Last week, the Colorado Department of Public Health and Education announced that, in conjunction with the Centers for Disease Control and Information, they are investigating an unprecedented outbreak of rare viral infections with neurological complications among young children. Testing conducted by the CDC has revealed that most of these cases are associated with, and may be caused by, enterovirus A71.
Enteroviruses are defined as a group of common viruses that typically cause a number of illnesses which are usually mild, such as cold-like illnesses; hand, foot and mouth disease; and skin rashes. In the rare occasion where the virus affects the central nervous system, they can also cause neurological illnesses not commonly seen with enteroviruses, such as encephalitis, meningitis and acute flaccid myelitis.
Enterovirus A71 is a less common type of enterovirus in the United States and usually causes only mild illnesses. It is also most often associated with hand, foot and mouth disease.
However, this year, Colorado has seen unprecedented numbers of cases with 41 cases of enterovirus A71 associated with neurological illness in children. As part of this outbreak, Colorado has also had 14 diagnosed cases of acute flaccid myelitis (AFM). Of those 14 cases, 11 tested positive for enterovirus A71, one tested positive for enterovirus A68 and one tested negative for enteroviruses.
Acute flaccid myelitis is a very rare but serious condition that affects the spinal cord—that is, the part of the nervous system that carries messages to and from the brain. Symptoms of AFM include sudden weakness in the arms or legs, along with loss of muscle tone and decreased reflexes or reflexes that are absent altogether. It often starts with the face or the eyelids and typically impacts the arms. While some children never fully recover from AFM, the vast majority who come down with AFM recover completely.
Currently, research scientists don’t think that AFM is a result of enterovirus A71 but is, instead, the result of the immune’s system reaction to the enterovirus A71, but research is on-going.
In Colorado, all of the diagnosed patients were in the metro Denver area. All were also hospitalized and nearly all have fully recovered. No one diagnosed with the viral infections has died.
However, Colorado is not the only impacted stated. Ten cases of AFM have been diagnosed in Illinois and at least six in Minnesota since mid-September.
Enteroviruses are highly contagious and spread through contact with an infected person’s feces, saliva, mucus, sputum and fluid from blisters caused by the virus. Some people can have an enterovirus and spread the infection to others despite having no symptoms. There is no vaccination or specific treatment for enteroviruses. Typically, in cases of mild illness, the only treatment is for symptoms, but, as stated, some of the more severe cases require hospitalization.
The good news: enteroviruses typically increase in the spring and fall, and some experts state that we should be approaching the end of the season. Nonetheless, CDPHE and the CDC have been investigating the outbreak since early spring and will continue to investigate for the foreseeable future. In the meantime, they have issued alerts to health care providers on how to test for the virus and provided enhanced guidelines to child care centers on infection prevention and control.
CDPHE and the CDC advise parents and guardians to contact their health care provider if they see any of the following symptoms which may indicate enterovirus complications or acute flaccid myelitis.
Severe symptoms such as sudden weakness in arms and legs, trouble breathing, unsteady walking, severe headache, stiff neck or seizures. Dizziness, wobbliness, or abnormal, jerking movements that are worse at night. Fever along with any other concerning symptoms.
CDPHE also reminds parents, guardians and other individuals to take steps to protect themselves and others from enteroviruses by following standard infection control procedures, including, among other things, washing your hands often with soap and water for at least 20 seconds, cleaning and disinfecting frequently touched surfaces, avoiding touching face with unwashed hands and keeping children home from school or daycare for 24 hours after fever ends.
As far as Kiowa County is concerned, the health care providers with Kiowa County Hospital District state they have not seen any cases of enterovirus A71 but parents should always bring their child to the clinic if they are concerned about symptoms and the ER is always available after clinic hours.