Enterovirus D68

What is enterovirus D68?

Enterovirus D68 (EV-D68) is a virus that causes respiratory infections, mostly in children and teens. But adults can get it, too. It usually causes mild, cold-like symptoms.

Some people with EV-D68 develop severe breathing problems or a nervous system disorder called acute flaccid myelitis (AFM). AFM causes sudden, extreme muscle weakness and paralysis. There are outbreaks of these serious symptoms every couple of years in the U.S., in late summer and early fall.

How common is enterovirus D68?

Enterovirus D68 seems to be very common. In fact, most people over the age of 5 have evidence of a previous infection. Neurological complications are relatively rare, but there’ve been outbreaks of severe EV-D68 and AFM in the U.S. every two years since 2014.

While other enteroviruses, like poliovirus and enterovirus 71 (which causes some cases of hand, foot and mouth disease) can also lead to AFM, experts aren’t sure what’s caused the recent increase in AFM associated with EV-D68. In the U.S., the highest number of cases in recent years was in 2018, with 238 cases of AFM. But in the last peak year, 2022, there were only 47 cases. These cases may not all be linked to EV-D68.

What are the symptoms of enterovirus D68?

Symptoms of enterovirus D68 include:

• Stuffy or runny nose.
• Cough.
• Fever.
• Muscle pain or body aches.
• Sore throat.
• Wheezing.
• Shortness of breath.
• Diarrhea.

A few days to two weeks after initial EV-D68 symptoms, some people develop symptoms of AFM, including:

• Weakness.
• Slurred speech.
• Difficulty swallowing (dysphagia).
• Drooping eyelids.
• Difficulty moving your eyes.
• Facial paralysis.
• Back, neck, arm or leg pain.

What causes an enterovirus D68 infection?

EV-D68 is a viral infection — specifically, it’s a nonpolio enterovirus. There are more than 100 nonpolio enteroviruses that cause a variety of (mostly mild) symptoms. Most people with enterovirus D68 have respiratory infections that cause symptoms like a runny nose or cough. But it can also infect your spinal cord, similar to the virus that causes polio (another enterovirus). This can damage the nerves that make your muscles work, causing temporary or permanent paralysis.

Is enterovirus D68 contagious?

Yes, enterovirus D68 is contagious (spread from person to person). It can spread through:

• Sneezing or coughing (respiratory droplets).
• Sharing eating utensils and cups.
• Touching contaminated doorknobs, toys or other surfaces.
• Contact with infected poop (like not washing your hands well enough after changing a diaper or using the bathroom).

What are the complications of this condition?

In addition to AFM, EV-D68 can lead to:

• Pneumonia.
• Encephalitis.
• Meningitis.

People with asthma or a compromised immune system are more likely to have severe respiratory symptoms. Kids under the age of 7 are most at risk for acute flaccid myelitis.

How is enterovirus D68 diagnosed?

If you have mild, cold-like symptoms, your healthcare provider likely won’t test you for EV-D68. But if you seek care for more severe symptoms, they might use a nasal swab to test you for common viruses, like the flu and COVID-19. If those results are negative, your provider may suspect EV-D68 if it’s spreading in your area.

To confirm a diagnosis, you might need a blood test or lumbar puncture to test your cerebrospinal fluid (if you have nervous system symptoms). Your provider may need to send samples to a specialized lab for testing. An MRI (magnetic resonance imaging) can also help diagnose and rule out other causes of weakness and paralysis (like stroke).

How is enterovirus D68 treated?

There isn’t a specific antiviral treatment to fight EV-D68. Mild symptoms typically improve in a week or two with minimal at-home care. Severe cases need to be treated in a hospital. If you have severe symptoms, your provider may treat you with:

• Corticosteroids to reduce inflammation.
• Bronchodilators for severe respiratory symptoms.
• Intravenous immunoglobulin, an antibody treatment that can help you fight off infections.

How can I prevent an enterovirus D68 infection?

You can reduce your risk of getting sick with EV-D68 and spreading it to others by practicing good hygiene:

• Sneeze or cough into the crook of your elbow.
• Disinfect high-touch surfaces like toys, phones, countertops and doorknobs.
• Don’t share eating utensils, cups, towels or clothing.
• Keep your kids home from school and away from gatherings when they’re sick.
• Wash your hands often with soap and water for at least 20 seconds. This is especially important after going to the bathroom or changing diapers and before eating or preparing food.

How long does it take to recover from enterovirus D68?

If you have mild symptoms of EV-D68, you’ll likely feel better in a week or two. You may need to be hospitalized for severe symptoms.

If your child develops AFM, it can take over a year for them to recover. Their healthcare provider might recommend physical or occupational therapy. Over time, most kids with AFM regain some degree of muscle strength and function, but some never fully recover.

How can I take care of myself at home?

You can take these steps to ease mild symptoms:

• Drink lots of fluids and get plenty of rest.
• Take hot, steamy showers or sit in a steamy bathroom to loosen congestion.
• Take over-the-counter (OTC) pain medicines or nonsteroidal anti-inflammatory drugs (NSAIDs) for fever and pain. Talk to your child’s pediatrician before giving medications to your child.

When should I go to the ER?

Go to the emergency room if you or your child develops severe symptoms, including:

• Difficulty breathing.
• Blue skin, lips or nails (cyanosis).
• Any symptoms of AFM, like slurred speech, weakness or paralysis.
• Confusion.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

• What’s the best way to treat my symptoms?
• How can I prevent spreading the infection to others?
• Am I at risk for severe illness?
• What serious symptoms should I look out for?

A note from Cleveland Clinic

Enterovirus D68 is very common — in fact, you’ve probably had it at some point in your life and didn’t even realize it. While you might see some scary headlines every few years about paralysis and EV-D68, it’s fortunately very rare. Still, it’s natural to feel uneasy about the idea that a cold — one that most people have never heard of — can sometimes turn into something serious.

Talk to your child’s pediatrician if you have any concerns about EV-D68 or AFM. They can talk you through the best ways to stay healthy, and what to do if you notice any concerning symptoms. It can often help just to feel prepared.