In 2014 the U.S. experienced a nationwide outbreak of EV-D68, raising concerns about children’s respiratory health. Acute flaccid myelitis disease (AFM) also spiked. EV-D68 is defined as a group of enteroviruses like a cold virus. The disease exhibits asthma-like symptoms and spreads among people through sneezing and coughing.

The CDC, along with seven pediatric medical centers in the United States, reported a possible association between EV-D68 and respiratory disease in children, even though they had no prior coexisting medical conditions. During the 2014 outbreak, as stated in MedicalXpress, many children who had no asthma or reactive airway disease (RAD), faced severe outcomes.

RAD, an asthma-like disease, is an excessive reaction to irritants. The airway in the lungs creates tightening of the chest, wheezing, and coughing. RAD is not to be considered a diagnosis but a description used during treatment of children who are too young to receive a formal diagnosis.

The Contagious Period

Enterovirus may cause conditions such as foot, hand, or mouth disease. The contagious period is about three to ten days after the infection to about ten days from the time symptoms appear.

The virus may still appear if a person does not have symptoms (asymptomatic) or after the symptoms have resolved. Note that the virus may remain in the stool for a few weeks or longer.

Severe cases, however, are associated with a neurological condition called acute flaccid myelitis (AFM) that causes limb weakness. Recovery is unpredictable.

Testing Capacity

Although testing capacity was included in certain public health and clinical settings, surveillance has been limited. Current data is mostly drawn from investigations in a short-term virus outbreak or at single sites.

JAMA published a study that assessed EV-D68 in 976 children in the US under eighteen years of age from 2017 through 2022. Data was collected from seven medical centers, and showed that over fifty percent (n536) of the cases were associated with respiratory disorders requiring hospitalization, while 87 patients were transferred to ICU.

Children with no underlying asthma conditions had increased odds of having severe outcomes, such as requiring supplemental oxygen and being more likely to require ICU admission.

Asthma-related diagnoses appeared often for children with no previous history of the disease. Having a history of asthma had no correlation with severe outcomes. Nonetheless, health practitioners should continue to be diligent and aware that EV-D68 is a concern.

Parents, public health personnel, and clinicians are especially at risk during periods of elevated EV-D68 breakouts.