Children's Hospital Colorado

Research Into Enterovirus D68 Conducted by Children's Hospital Colorado Featured in World-Renowned Medical Journal The Lancet

The Lancet | February 18, 2015

The Lancet, one of the oldest and most well-known medical journals in the world, recently featured research conducted by Children’s Hospital Colorado on the potential link between enterovirus D68 (EV-D68) and muscle weakness. 

Children's Colorado physicians discover a link between EV-D68 and muscle weakness

Children’s Colorado doctors were the first to report the potential link between the virus and muscle weakness after identifying a cluster of 12 patients between Aug. 1 and Oct. 31, 2014, who showed signs of limb weakness in the midst of a large outbreak of respiratory disease. During the outbreak many children tested positive for rhinoviruses or enteroviruses, some of which were identified as EV-D68.

“Due to global poliovirus eradication efforts, clusters of acute flaccid paralysis (AFP) in children have become rare,” said Kevin Messacar, MD, lead author and pediatric infectious diseases specialist at Children’s Colorado. “These 12 new cases raise the possibility that EV-D68 may be emerging as part of a short list of other viruses (e.g., enterovirus 71 and West Nile Virus) that are linked to outbreaks of AFP among children in regions where polioviruses are no longer circulating such as North America, Asia and Europe.”

Varying degrees of weakness

The children identified in the cluster presented with varying degrees of muscle weakness to the arms and legs, difficulty swallowing, and/or facial weakness. All had a fever and respiratory illness about a week before the neurological symptoms began. Ten of the children had spinal cord lesions, and brainstem lesions were seen in nine children. Eleven of the children had been previously vaccinated against poliovirus.

107 similar cases reported in the United States after the discovery at Children's Colorado

 “The extent to which this new distinctive neurological disease has spread is unknown, but it does not appear to be isolated to Colorado or the USA,” said Samuel Dominguez, MD, PhD, senior author and microbial epidemiologist at Children’s Colorado. “Since the reporting of this cluster, 107 similar cases have been reported across the USA and one in France. If further investigation confirms the link between EV-D68 and AFP and cranial nerve dysfunction, EV-D68 will be added to the list of non-poliovirus enteroviruses capable of causing severe, potentially irreversible neurologic damage, and finding effective antiviral therapies and vaccines will be a priority.”

Children’s Colorado remains at the forefront of research into this issue. In the meantime, experts recommend the following steps to help prevent the spread of any respiratory virus:

  • Wash your hands
  • Drink plenty of fluids
  • Avoid close contact with anyone who may have a respiratory virus
  • If you suspect you or your child has a respiratory virus, stay home and rest. Do not go to work or school in order to prevent the spread of the virus.
  • Make sure you and your child are current on your vaccines, including flu and 
    pertussis vaccines

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