Rhinovirus And Enterovirus-D68 In Kids: What You Should Know About The CDC Warning

CDC published a health alert for clinicians regarding an increase in rhinovirus and enterovirus cases that cause respiratory infections, including one that causes an uncommon type of paralysis in kids called acute flaccid myelitis (AFM) [1].

There was an increase in cases of rhinovirus and enterovirus in July and August. These two viruses cause common upper respiratory infections in children. Increased cases have been reported following the last wave of these viruses in the summer and fall of 2018, before the outbreak of COVID-19.

Hospital beds are in short supply in India, where several facilities are overburdened with patients. As a result, there is a real concern that the most deserving children may not receive hospitalization. Moreover, observing an increase in re-infections, the doctors urge parents and schools to ensure that sick children remain at home for at least ten days [2].

Rhinovirus And Enterovirus-D68: What You Should Know

What is rhinovirus?

The rhinovirus (RV) is an RNA virus that causes more than 50 per cent of human upper respiratory tract infections worldwide. In conjunction with Respiratory Syncytial Virus, RV is one of the leading causes of viral bronchiolitis in infants and the most common cause of wheezing in children between the ages of one and two years old.

The rhinovirus is more likely to cause severe lung infections, such as pneumonia and bronchitis, only in premature babies and children or those with heart disease or asthma [3].

What is enterovirus?

Enterovirus is a virus that enters the body through the mouth and is absorbed through the intestines. In most cases, enterovirus infections do not cause symptoms or cause only a mild fever.

Infected individuals may spread enteroviruses by sneezing or coughing droplets into the air or surfaces. As a result, a child may breathe in droplets or touch a surface that has been contaminated and touch his or her eyes, mouth, or nose. Viral infections are treated with supportive care, such as pain medication [4].

Rhinovirus, Enterovirus-D68 And Acute Flaccid Myelitis In Kids

The rhinovirus is typically associated with upper respiratory infections. Although it is present throughout the year, there is usually a peak in the spring and fall of each year. There are many similarities between enterovirus symptoms and rhinovirus symptoms, but enterovirus can also cause fever, rash, and neurological symptoms [5].

Enterovirus D-68 is a type of enterovirus that can cause acute flaccid myelitis in rare cases. It is one of many non-polio enteroviruses that causes respiratory and gastrointestinal symptoms. Enterovirus is present throughout the year but peaks in late summer and early fall.

In most cases, children with these viruses will only present with common cold symptoms, such as a runny nose, body aches, sneezing, and fever. However, with recent hospitalizations increasing due to these viruses, clinicians are seeing an increase in cases of acute flaccid myelitis, which can result in paralysis.

Symptoms of acute flaccid myelitis include neck, back, arm, or leg pain, neck, arms, or legs weakness, difficulty swallowing, slurred speech, facial weakness, or double vision [6].

When children are infected with enteroviruses, they usually experience upper respiratory symptoms after they experience the traditional upper respiratory symptoms. In rare instances, the EV-D68 virus can cause a paralytic illness similar to polio.

After the onset of the respiratory illness, paralysis usually occurs five days later. However, there is a rapid onset - from hours to days - and it may affect any combination of limbs, including the arms [7][8].

"Increases in EV-D68 respiratory illnesses have typically preceded cases of AFM, indicating that increased vigilance for AFM in the coming weeks will be essential," the CDC cautioned.

Acute Flaccid Myelitis in India

In the last decade, numerous outbreaks have been reported in countries including the United States, European countries, and Japan. There have already been two outbreaks reported in India. However, pathogen testing was limited and inconclusive in both groups. The presence of AFM in India has not been frequently reported despite ongoing AFP surveillance.

AFM is misdiagnosed and underrecognized in India, as in Australia. AFM is frequently misdiagnosed as transverse myelitis during the initial course of the disease since it frequently involves the entire spinal cord, not only the grey matter. Consequently, there is a need to raise awareness about this evolving entity [9][10].

On A Final Note...

Early diagnosis and detection are important if your child starts to experience symptoms that seem more severe than an average upper respiratory infection. Visiting your primary care physician, paediatrician, local health department, or emergency room physician can help you obtain an early diagnosis.