A respiratory virus that can paralyze children is spreading across the United States, raising concerns about a possible resurgence of polio-like diseases.
Wastewater samples showed a significant increase in an enterovirus called D68, which is rarely associated with acute flaccid myelitis (AFM), a disease that affects the nervous system and causes severe weakness in the arms and legs, most commonly in young children.
“EV-D68 nucleic acid is now being detected in wastewater across the country, and levels are rising,” said Alexandria Bohm, program director for the nonprofit monitoring network WastewaterSCAN and professor of civil and environmental engineering at Stanford University.
This is the first clue that the country may see an increase in AFM this year, said Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security and author of “Averting the Crisis: The Hidden Science of Outbreak Preparedness.”
“The second tip is that the timing is right,” she said.
Historically, September is the month with the highest number of AFM cases.
If you’ve ever had a runny nose, you’ve probably been infected with an enterovirus. It’s that common. In most cases, the virus causes mild symptoms like a runny nose, cough, headache, and a general “whatever” mood.
The D68 enterovirus strain first began causing a more serious problem in the United States in 2014, when a surge in pediatric AFM was first seen. That year, 120 children were diagnosed.
There is no cure or specific treatment for this paralysis, and many are left with life-changing disabilities, even after years of intensive physical therapy.
The mystery of the virus
Since then, although dozens of cases have been reported each year, major waves of AFM have followed a biennial pattern, with spikes in 2016 (153 cases) and again in 2018 (238 cases).
This trend was halted in 2020 when the COVID-19 pandemic forced the country into lockdown, significantly reducing the spread of the virus. That year, there were only 32 cases. The spread of D68 increased again when the lockdown was lifted in 2022.
Curiously, there has been no corresponding increase in AFM cases.
“We had seen viruses that were causing AFM cases before, but we hadn’t seen any associated AFM cases,” said Dr. Kevin Messacher, an infectious disease specialist at Children’s Hospital Colorado who treated some of the earliest AFM cases in 2014.
It’s a mystery any virologist can understand: While experts try to predict what the virus will do, the virus itself always strives to stay a few steps ahead.
It’s possible that the virus itself has changed, or that more people in the U.S. have become infected and developed immunity to D68. “We’re still trying to figure that out,” Messacher said.
According to the Centers for Disease Control and Prevention (CDC), 13 cases of AFM have been confirmed so far in 2024. Since 2014, 758 cases have been recorded.
That means hundreds of families and their children have been left permanently paralyzed and life-changing by the virus.
After several years of physical therapy, he recovered to some extent.
The Cagolanu family of Los Altos, California, were getting into a heated game of Monopoly one Friday night in November 2014 when 7-year-old Vishnu’s head inexplicably began tilting to one side. Vishnu admits that this wasn’t an attention-seeking behavior, even though he was losing the game.
“My dad said, ‘Hey, what are you doing? Move your head straight back,'” said Vishnu, now 17. “I just thought, I can’t do that.”
Within an hour, Vishnu had completely lost the ability to move his arms and legs. “I couldn’t even get up off the floor,” he said.
Vishnu was one of the first people to be diagnosed with AFM in 2014. At the time, no one knew about the link between D68 and the “mystery disease.”
“We didn’t know what was going on. Even the doctors didn’t know what was going on,” said Vishnu’s mother, Saira Khagolanu. “It was the worst experience of my life.”
Doctors warned Vishnu’s family that he may never regain use of his arms and legs. The poor news left Vishnu devastated. He had always been the “playground king” when it came to sports and other physical activities.
“It was horrible to see my legs getting thinner and thinner every day,” he said. “I couldn’t move.”
Vishnu has been undergoing physiotherapy for years to regain his ability to walk. It has been successful. There is not much else the doctors can do. His right shoulder remains stiff.
Testing potential treatments
“It’s really frustrating every time we get to this stage, and we don’t have any antiviral drugs readily available,” said Dr. Buddy Creech, a pediatric infectious disease physician at Vanderbilt University Medical Center in Nashville. “We don’t have a lot to offer these kids.”
Creech and his colleagues are working toward a solution: They have begun safety studies of a monoclonal antibody that would ideally block the progression of D68.
“In mice, we were able to prevent the infection that leads to AFM,” Creech said. Studies are expected to take several years before the treatment is deemed safe and effective.
Meanwhile, young people like Vishnu Khagolanu are using AFM to step up and even inspire others. In recent years, he founded a non-profit called Neurostronger, which raises funds and awareness for children with neurological disorders.
“Growing up with AFM is hard,” Kagolanu says, “but at the same time, there are ways to get around some of those obstacles. There are ways to find joy.”
This article originally appeared on NBCNews.com.
