Like other specialists, Sejvar thinks there’s a striking association between EV-D68 and the sudden onset of paralysis. “If you overlay the epidemiological curves,” he said, “they are almost identical.”
CDC scientists haven’t had any more luck than other researchers in finding a direct link. They recently developed a test for antibodies in the blood that was designed to show whether children who became paralyzed were more likely to have had EV-D68 than other children.
But when officials tested the blood of children who had experienced severe respiratory problems and other flu-like symptoms from last fall and from previous years, nearly all of them possessed antibodies to the virus, offering no new evidence that EV-D68 was the cause of the paralysis cases. It was another dead end.
“We were really hoping that would pan out,” Sejvar said. “Everybody wants an answer.”
The CDC is putting together a long-term study to track the 112 children it has identified so far with the condition — how their paralysis progresses, whether they improve over time, which treatments work.
Kevin Messacar, an infectious-diseases physician at Children’s Hospital Colorado in Aurora, will be part of that effort. He and several colleagues recently published a study in the Lancet describing a dozen children with the disease who were treated at the hospital. Their findings suggested “the possibility of an association” between EV-D68 and the neurological problems that followed, saying it could represent a newly emerged strain or a viral mutation. “We don’t have an answer, but I think science progresses by generating hypotheses and theories that get further tested,” Messacar said.
He and others have been helping set up a multidisciplinary clinic where paralyzed children and their families can receive medical care but also can come together for emotional support while they wait for answers.
“It’s got to be very frustrating as a parent to not know,” Messacar said. “Our obligation is to be honest with them. At this time, there’s so much that’s unknown about a new condition like this. Our job is to provide physical and psychological support to help them deal with this.”
Genetic fears
Hopkins researchers are eager to compare the DNA of children who experienced paralysis with that of their siblings who didn’t. “It’s highly likely that children in the same family got the same virus. . . . But one got this severe outcome, and one only got a viral infection,” Duggal said. “It raised flags to us that it potentially could be something genetic.”
Sheehan thinks that theory makes sense. On Feb. 17, in between Bailey’s doctors’ visits and physical therapy sessions, she collected saliva samples from Bailey and Caleb in two plastic tubes from Hopkins. She slipped them into a pre-addressed envelope and dropped it off at a post office.
She knows it could take a year or longer for the study to produce results, and even then the answers might remain elusive. But knowing that experts are working on the mystery helps soothe what has become her biggest fear.
“I’m scared,” she said, “that Bailey and these other kids are going to be forgotten.”
Researchers hope parents of children who contracted the virus will contact them to participate in the study. Participants are sent this tube as part of a saliva sample kit. (Linda Davidson/The Washington Post)


Find information about a new disease that seems to be emerging with polio-like symptoms.

I'm interested in the states that have children who have been diagnosed with the polio like disease (PLD).  I'm not interested with any other country who has identified children with the PLD.  Interested in experimental trials and research on PLD.  What do we know about this disease?

I'm interested in the states that have children who have been diagnosed with the polio like disease (PLD).  I'm not interested with any other country who has identified children with the PLD, nor information solely from any one individual state - it must reference multiple states or the broader USA.  Interested in experimental trials and research on PLD.  What do we know about this disease?

Find research or data on a specific disease's impact within a region to answer this question.

Severe respiratory virus afflicting children confirmed in at least six states, as others investigate possible cases

Will Cornejo, 13, recovers at Rocky Mountain Hospital for Children at Presbyterian/St. Luke’s Medical Center in Denver from what doctors suspect is enterovirus 68. (Cyrus McCrimmon/Denver Post)
Scores of children in at least a dozen states are afflicted by a severe respiratory illness, with at least six states confirming the presence of a rare virus strain in children as young as six weeks old, public health officials say.
Hospital officials in Chicago and Kansas City, Mo., reached out to the CDC last month after the number of people needing care for severe respiratory illnesses was “higher than expected for this time of year,” Anne Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases, said Monday.
Testing confirmed that patients in several of these states had a rare enterovirus strain that primarily leads to difficulty breathing, rather than rashes or neurological issues. Enteroviruses are incredibly common, with more than 100 strains leading to between 10 and 15 million infections each year, the CDC said. This rare strain, known as enterovirus 68, has been identified before in the U.S. and other countries, but it is fairly uncommon, Schuchat said during a conference call with reporters.
Other states are also investigating clusters of severe respiratory illness reports to see if this same strain is cropping up, the CDC said. About a dozen states in total had contacted the CDC by Monday, Schuchat said. The virus was confirmed to be in at least six states, according to the CDC and state health officials: Missouri, Illinois, Iowa, Kentucky, Colorado and Kansas. There are also suspected cases in Alabama, Georgia, Michigan, Oklahoma, Ohio and Utah, the CDC said Monday.
“We’re in a stage where it’s difficult to say just how big this is, how long it will go on for and how widespread it will be,” Schuchat said during a conference-call with reporters.
Centers for Disease Control officials say a potentially deadly respiratory virus that has sent hundreds of kids to the hospital in the Midwest is likely to spread across the country.
One hospital in Kansas City, Mo., reported treating nearly 500 children — ranging from six weeks old to 16 years old — for respiratory illnesses. Mary Anne Jackson, director of the infections diseases division at Children’s Mercy Hospital, said the “unusually severe outbreak” saw a surge that included dozens of children requiring care each day and required the hospital to open up new beds to treat everyone.
“It’ll be interesting to see what happens over time, because the way this virus spreads, kid to kid, it’s likely if it’s in 12 states it will be in more than 12 states over the next several weeks,” she said.
Jackson said that she believes that between 70 and 90 percent of the children treated at Children’s Mercy had this particular strain. Still, she said there is no need for public panic, because the majority of illnesses that will crop up will be like a “low-grade, common cold.”
There is no vaccination for this virus.
“Many people with this kind of respiratory virus will do well with time,” Schuchat said, adding that the virus typically lasts for about a week.
Most enterovirus infections in the U.S. occur in the summer and fall, so the timing of these infections are not unusual, Schuchat said. But the particular strain and the number of infections is unusual. In addition, children facing this strain could be wheezing or having difficulty breathing, a fairly clear sign that they need medical help.
“Most of the runny noses out there are not going to be turning into this,” she said
The only confirmed cases of this rare strain have been found in children, she said. More than half of the children confirmed to have this enterovirus strain in Kansas City and Chicago have a history of asthma or wheezing, which is why public health officials are urging extra care with children who have asthma.
On Monday, other states confirmed cases of the rare strain. Ann Garvey of the Iowa Department of Public Health said that the CDC confirmed samples sent from the state showed the strain. “It’s leading us to believe that we likely have some transmission statewide,” Garvey said, though she noted that so far health-care providers have not reported an overwhelming number of cases.
Health care officials in Colorado and Kentucky also told The Post on Monday that CDC testing had revealed that the virus was appearing in those states.
In Illinois, nearly a dozen specimens from a Chicago hospital tested positive for this strain. There have been increased reports of respiratory illnesses elsewhere in the state, but they have not been tested for the enterovirus strain, according to Melaney Arnold of the Illinois Department of Public Health.
Last month, 141 children from Kansas were treated at Children’s Mercy Hospital in Missouri and tested positive for either a rhinovirus or enterovirus; some of these children also tested positive for the rare strain of enterovirus, Aimee Rosenow, a spokeswoman for the Kansas Department of Health and Environment, told The Post.
States without any confirmed cases also remain on the lookout. While Ohio had no confirmed cases as of Monday, it did have potential cases across the state that required hospitalizing children, said Melanie Amato, a spokeswoman for the state Department of Health. The department is working with children’s hospitals in Cleveland and Cincinnati to send samples to the CDC and expects that some could come back positive.
“So far, we have not had any confirmed cases,” said Zack Moore, medical epidemiologist with the North Carolina Department of Health and Human Services. “But we don’t know what the future will hold, so we’re monitoring it very closely.”
Moore said that the reason this strain is worrisome is because it has been linked to clusters of illnesses, popping up in groups of infections.
The enterovirus 68 strain was first isolated in 1962 in California. While it has been rarely seen since then, it has cropped up in clusters and has been blamed for three deaths in the Philippines and Japan in recent years. Between 2009 and 2013, the National Enterovirus Surveillance System showed 79 reports of this strain, the CDC said.
Earlier this year, up to two dozen children in California were believed to be suffering from a polio-like illness. A report found that two of the five children tested positive for enterovirus 68; doctors noted that the exact symptoms varied in the five children.
Related:


Could polio drugs treat children with a mysterious paralyzing disease?

A child receives an oral polio vaccine. (Yahya Arhab/European Pressphoto Agency) Researchers developing drugs against polio and other polio-like viruses say those drugs could potentially be effective against a mysterious, polio-like condition called acute flaccid myelitis (AFM). One of the drugs in development, pocapavir, was used briefly on a few patients during a 2014 outbreak of AFM under a compassionate-use exception that allows extremely sick patients to be given unapproved drugs without the usual kinds of placebo-controlled trials required by the Food and Drug Administration. “There were a couple of kids who got pocapavir in the Colorado outbreaks,” said Benjamin Greenberg, a neurologist who has treated children with AFM at the University of Texas Southwestern in Dallas. “It had relatively weak but measurable impact on viral replication. A larger study would definitely be warranted. We'll take anything we can get.” Although the CDC says no cause has been conclusively linked to AFM, many researchers suspect a family of viruses known as enteroviruses. “I have been studying enteroviruses for 40 years now,” said John Modlin, deputy director of the polio eradication program at the Bill and Melinda Gates Foundation. “If I had a child with acute flaccid myelitis, I would be on the phone in a second to the companies making these drugs.” None of the drugs is approved by the Food and Drug Administration. Even pocapavir is currently unavailable on any basis because the FDA has required the small company studying it to submit a New Drug Application before it would consider allowing the drug to be offered on a compassionate-use basis again, said Marc Collett, president of the company, ViroDefense of Chevy Chase, Md. Even if the drugs could reach patients, Modlin said, they would be effective — if they work at all — only in the few days or hours when the condition first strikes. Despite those considerable drawbacks, not to mention the fact that no enterovirus has been proved to cause AFM, the CDC official in charge of its polio research says he understands the logic in trying to make the drugs available on a compassionate-use basis. “It is true there are a number of drugs that have been through safety trials,” said Steve Oberste, chief of the CDC's Polio and Picornavirus Laboratory Branch. “Some have been through phase 2 efficacy trials, and some have previously been used in other compassionate-use cases. But in those cases, at

A child receives an oral polio vaccine. (Yahya Arhab/European Pressphoto Agency)
Researchers developing drugs against polio and other polio-like viruses say those drugs could potentially be effective against a mysterious, polio-like condition called acute flaccid myelitis (AFM).
The Centers for Disease Control and Prevention has confirmed 89 cases of the paralyzing disease in the United States through September. A 6-year-old boy suspected of having AFM died in Seattle on Sunday, the first death believed to be caused by the disease.
One of the drugs in development, pocapavir, was used briefly on a few patients during a 2014 outbreak of AFM under a compassionate-use exception that allows extremely sick patients to be given unapproved drugs without the usual kinds of placebo-controlled trials required by the Food and Drug Administration.
“There were a couple of kids who got pocapavir in the Colorado outbreaks,” said Benjamin Greenberg, a neurologist who has treated children with AFM at the University of Texas Southwestern in Dallas. “It had relatively weak but measurable impact on viral replication. A larger study would definitely be warranted. We'll take anything we can get.”
Although the CDC says no cause has been conclusively linked to AFM, many researchers suspect a family of viruses known as enteroviruses.
“I have been studying enteroviruses for 40 years now,” said John Modlin, deputy director of the polio eradication program at the Bill and Melinda Gates Foundation. “If I had a child with acute flaccid myelitis, I would be on the phone in a second to the companies making these drugs.”
None of the drugs is approved by the Food and Drug Administration. Even pocapavir is currently unavailable on any basis because the FDA has required the small company studying it to submit a New Drug Application before it would consider allowing the drug to be offered on a compassionate-use basis again, said Marc Collett, president of the company, ViroDefense of Chevy Chase, Md.
Even if the drugs could reach patients, Modlin said, they would be effective — if they work at all — only in the few days or hours when the condition first strikes.
Despite those considerable drawbacks, not to mention the fact that no enterovirus has been proved to cause AFM, the CDC official in charge of its polio research says he understands the logic in trying to make the drugs available on a compassionate-use basis.
“It is true there are a number of drugs that have been through safety trials,” said Steve Oberste, chief of the CDC's Polio and Picornavirus Laboratory Branch. “Some have been through phase 2 efficacy trials, and some have previously been used in other compassionate-use cases. But in those cases, at least we knew there was an infectious agent, we knew what it was, so it was easier to justify. Still, I can certainly understand why someone might say, well, this drug is proven safe, what have I got to lose?”
Marijo De Guzman, whose son Daniel died Sunday following a tentative diagnosis of AFM, said that if her child had been offered the opportunity to receive one of the experimental drugs, “I would have said, let's try it, whatever we can do to try to save my son.”
Centers for Disease Control and Prevention
One of the drugs, pleconaril, was tested in newborns for the treatment of sepsis caused by enterovirus. In the study published in March, the drug was found to cut the risk of death from 42 percent in the placebo group to 23 percent in the group that received the drug. It is now under development as a treatment for enterovirus sepsis.
Pleconaril was rejected a decade ago by the FDA as a treatment for rhinovirus, the cause of the common cold. Despite evidence from randomized clinical trials that it shortened the duration and severity of the cold, it appeared to increase the possibility that women taking birth control pills would get pregnant. Because the common cold is relatively benign and self-limiting, the side effect was considered too much to justify approval.
The other two drugs, pocapavir and V7404, are under study by ViroDefense, a company that consists of Collett and two other employees. With funding or assistance from the CDC, the World Health Organization, the Gates Foundation, Rotary International and the FDA, they are developing the drugs as possible treatments for polio and other enterovirus infections.
Although vaccines against polio were first developed in the 1950s and have remained the backbone of eradication efforts, these drugs are being developed for people with immune deficiencies who can excrete the modified version of the virus contained in the vaccine for months following inoculation. Once excreted, the virus can continue to mutate in the environment and regain enough strength to infect other, non-vaccinated people.
By stopping replication of the virus in those people with immune deficiencies, therefore, the drugs are considered a necessary final nail to shut the coffin on polio forever. But the drugs also look to be effective against other non-polio enteroviruses, which can cause sepsis in newborns and brain inflammation in children or adults as well as, possibly, AFM. Even type 1 diabetes has been linked in many studies to exposure to enteroviruses.
“We're contemplating a combination product with the two compounds that would have broad spectrum, high potency,” said Collett, a molecular biologist.
Like the drugs used to control HIV infection, V7404 is a protease inhibitor, which prevents an enterovirus from replicating inside a cell. Pocapavir, on the other hand, is a capsid inhibitor, blocking formation of the shell that houses the virus's nucleic acid.
“We do get compassionate-use request periodically,” Collett said. “We currently are allowed to do it only for patients outside the United States.” The company hopes to have a New Drug Application ready to submit to the FDA by early in 2017, he said. Only then would the FDA consider allowing the drug to be offered again on a compassionate-use basis.
If AFM is caused by an enterovirus, he said, “I think the drugs will be useful. We're treating a polio case right now [in Argentina]. Pocapavir has been in a phase 1 study involving 114 patients, a phase 2 study, and was given on a compassionate-use basis to 23 infants, children and adults in the United States. No adverse events have been seen above and beyond the control-study levels. We're pretty hopeful. I don't think anyone would doubt the urgency or the need. But then there's the reality of clinical development. Trying to raise the money to lead to the drug getting to these very sick patients remains a significant challenge.”
Current treatments for AFM include the use of intravenous gamma globulin — antibodies obtained from the blood serum of many people and given in an attempt to boost a patient's ability to fight infections. Prozac has also been used, based on studies in animals suggesting it might have an effect. None of the therapies has yet been shown to have a significant benefit on patients.
Despite the uncertainties, Modlin at the Gates Foundation said, “There is a far greater likelihood that these drugs would work better than existing therapies for AFM.”


Faster lab test will check for rare respiratory virus, which means a surge in confirmed cases is coming

Jayden Broadway, 9, was treated for the rare virus at Children’s Hospital Colorado in Aurora, Colo., before being released. (Cyrus McCrimmon/The Denver Post via AP)
As a rare respiratory virus continues to sicken children around the country, spreading to hundreds in almost every state in a matter of weeks, the actual number of infections has remained a mystery. That is because the volume of possible cases requiring testing has been so large — and the testing process so, so slow — that public health officials are still working through a backlog that stretches back about a month.
This is about to change, as a new form of testing announced Tuesday by the Centers for Disease Control and Prevention should provide an up-to-date number of people infected with enterovirus 68, the rare virus strain, which is also known as EV-D68..
Of course, this means the number of confirmed infections is about to surge, which will only increase anxiety about a virus that has been linked to at least six deaths. Still, even as the CDC acknowledged that the number of cases “will likely increase substantially in the coming days,” the agency stressed that this didn’t mean there was a sudden surge in enterovirus infections.
“These increases will not reflect changes in real time or mean that the situation is getting worse,” the CDC said in a statement.
Rather, the higher numbers expected sometime next week will be due to the new testing, which will screen more than four times as many samples each day as the older lab tests.
So far, about half of the samples sent to the CDC for testing have been checked. These tests have found nearly 700 confirmed cases in 46 states and Washington, D.C., since the virus began sickening children in mid-August, according to the CDC.
The positive test results were found in about 60 percent of the 1,100 samples that have been tested from August through Oct. 10. And there are still about 1,000 samples that need to be tested, many of them received over the last month.
Columbia University virologist Vincent Racaniello explains how viruses like Enterovirus D68, influenza and Ebola mutate, and why it’s hard for doctors to keep up.
“CDC has received substantially more specimens for enterovirus lab testing than usual this year, due to the large outbreak of EV-D68 and related hospitalizations,” Anne Schuchat, director of the CDC’s National Center for Immunization and Respiratory diseases, said in a statement Tuesday.
The older test, which had been used by the CDC for nearly a decade, required more time and labor, and it only allowed about 40 tests to be conducted each day. This also took several weeks, Schuchat said. The new test is shorter, has fewer steps and actually lets the CDC check out multiple samples at the same time. The CDC said it will now be able to conduct about 180 tests each day and have results in just a few days.
The rare enterovirus was first identified as a growing problem for children late in the summer. Enteroviruses are quite common and are responsible for between 10 and 15 million infections each year, typically in the summer and fall, according to the CDC. This particular strain, which causes breathing problems, was first isolated in California in 1962 and has only been seen occasionally since the. There is no vaccination.
Between 2009 and 2013, the National Enterovirus Surveillance System received 79 reports of this strain, the CDC says. It has been blamed for three deaths in the Philippines and Japan, while researchers said earlier this year that some children suffering from polio-like symptoms in California had tested positive for this strain.
This year, hospitals have reported a significant number of cases of this strain over the last two months. Hospitals in Chicago and Kansas City, Mo., reached out to the CDC in August after they saw a higher number of children with breathing problems. Cases were identified in six states by early September, at which point Schuchat said it was difficult to know “just how big” the outbreak was going to be.
Centers for Disease Control officials say a potentially deadly respiratory virus that has sent hundreds of kids to the hospital in the Midwest is likely to spread across the country.
The rare strain spreads when an infected person coughs, sneezes or touches some kind of surface that other people touch. Almost all of the confirmed cases so far this year involved children, who do not have the immunity that adults have developed, and children with asthma or preexisting breathing issues are at a particular risk.
However, while hospitals are able to test for enteroviruses, most are not able to check for a specific strain, which is why states are sending their samples to the CDC and waiting. The official numbers grew and grew and kept on growing as the CDC tested more and more samples.
Meanwhile, there have been six known cases where a patient with this enterovirus died. A Rhode Island child died of a staph infection associated with the enterovirus infection, but at the time it was unclear exactly how much of a role the enterovirus played. Authorities directly blamed the enterovirus for the death of a four-year-old in New Jersey late last month, while a child in Michigan died last week while battling the enterovirus infection.
The CDC also said Tuesday it has heard “informal reports” from hospitals and states suggesting that fewer enterovirus 68 infections were seen, but it does not know yet if there is any sort of national decrease occurring.
A 21-month-old girl is the second child in the U.S. to die this year from a strain of the enterovirus that has infected more than 500 people.
Related:
What is Enterovirus 68?
New Jersey child dies of Enterovirus
Michigan toddler dies of Enterovirus
How viruses like Enterovirus, Ebola mutate
Rhode Island child dies of infection associated with virus


Paralyzing polio-like illness mainly affecting children confirmed in 22 states, CDC says

Federal health officials took the unusual step on Tuesday of warning the public about an increase in a mysterious and rare condition that mostly affects children and can cause paralysis.
So far this year, 127 confirmed or suspected cases of acute flaccid myelitis, or AFM, have been reported to the Centers for Disease Control and Prevention — a significant increase over 2017 and a worrying perpetuation of a disease for which there is little understanding.
Of the cases announced Tuesday, 62 have been confirmed in 22 states, according to Nancy Messonnier, a top official at the CDC. More than 90 percent of the confirmed cases have been in children 18 and younger, with the average age being 4 years old.
The surge has baffled health officials, who on Tuesday announced a change in the way the agency is counting cases. They also wanted to raise awareness about the condition so parents can seek medical care if their child develops symptoms, and so physicians can quickly relay reports of the potential illness to the CDC.
“We understand that people, particularly parents, are concerned about AFM,” said Messonnier, director of the National Center for Immunization and Respiratory Diseases. Despite extensive laboratory and other testing, CDC has not been able to find the cause for the majority of the cases. “There is a lot we don’t know about AFM, and I am frustrated that despite all of our efforts, we haven’t been able to identify the cause of this mystery illness."
The increase in cases appeared to begin in 2014, when the CDC started tracking the illness. Each year since then, usually in August or September, the CDC has logged a spike in the illness. The spikes were significantly higher in 2014, 2016 and 2018-to-date than in 2015 or 2017. The CDC knows of one child who died with the disorder in 2017.
Since officials have been unable so far to determine how the disease spreads, they are starting to count suspected cases as well as confirmed to better anticipate increases over the coming months. It’s too early to know whether the total for 2018 will surpass those previous years. But the data reported Tuesday represents “a substantially larger number than in previous months this year,” Messonnier said.
There is no specific treatment for the disorder, and long-term outcomes are unknown. The rare but serious disorder affects a person’s nervous system, specifically the spinal cord. Neurological conditions like it have a variety of causes, such as viruses, environmental toxins and genetic disorders.
Among the cases under investigation are five reported to Maryland health officials in recent weeks, a health department spokeswoman said Tuesday. Maryland’s first case was reported Sept. 21. No known cases have been reported in Virginia or the District this year, but there were three confirmed cases in Virginia in 2016, health department officials said.
Messonnier said it was important for parents and clinicians to remember that this is a rare condition, affecting less than 1 in 1 million children under 18. “As a parent myself, I understand what it’s like to be scared for your child,” she said. “Parents need to know that AFM is rare even with the increase in cases we are seeing now.”
Still, because this is a “pretty dramatic disease,” Messonnier said health officials want to raise awareness about the symptoms to make sure parents seek medical care immediately if their children show a sudden onset of weakness or loss of muscle tone in their arms and legs.
Once diagnosed, some patients have recovered quickly, but some continue to have paralysis and require ongoing care, Messonnier said.
After testing patients’ stool specimens, the CDC determined poliovirus is not the cause of the AFM cases. Messonnier said West Nile virus, which had been listed as a possible cause on CDC’s website, is also not causing the illnesses. In some individuals, health officials have determined that the condition was from infection with a type of virus that causes severe respiratory illness.
So far, the CDC has found no relationship between vaccines and children diagnosed with AFM from the 2014 cases. Officials said they will be conducting additional analysis on this year’s cases. “Our medical team has been reviewing vaccine records when available during this year’s investigation and do not see a correlation,” said CDC spokeswoman Kristen Nordlund. The disorder has been diagnosed in unvaccinated children and also in children who have received some of their recommended vaccinations, she said.
The agency doesn’t know who may be at higher risk for developing this condition or the reasons they may be at higher risk. The CDC has tested many different specimens from patients with this condition for a wide variety of pathogens, or germs, that can cause AFM. No pathogen has been consistently detected in the patients' spinal fluid.
There appears to be no geographical clustering of the U.S. cases and no other country has reported the pattern seen here so far of cases spiking every two years, Messonnier said.
Parents can best protect their children from serious diseases by taking prevention steps, such as washing their hands, staying up to date on recommended vaccines and using insect repellent to prevent mosquito bites.
Neurologists who specialize in treating brain and spinal cord illnesses may recommend certain interventions, such as physical or occupational therapy, on a case-by-case basis.
Benjamin Greenberg, a neurologist who has treated children with AFM at the University of Texas Southwestern in Dallas, said AFM is “exquisitely rare.” But, if their child is diagnosed, parents should prepare for extensive physical therapy — therapy that isn’t always covered by insurance, he said. Some children paralyzed by AFM have eventually regained their ability to walk, but need time.
“Families really sticking with it are seeing slow but steady recovery,” he said.
CDC is not releasing a list of the 22 states with confirmed and suspected cases because of privacy issues. But some state health departments have been making public their reported cases. States are not required to provide this information to CDC, but they have been voluntarily reporting their data.
Dana Hedgpeth and Justin Wm. Moyer contributed to this report.
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Spread of enterovirus D68 takes an alarming turn with reports of paralysis: What we know and don’t know

Since doctors in Denver reported last week that several children who tested positive for the respiratory virus experienced limb weakness or paralysis, there’s been a lot of confusion about what that means. Here’s the latest on what we do and don’t know about the mystery symptom: *None of the children are completely unable to move but have “varying degrees of muscle weakness, difficulty swallowing, difficulty breathing, weakness in the neck and trunk, and difficulty walking,” Joyce Oleszek, a pediatric rehabilitation specialist, told the Denver Post. *It’s too early to say whether the symptoms are permanent," hospital officials said. *Four of the children in Colorado tested positive for enterovirus D68. *Their symptoms are probably not related to polio. Eight of the 10 children affected were up to date on their polio vaccinations. (D68 is related to the virus that causes polio but D68 and other viruses in the enterovirus family typically do not cause these types of symptoms.) *They don't seem to be due to West Nile either. Tests of the children’s spinal fluid came back negative for the mosquito-borne virus. *The Centers for Disease Control and Prevention labs are backlogged with samples, but so far at least 443 people in 40 states and the District of Columbia have been confirmed as having been infected with the virus. It’s unclear how many of the children in that group are experiencing muscle weakness or paralysis symptoms as the CDC is still in the process of collecting that data. *There have been no deaths definitively linked to D68 although the New Jersey Department of Health on Monday said the CDC took samples from a four-year-old who died at home with suspicious symptoms.

Since doctors in Denver reported last week that several children who tested positive for the respiratory virus experienced limb weakness or paralysis, there’s been a lot of confusion about what that means. Here’s the latest on what we do and don’t know about the mystery symptom:
*Ten children at Children’s Hospital Colorado who were admitted between Aug. 9-Sept. 28 have experienced “paralysis-like symptoms,” according to the Denver Post. The affected children were ages 1 to 18 with the average age being 8.
*None of the children are completely unable to move but have “varying degrees of muscle weakness, difficulty swallowing, difficulty breathing, weakness in the neck and trunk, and difficulty walking,” Joyce Oleszek, a pediatric rehabilitation specialist, told the Denver Post.
*It’s too early to say whether the symptoms are permanent," hospital officials said.
*Four of the children in Colorado tested positive for enterovirus D68.
*Their symptoms are probably not related to polio. Eight of the 10 children affected were up to date on their polio vaccinations. (D68 is related to the virus that causes polio but D68 and other viruses in the enterovirus family typically do not cause these types of symptoms.)
*They don't seem to be due to West Nile either. Tests of the children’s spinal fluid came back negative for the mosquito-borne virus.
*Doctors at Children’s Mercy Hospital in Kansas City, Mo. are investigating three cases of children with similar symptoms, according to Bloomberg.
*The Centers for Disease Control and Prevention labs are backlogged with samples, but so far at least 443 people in 40 states and the District of Columbia have been confirmed as having been infected with the virus. It’s unclear how many of the children in that group are experiencing muscle weakness or paralysis symptoms as the CDC is still in the process of collecting that data.
*There have been no deaths definitively linked to D68 although the New Jersey Department of Health on Monday said the CDC took samples from a four-year-old who died at home with suspicious symptoms.
*A cluster of five children in California who also experienced paralysis-like symptoms was identified last year, and two of those children tested positive for EV-D68, according to CNN.
*A similar cluster was reported in Victoria, Australia in 2013. The Age reported that the enterovirus they were infected with was EV71, which is different from D68 but related to it.
*Since 2012, Stanford University researchers have been tracking at least 20 cases of childhood paralysis that appears to be similar to polio and began with respiratory symptoms. In a news release earlier this year, pediatric neurologist Keith Van Haren warned of a possible new threat.
"In the past decade, newly identified strains of enterovirus have been linked to polio-like outbreaks among children in Asia and Australia. These five new cases highlight the possibility of an emerging infectious polio-like syndrome in California,” Van Haren said.


What is Enterovirus 68, the mysterious illness that is sickening hundreds of children?

Centers for Disease Control officials say a potentially deadly respiratory virus that has sent hundreds of kids to the hospital in the Midwest is likely to spread across the country.
There have now been 153 confirmed cases in 18 states of a respiratory illness that has sent scores of children to emergency rooms and, in some cases, even to intensive care units.
Cases have now been confirmed in Minnesota and New Jersey, the Centers for Disease Control and Prevention said Thursday. Public health officials had previously confirmed cases in Alabama, Colorado, Connecticut, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Missouri, Montana, Nebraska, Oklahoma, Pennsylvania, New York and Virginia.
The culprit is Enterovirus 68 (also known as EVD-68 or Eentrovirus D68), a rare viral infection that can cause symptoms such as coughing, wheezing and low blood oxygen levels (also known as hypoxemia). In some cases, however, the symptoms can be severe — particularly for children who already suffer from asthma or other respiratory problems.
Jennifer Cornejo of Colorado told Denver's ABC affiliate that her 13-year-old son, William, had cold symptoms that developed overnight into a life-threatening illness. "He was in really bad shape," she told the station. "He came really close to death. He was unconscious at our house and white as a ghost with blue lips — he just passed out."
Here is how William Cornejo described it: "My head started hurting. And after that my lungs started closing up. It felt different."
Until recently, Enterovirus 68 was only thought to cause sporadic infections, but there have been reports of more widespread outbreaks in Georgia, Pennsylvania and Arizona between 2008 and 2010.
Only Missouri and Illinois have confirmed cases of EV-D68, but cases with similar symptoms have been reported in Colorado, Georgia, Iowa, Kansas, Kentucky, North Carolina, Ohio and Oklahoma, as well. Cases of EV-D68 have also been confirmed in Canada.
The outbreak, though worse than usual, is typical for this time of year, and the CDC expects that cases will decline in the fall. In the mean time, here is what you should know now:
Why is it called Enterovirus 68?
Enterovirus is the name used to describe a group of more than 100 of the most common viruses that affect humans and other mammals. Most people might interact with an enterovirus by way of the common cold, which can be caused by enteroviruses as well as rhinoviruses.
Enterovirus 68 got its number based on the order in which it was discovered. The first cases were identified in California in 1962 in four children who had bronchitis and pneumonia. Since it was discovered, and through 2005, there were only 26 confirmed reports of the virus to the Centers for Disease Control and Prevention.
How did it spread so quickly?
Enterovirus 68 spreads like the common cold: coughing, sneezing, or touching people or things infected with the virus and coming into contact with the nose or mouth.
With the start of school in late August and early September for most children in the United States, spreading the disease is more likely than ever.
"This is the right time of year for enterovirus infections," said Anne Schuchat, Assistant Surgeon General and Director, of the National Center for Immunization and Respiratory Diseases with the CDC. But she added that the number of potential cases is "higher than expected for this time of year."
But because there isn't much known about this virus, it is possible that Enterovirus 68 is more contagious than it was believed to be.
Since it was discovered in the 1960s, the virus has evolved, making it likely that how it is spread has also changed, said Rafal Tokarz, a scientist at Columbia University's Center for Infection and Immunity who has studied the spread of Enterovirus 68.
"We speculate that this virus in the past 10 to 15 years has sort of evolved into different sub types and has allowed it to become more prevalent worldwide," he said. "Maybe it has mutated into something that is more easily transmissible, I don’t know if that is the case but it's certainly possible."
Why are children getting sick but not adults?
So far, all of the confirmed cases of this virus have been in children, the CDC said, but the Enterovirus can also affect adults. According to the CDC, approximately a quarter of all Enterovirus 68 cases before 2005 were adults.
It is possible that the respiratory symptoms are more acute among children than adults. Kids, particularly if they suffer from asthma or other respiratory problems, might become so sick that they require a trip to the emergency room where they can be treated with breathing aids.
"It was initially believed to be associated mostly with kids, but there have been reports that it can also appear in adults," said Tokarz. "In adults, the symptoms may not be as severe, which is why in some cases the symptoms may be missed."
How do I know if my child has it?
Enterovirus 68 is just one of many potential causes of respiratory illness. And the only way to know if someone has this particular type of virus is through a form of testing that sequences the virus. If a child reports severe difficulty breathing, and especially if that child also suffers from asthma, parents should consult a health care professional.
Many hospitals are able to do this kind of testing, but if they cannot, they can send samples to the CDC, which has the ability to conduct more advanced testing and confirm an infection.
Is there treatment or a cure?
There is no treatment that is specific to the virus, and there are no anti-viral medications. But most cases of the virus are not fatal. Intensive treatment and supportive care, including oxygen provided in a hospital setting help. And in the confirmed cases of Enterovirus 68 from 2008 to 2010, the median length of time patients were hospitalized ranged from 1.5 to five days.
How do we stop it from spreading?
Other than treating the symptoms of patients who have contracted the virus, there is very little that can be done to stop the spread of EV-D68.
But practicing normal, good hygiene is more important now than ever. Washing hands, disinfecting surfaces, avoiding touching eyes, mouths, and noses with dirty hands can all help stop the spread of the virus. And if you or your child feels sick, stay home rather than risking further spreading the virus at work or at school.
Sarah Kaplan contributed to this report.
[This post has been updated.]
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Respiratory virus Enterovirus D68 hits the Northeast

Hundreds of children in several states have been stricken by a potentially deadly strain of enterovirus that is spreading across the United States. Mild symptoms typically look like those of a common cold: fever, runny nose, couching and sneezing, body and muscle aches. Many who became severely ill had asthma and experienced difficulty breathing and wheezing. “We’re starting to see a few just in the last day or so, where I’m really suspicious that’s what’s happening,” he told the station. He said at least one was treated in the Intensive Care Unit at the medical center. According to the CDC, Enterovirus D68 is spread by coughing, sneezing or touching contaminated surfaces. Although the virus could potentially infect adults, most cases have been reported in children.

Hundreds of children in several states have been stricken by a potentially deadly strain of enterovirus that is spreading across the United States.
Connecticut and New York are the two latest states to report possible cases of Enterovirus D68, the respiratory illness suspected of hospitalizing hundreds of children in 21 states in the South, Midwest and now Northeast.
New York became the first state on the East Coast to report cases of the virus that has been attacking children, especially those with asthma. On Friday, the New York State Department of Health announced the virus has been confirmed in more than a dozen children in the capital region and central New York. Onondaga County Health Department’s Medical Director Quoc Nguyen said two patients were in Onondaga County.
Although Enterovirus D68 has caused concern, particularly among parents of young children, enteroviruses themselves are common. The CDC estimated that 10 to 15 million people are infected with them each year. The Enterovirus D68 strain, in particular, dates to 1962 and hasn’t been widely reported in years, which experts said could be part of the problem.
“What’s unusual this time is this strain is causing severe respiratory disease,” Kennedy University Hospital Chief of Infectious Diseases David Condoluci told NJ.com. “We haven’t seen this strain for a long time, so a lot of kids don’t have the immunity for it.” In addition, there are no available vaccines or specific treatments for the virus, according to the CDC.
Mild symptoms typically look like those of a common cold: fever, runny nose, couching and sneezing, body and muscle aches. Many who became severely ill had asthma and experienced difficulty breathing and wheezing.
The Centers for Disease Control and Prevention sent out a health advisory stating it was working with hospitals and health departments to investigate such cases. The CDC has not yet confirmed the cases in New York State.
On Saturday, the Connecticut Department of Public Health said in a statement two hospitals in different parts of the state reported suspected cases of Enterovirus D68. The state health department said it is working with those hospitals and the CDC to facilitate laboratory testing.
Nicholas Bennett, head of the infectious disease department at Connecticut Children’s Medical Center, told FOXCT last week he saw a handful of patients whom he “highly suspects” have the fast-spreading virus.
“We’re starting to see a few just in the last day or so, where I’m really suspicious that’s what’s happening,” he told the station. He said at least one was treated in the Intensive Care Unit at the medical center.
After a surge in cases of severe respiratory illnesses last month popped up in Illinois and Missouri, the CDC ran tests and determined dozens of the children who were hospitalized there tested positive for a rare enterovirus strain. Most recently, Alabama and Washington state hospitals have seen an influx of sick children. Georgia, Michigan, Ohio, Oklahoma and Utah are also now investigating cases of respiratory illnesses, CNN reported.
The CDC since confirmed nearly 100 cases in six states: Colorado, Illinois, Iowa, Kansas, Kentucky and Missouri. Some state laboratories may have confirmed cases too, but those were not included in the CDC’s total.
According to the CDC, Enterovirus D68 is spread by coughing, sneezing or touching contaminated surfaces. Although the virus could potentially infect adults, most cases have been reported in children.
“It is important that we follow common sense rules to prevent the spread of this virus, as we do for flu and other contagious illnesses,” New York State’s State Health Commissioner Howard Zucker said in a statement. “Because there is no specific treatment or vaccination against this virus, our best defense is to prevent it by practicing proper hygiene.”
Related: What is Enterovirus 68?


Virus hospitalizes hundreds of kids in Midwest and South

Centers for Disease Control officials say a potentially deadly respiratory virus that has sent hundreds of kids to the hospital in the Midwest is likely to spread across the country. “You could see his ribs and his stomach was pushing out really hard. I thought it was an asthma attack,” Pam Sheldon told the station. “My head started hurting,” William said. “And after that my lungs started closing up. It felt different.” Hospitals in Colorado, Missouri and potentially eight other states are admitting hundreds of children for treatment of an uncommon but severe respiratory virus. Though only Missouri has confirmed cases of EV-D68, cases with similar symptoms have been reported throughout the Midwest and South. According to news reports, Missouri, Colorado, Georgia, Illinois, Iowa, Kansas, Kentucky, North Carolina, Ohio and Oklahoma have sent samples to the Centers for Disease Control for identification. Hospitals usually aren’t able to perform testing required to identify specific types of enteroviruses on their own. 13-year-old Will Cornejo is recovering at Rocky Mountain Hospital for Children at Presbyterian/St. Luke’s Medical Center in Denver on Sept. 5 from what doctors suspect is the respiratory virus, human enterovirus 68 that has come to Colorado. (Cyrus McCrimmon/Denver Post) Mark Pallansch, director of the CDC’s Division of Viral Diseases, said that the recent hospitalizations may be “just the tip of the iceberg in terms of severe cases.” EV-D68, which is likely causing this most recent outbreak, almost exclusively affects the upper respiratory tract and is especially severe in people who already experience breathing difficulties. Of the 90 confirmed cases described in the report, three were fatal, none of which occurred in the United States. But an editorial note warns that the virus is “increasingly recognized” for causing severe — and potentially deadly — respiratory illness. This year’s outbreak has hospitals scrambling to deal with the large number of cases. But early September is peak season for enteroviruses, and doctors say they expect the number of infections to begin leveling off.

Centers for Disease Control officials say a potentially deadly respiratory virus that has sent hundreds of kids to the hospital in the Midwest is likely to spread across the country.
Preston Sheldon’s mother said he seemed fine when she took him to preschool on Tuesday. Minutes later, according to News Channel 4, the Kansas City mom got a call that her 3-year-old was having trouble breathing.
“You could see his ribs and his stomach was pushing out really hard. I thought it was an asthma attack,” Pam Sheldon told the station.
Jennifer Cornejo of Lone Tree in Colorado told News7 in Denver her 13-year-old son William had cold symptoms that developed overnight into a life-threatening respiratory illness. “He was in really bad shape,” she said. “He came really close to death. He was unconscious at our house and white as a ghost with blue lips — he just passed out.”
“My head started hurting,” William said. “And after that my lungs started closing up. It felt different.”
Hospitals in Colorado, Missouri and potentially eight other states are admitting hundreds of children for treatment of an uncommon but severe respiratory virus.
The virus, called Enterovirus D68, causes similar symptoms to a summer cold or asthma: a runny nose, fever, coughing and difficulty breathing. But the illness can quickly escalate, and there are no vaccines or antiviral medications to prevent or treat it.
Though only Missouri has confirmed cases of EV-D68, cases with similar symptoms have been reported throughout the Midwest and South.
According to news reports, Missouri, Colorado, Georgia, Illinois, Iowa, Kansas, Kentucky, North Carolina, Ohio and Oklahoma have sent samples to the Centers for Disease Control for identification. Hospitals usually aren’t able to perform testing required to identify specific types of enteroviruses on their own.
This particular outbreak is associated with an unusually high number of hospitalizations — Children’s Hospital Colorado has reported more than 900 cases since Aug. 18, while Children’s Mercy Hospital in Kansas City, Mo., has seen about 30 children per day with the illness, the Denver Post reported.
13-year-old Will Cornejo is recovering at Rocky Mountain Hospital for Children at Presbyterian/St. Luke’s Medical Center in Denver on Sept. 5 from what doctors suspect is the respiratory virus, human enterovirus 68 that has come to Colorado. (Cyrus McCrimmon/Denver Post)
Mark Pallansch, director of the CDC’s Division of Viral Diseases, said that the recent hospitalizations may be “just the tip of the iceberg in terms of severe cases.”
“We’re in the middle of looking into this,” he told CNN on Sunday. “We don’t have all the answers yet.”
Enteroviruses are common in the United States, causing 10 to 15 million infections per year, most of which are mild or asymptomatic. Infections usually occur in the summer and fall, coinciding with the start of the school year, and the viruses are most often found in infants, children and teenagers, who haven’t yet built up an immunity.
EV-D68, which is likely causing this most recent outbreak, almost exclusively affects the upper respiratory tract and is especially severe in people who already experience breathing difficulties.
The virus was first identified in 1962, but has been relatively rare until recently. Between 1987 and 2005, 26 cases were reported worldwide — in the past month, 19 have been confirmed from Kansas City alone.
Identifying particular types of enteroviruses is difficult, but a 2011 CDC report on EV-D68 pinpointed clusters of the disease in the Philippines, Japan, the Netherlands and three U.S. states since 2008.
Of the 90 confirmed cases described in the report, three were fatal, none of which occurred in the United States. But an editorial note warns that the virus is “increasingly recognized” for causing severe — and potentially deadly — respiratory illness.
This year’s outbreak has hospitals scrambling to deal with the large number of cases.
“It’s worse in terms of scope of critically ill children who require intensive care. I would call it unprecedented,” Mary Anne Jackson, division director for infectious diseases at Kansas City’s Children’s Mercy Hospital, told CNN. She said the facility has had to call in help from other providers.
Some hospitals, including Blessing Hospital in Quincy, Ill., are barring children — who are most vulnerable to the virus — from visiting as a result of the outbreak. Though it is still unclear whether EV-D68 is present at the facility, Blessing’s emergency center saw 70 pediatric patients with breathing difficulties since Labor Day weekend, seven of whom were admitted for treatment.
But early September is peak season for enteroviruses, and doctors say they expect the number of infections to begin leveling off.
“The vast majority of these kids will get better,” William Schaffner, chair of Vanderbilt University’s Department of Preventative Medicine, told NBC.
In the meantime, an alert from the Missouri Department of Health and Senior Services advises residents to take standard precautionary measures, including washing hands frequently and avoiding contact with people who are sick, and warns clinicians to be on the lookout for unexplained respiratory illnesses.


Rare respiratory illness confirmed in 10 states, expands to New York and Alabama

Will Cornejo, 13, recovers at a Denver hospital. (Cyrus McCrimmon/Denver Post) Alabama and New York are among the newest states with confirmed cases of the virus. The Alabama Department of Public Health confirmed Monday that four of six specimens from Mobile County positive for the virus. That follows the New York State Department of Health’s confirmation Friday that more than a dozen children in two parts of the state have enterovirus 68. Connecticut has also joined the list of states with possible cases. The state’s Department of Public Health said over the weekend that it has received reports of clusters of children in two different areas who may be suffering from this virus; it is awaiting confirmation from the CDC. The precise number of children with this virus, along with the number of states where it has occurred, is unknown. But one hospital in Kansas City, Mo., is believed to have seen hundreds of cases, which suggests that the national number could be significantly higher. There is no vaccine for this virus strain. Enteroviruses are actually very common, causing between 10 million and 15 million infections a year (many people who get them just wind up with a cold or don’t even get sick). But this strain is fairly rare — not appearing very often since it was first isolated in California in 1962 — and it has caused concern for health officials, particularly since it can lead to breathing problems for children. Authorities in some states that are awaiting word from the CDC, including Utah and Ohio, have said they expect to be told they have cases of the virus. This post has been updated with the full list of states that have confirmed cases now that the CDC revealed that there are cases in Louisiana and Indiana.

Will Cornejo, 13, recovers at a Denver hospital. (Cyrus McCrimmon/Denver Post)
The rare and severe respiratory illness sickening children around the country has expanded to new states, and health officials believe there could also be unconfirmed cases in other places.
These children — and it has only affected children so far, for reasons we explain here — are suffering from enterovirus 68, an uncommon virus strain that can cause severe breathing problems.
Alabama and New York are among the newest states with confirmed cases of the virus. The Alabama Department of Public Health confirmed Monday that four of six specimens from Mobile County positive for the virus. That follows the New York State Department of Health’s confirmation Friday that more than a dozen children in two parts of the state have enterovirus 68.
As of Monday, there are now 10 states with confirmed cases, according to the Centers for Disease Control and Prevention. In addition to Alabama and New York, there are now confirmed cases in Indiana and Louisiana, with those four states joining Colorado, Illinois, Iowa, Kansas, Kentucky and Missouri.
Health officials in New York say samples from around the state are being sent to a laboratory in Albany for testing to see if there are cases in other parts of the state. Unlike New York, which has a laboratory that can test for the strain, most other states have sent their samples to the CDC, and they are awaiting responses to see whether they have the strain.
Connecticut has also joined the list of states with possible cases. The state’s Department of Public Health said over the weekend that it has received reports of clusters of children in two different areas who may be suffering from this virus; it is awaiting confirmation from the CDC.
The precise number of children with this virus, along with the number of states where it has occurred, is unknown. But one hospital in Kansas City, Mo., is believed to have seen hundreds of cases, which suggests that the national number could be significantly higher.
There is no vaccine for this virus strain. Enteroviruses are actually very common, causing between 10 million and 15 million infections a year (many people who get them just wind up with a cold or don’t even get sick). But this strain is fairly rare — not appearing very often since it was first isolated in California in 1962 — and it has caused concern for health officials, particularly since it can lead to breathing problems for children.
Authorities in some states that are awaiting word from the CDC, including Utah and Ohio, have said they expect to be told they have cases of the virus.
This post has been updated with the full list of states that have confirmed cases now that the CDC revealed that there are cases in Louisiana and Indiana.


CDC probing reports of paralysis in 9 Colorado children, including some with Enterovirus 68

illness more difficult to fight. (AP Photo/The Denver Post, Cyrus McCrimmon) Colorado health officials say nine children were identified between Aug. 8 and Sept. 17 after they developed neurological symptoms that are not commonly associated with Enterovirus 68, which causes severe breathing problems particularly in children with pre-existing asthma or respiratory problems. That virus has been confirmed in the District of Columbia and all but 10 states, according to the Centers for Disease Control and Prevention, and it has sickened more than 277 people, mostly children. The CDC said it is investigating the cases in Colorado and has called on health officials nationwide to be on the lookout for similar symptoms. They do not believe that the symptoms are related to polio, which is caused by a viral infection that leads to paralysis, because most of the children -- eight out of nine -- are fully up to date on their polio vaccinations. Of the eight that were tested by the CDC, four tested positive for Enterovirus 68, and two others were positive for different unidentified strains of an enterovirus. The children are from the Denver area and are being treated at Children’s Hospital Colorado in Aurora, Colo., and they all reported symptoms of fever and breathing problems two weeks before developing limb weakness, according to the CDC. None have fully recovered from their symptoms, Wolk said. Outbreaks of enteroviruses and rhinoviruses, which cause the common cold, are common in the fall, and the often go undiagnosed if the symptoms are not severe. But this year, the outbreak has been worse than usual and children with asthma or other pre-existing breathing problems have been particularly hard hit. The CDC said that it expects the number of cases to wane later in the fall. The CDC's advisory asked doctors to be watchful for any acute onset of limb weakness and evidence an magnetic resonance imaging (MRI) test of the spinal cord that shows large lesions on the gray matter of the spinal cord. None of the children experienced seizures or an altered mental state. While it isn't necessarily common for non-respiratory symptoms to occur with Enterovirus 68 infections, Wolk told the Denver Post that myelitis, or the infection of gray matter of the spinal cord, can occur as a complication of viral infections. "We've seen this in the past and have studied these kinds of clusters in the past," Wolk said.

In this Monday, Sept. 8, 2014 photo, Melissa Lewis, of Denver, helps her son, Jayden Broadway, 9, as he coughs in his bed at the Children's Hospital Colorado in Aurora, Colo. He was treated for the enterovirus 68 and released, but his asthma made the illness more difficult to fight. (AP Photo/The Denver Post, Cyrus McCrimmon)
Several children in Colorado, including some that have tested positive for the Enterovirus 68 respiratory illness, also reported neurological symptoms including muscle weakness and paralysis.
Colorado health officials say nine children were identified between Aug. 8 and Sept. 17 after they developed neurological symptoms that are not commonly associated with Enterovirus 68, which causes severe breathing problems particularly in children with pre-existing asthma or respiratory problems.
That virus has been confirmed in the District of Columbia and all but 10 states, according to the Centers for Disease Control and Prevention, and it has sickened more than 277 people, mostly children.
The CDC said it is investigating the cases in Colorado and has called on health officials nationwide to be on the lookout for similar symptoms.
They do not believe that the symptoms are related to polio, which is caused by a viral infection that leads to paralysis, because most of the children -- eight out of nine -- are fully up to date on their polio vaccinations. Of the eight that were tested by the CDC, four tested positive for Enterovirus 68, and two others were positive for different unidentified strains of an enterovirus.
"This is a very small number of patients," Larry Wolk, director of the Colorado Department of Public Health and Environment told the Denver Post. "That's why we're asking if there are other cases. People shouldn't panic."
The children are from the Denver area and are being treated at Children’s Hospital Colorado in Aurora, Colo., and they all reported symptoms of fever and breathing problems two weeks before developing limb weakness, according to the CDC. None have fully recovered from their symptoms, Wolk said.
Outbreaks of enteroviruses and rhinoviruses, which cause the common cold, are common in the fall, and the often go undiagnosed if the symptoms are not severe. But this year, the outbreak has been worse than usual and children with asthma or other pre-existing breathing problems have been particularly hard hit. The CDC said that it expects the number of cases to wane later in the fall.
The CDC's advisory asked doctors to be watchful for any acute onset of limb weakness and evidence an magnetic resonance imaging (MRI) test of the spinal cord that shows large lesions on the gray matter of the spinal cord.
None of the children experienced seizures or an altered mental state.
While it isn't necessarily common for non-respiratory symptoms to occur with Enterovirus 68 infections, Wolk told the Denver Post that myelitis, or the infection of gray matter of the spinal cord, can occur as a complication of viral infections.
"We've seen this in the past and have studied these kinds of clusters in the past," Wolk said.
Earlier this year, health officials in California investigated 25 cases of polio-like symptoms in children, some of whom tested positive for Enterovirus 68.


Find information about a new disease that seems to be emerging with polio-like symptoms.

States await word on whether they have cases of rare respiratory virus that has cropped up around the country

or how widely it could spread. Only children have been confirmed to have been infected so far, as adults are unlikely to get diagnosed with this type of virus, Schuchat said during a conference call with reporters. (Children lack the immunity that comes from being exposed to a disease.) “We’re in a stage where it’s difficult to say just how big this is, how long it will go on for and how widespread it will be,” she said. No vaccination is available for this strain. For states with suspected clusters but no confirmation, and for public health officials wondering about the breadth of the situation, they must now wait for the CDC’s test results. (While hospitals are able to test for enteroviruses, most are not able to check which particular strain they are facing, so states are sending samples from children to the CDC.) Utah has no confirmed cases yet, but authorities suspect that the virus is likely there, said Tom Hudachko, a spokesman for the Utah Department of Health. Primary Children’s Hospital in Salt Lake City said it has seen an increase in children admitted with symptoms of serious respiratory diseases. Samples from this hospital will be sent to the CDC for testing, Hudachko said. There are also no confirmed cases in Ohio, but health officials are working with children’s hospitals in Cleveland and Cincinnati to send samples to the CDC. Similarly, authorities expect that some of the test could come back positive, said Melanie Amato, a Health Department spokeswoman. The Michigan Department of Community Health reported an increase in children with respiratory illnesses across the state and is sending samples for testing. In Alabama, the state Department of Public Health has received multiple reports of suspected cases of this strain, but nobody has tested positive for it yet. The state is looking into two clusters of respiratory illnesses — one centered in Mobile, the other in the northern part of the state — and half a dozen samples have been sent for testing. They don’t expect test results for between one and two weeks. Officials in other states said they had already heard back from the CDC that they had children stricken with this strain. Children’s Hospital Colorado sent 25 samples to the CDC, and 19 of them tested positive, according to the state Department of Public Health and Environment. Specimens sent to the CDC from central Iowa

Will Cornejo, 13, recovers at Rocky Mountain Hospital for Children at Presbyterian/St. Luke’s Medical Center in Denver. (Cyrus McCrimmon/Denver Post)
As hospitals across the country see an increase in children dealing with respiratory illnesses, public health officials in several states say they are awaiting test results to see if they are indeed facing a rare virus strain that has been confirmed in six states.
After a surge in children with severe respiratory illnesses were treated at hospitals in Missouri and Illinois, the Centers for Disease Control and Prevention ran tests and determined that dozens of the children tested positive for a rare enterovirus strain. It is possible that just one hospital in Kansas City, Mo., has seen hundreds of cases, which hints at a potentially large number nationwide.
Enteroviruses are very common, causing between 10 and 15 million infections a year; many people who are infected with such a virus don’t get sick, or only develop a cold, the CDC says. But this uncommon strain, known as enterovirus 68, can cause severe breathing problems and has not appeared very often since it was first isolated in California in 1962.
“Severe respiratory illness is always a concern to us, especially when children are affected,” Anne Schuchat, head of the CDC’s National Center for Immunizations and Respiratory Diseases, said Monday.
The suspected cases are scattered in clusters around the country, and authorities have said they are ultimately not sure how many infections this strain could cause or how widely it could spread. Only children have been confirmed to have been infected so far, as adults are unlikely to get diagnosed with this type of virus, Schuchat said during a conference call with reporters. (Children lack the immunity that comes from being exposed to a disease.)
“We’re in a stage where it’s difficult to say just how big this is, how long it will go on for and how widespread it will be,” she said.
No vaccination is available for this strain.
The CDC said Monday that a dozen states had suspected cases of the strain. Half of those states had confirmed cases of the rare enterovirus, according to the CDC and state health officials: Missouri, Illinois, Iowa, Kentucky, Colorado and Kansas. In addition, there are suspected cases in Alabama, Georgia, Michigan, Oklahoma, Ohio and Utah, the CDC said Monday.
For states with suspected clusters but no confirmation, and for public health officials wondering about the breadth of the situation, they must now wait for the CDC’s test results. (While hospitals are able to test for enteroviruses, most are not able to check which particular strain they are facing, so states are sending samples from children to the CDC.)
Utah has no confirmed cases yet, but authorities suspect that the virus is likely there, said Tom Hudachko, a spokesman for the Utah Department of Health. Primary Children’s Hospital in Salt Lake City said it has seen an increase in children admitted with symptoms of serious respiratory diseases. Samples from this hospital will be sent to the CDC for testing, Hudachko said.
There are also no confirmed cases in Ohio, but health officials are working with children’s hospitals in Cleveland and Cincinnati to send samples to the CDC. Similarly, authorities expect that some of the test could come back positive, said Melanie Amato, a Health Department spokeswoman.
The Michigan Department of Community Health reported an increase in children with respiratory illnesses across the state and is sending samples for testing. In Alabama, the state Department of Public Health has received multiple reports of suspected cases of this strain, but nobody has tested positive for it yet. The state is looking into two clusters of respiratory illnesses — one centered in Mobile, the other in the northern part of the state — and half a dozen samples have been sent for testing. They don’t expect test results for between one and two weeks.
Officials in other states said they had already heard back from the CDC that they had children stricken with this strain. Children’s Hospital Colorado sent 25 samples to the CDC, and 19 of them tested positive, according to the state Department of Public Health and Environment. Specimens sent to the CDC from central Iowa tested positive, and reports of respiratory illnesses elsewhere in the state suggested “some activity statewide,” said Ann Garvey, the deputy state epidemiologist.
There were 11 positive tests from 14 samples sent by a Chicago hospital, a spokeswoman for the Illinois Department of Public Health said. And there are more reports of respiratory illnesses around the state, she said. Kentucky sent 10 samples to the CDC after a surge in respiratory illnesses in the central part of the state and half of them tested positive, the state’s Cabinet for Health and Family Services said.
Last month, 141 children from Kansas were treated at Children’s Mercy Hospital in Kansas City, Mo. Some of these children were found to have the rare strain, said a spokeswoman for the Kansas Department of Health and Environment.
Children’s Mercy saw nearly 500 children for respiratory problems, said Mary Anne Jackson, director of the hospital’s infectious diseases division. These children ranged in age from six weeks to old to 16 years.
The CDC said that 19 of the 22 samples sent from Children’s Mercy tested positive for the rare virus strain. But Jackson said that she thinks between 70 and 90 percent of the children they are treating will be confirmed for this strain, which would mean hundreds of infections.
“We definitely feel like we have an outbreak in our community in region,” she said in a telephone interview Monday. “Certainly I think we’ll be calling this an outbreak if all these other states have it.”


Michigan toddler dies after becoming infected with Enterovirus

A 21-month-old girl is the second child in the U.S. to die this year from a strain of the enterovirus that has infected more than 500 people.
A Michigan toddler died late last week while battling an Enterovirus D68 infection, and health officials in the state are now warning parents to take precautions against the mysterious virus that's sickening hundreds of children across the United States.
"While severe illness in children is always a concern, it's important to remember that very few people who contract EV-D68 will develop anything beyond mild flu-like symptoms," Jennifer Smith, a spokeswoman for the Michigan Department of Community Health, said in a statement to the Detroit News.
She added: "Residents should continue to lead their daily lives, practice good hygiene and vaccinate against illnesses that are vaccine-preventable, like the flu. Washing hands often with soap and water, covering coughs and sneezes with a tissue or shirt sleeve, and staying home from work or school when sick are all easy ways we can help stop the spread of illness."
Madeline Reid died Friday, her family and friends said in a statement on a GoFundMe page, which is raising money for the 21-month-old's "departing ceremonies."
A ribbon decorates a tree in front of Yardville Elementary School in Hamilton Township, N.J., after the Enterovirus-connected death of Eli Waller in September. Enterovirus patient Madeline Reid died less than three weeks later in a Detroit suburb. (Scott Ketterer/The Trentonian via Associated Press)
According to the family, from Clinton Township, Reid died from complications of Enterovirus infection, including "failure in all of Maddie's organs, along with congestive heart failure and myocarditis."
Although the outbreak of Enterovirus 68 has garnered a lot less attention than the handful of suspected and confirmed cases of Ebola in the United States, the respiratory illness is spreading rapidly across the country: According to the Centers for Disease Control and Prevention, there have been at least 691 confirmed Enterovirus cases in 46 states this year.
Many of those who have become ill from the seasonal virus are children, some of whom are being swept into emergency rooms by frantic parents.
Reid is the second child to die while infected with the particularly severe strain of the virus this year. In New Jersey, 4-year-old Eli Waller died in his sleep late last month, and officials determined that his death was the first one directly connected to Enterovirus 68, despite his having a lack of symptoms.
Four others infected with the virus also died, the CDC previously announced. But officials aren't sure what role EVD-68 played in those deaths, the AP reported.
Enterovirus symptoms are usually cold-like: runny nose, fever, body aches and skin rash, according to the CDC.
Rare cases cause more severe symptoms; Enterovirus D68 is known to produce breathing problems in children, particularly those with existing respiratory conditions such as asthma.
While unconfirmed, health officials are looking into a litany of other severe symptoms found in those who tested positive for Enterovirus 68. Those include reports of paralysis among a small group of Colorado children who had D86 and other strains of the virus.
Of a group of five children who reported paralysis-like symptoms in California last year, two also tested positive for Enterovirus 68.
Related:
What is Enterovirus 68?
New Jersey child dies of Enterovirus
Rhode Island child dies of infection associated with virus