In a concerning development that echoes the polio scares of the past, health officials are on high alert as wastewater samples across the United States show a significant spike in a respiratory virus linked to a rare but devastating paralytic condition in children. This surge in Enterovirus D68 (EV-D68) raises fears of a potential outbreak of acute flaccid myelitis (AFM), a polio-like illness that can leave children with life-altering disabilities.

The rising tide of EV-D68

Alexandria Boehm, program director of WastewaterSCAN and professor at Stanford University, reports a troubling trend:

“We are detecting EV-D68 nucleic acids in wastewater across the country now, and the levels are increasing.”

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This early warning system serves as the first indicator of a possible AFM surge in 2024.

Historically, AFM has followed a biennial pattern, with significant spikes occurring in even-numbered years:

• 2014: 120 cases
• 2016: 153 cases
• 2018: 238 cases

The Covid-19 pandemic disrupted this cycle in 2020, but as lockdowns lifted, EV-D68 resurged in 2022.

Understanding AFM and EV-D68

Enteroviruses are ubiquitous, often causing mild cold-like symptoms. However, the D68 strain took a sinister turn in 2014, leading to the first major AFM outbreak in the U.S.

Acute flaccid myelitis affects the nervous system, causing severe weakness in the arms and legs, primarily in young children. There’s currently no cure or specific treatment for the resulting paralysis.

Since 2014, 758 cases of AFM have been confirmed in the U.S., leaving hundreds of families grappling with life-altering paralysis. The CDC reports 13 confirmed cases so far in 2024, heightening concerns of an impending surge.

A family’s journey

The Kagolanu family’s story illustrates the sudden, devastating impact of AFM:

• In 2014, 7-year-old Vishnu Kagolanu lost all ability to move his arms and legs within an hour of first symptoms.
• Years of intensive physical therapy helped him regain the ability to walk, but his right shoulder remains paralyzed.
• Now 17, Vishnu has founded Neurostronger, a nonprofit supporting kids with neurological conditions.

“Growing up with AFM is hard,” Kagolanu said. “But at the same time, there are ways to get around some of those obstacles. There are ways to find joy.”

The race for solutions

Dr. Buddy Creech of Vanderbilt University Medical Center offers a glimmer of hope:

“We all get really frustrated every time we get to this point, and we don’t have antiviral medicines that are readily available. We don’t have much to offer these kids.”

Creech and his team have begun safety studies on a monoclonal antibody that could potentially stop EV-D68 in its tracks. However, it may be years before this treatment is proven safe and effective.

Looking ahead

As September approaches – historically the peak month for AFM cases – health officials and researchers remain vigilant. The mysterious absence of an AFM spike in 2022 despite EV-D68 circulation adds an element of unpredictability to the situation.

Dr. Kevin Messacar of Children’s Hospital Colorado sums up the challenge:

“We’re still trying to div it out.”

As the scientific community races to understand and combat this elusive threat, families across the nation hold their breath, hoping for a breakthrough that could protect their children from this devastating illness.