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State health officials in Colorado announced that they were investigating an outbreak of viral infections with neurological complications in young children.
Since the beginning of the year, Colorado has recorded 41 cases of enterovirus A71 infection associated with a neurological disease in the child. In addition, as part of this outbreak, Colorado also had 14 cases of flaccid acute myelitis (AM). Of the AFM cases, 11 were positive for enterovirus A71, one positive for enterovirus D68 and two negative for enteroviruses.
Although all patients were hospitalized, almost all recovered fully. There were no deaths.
The Colorado Department of Public Health and the Environment is working with the US Centers for Disease Control and Prevention to investigate the outbreak.
Acute flaccid myelitis is a condition that affects the spinal cord. most sufferers have a sudden onset of limb weakness and most of them recover.
Enteroviruses are common and can cause cold-like diseases; disease of the hands, feet and mouth; and rashes. EV-A71 and EV-D68 are less common types of enteroviruses in the United States and usually cause mild illness. Rarely, they can cause neurological diseases that are not commonly encountered with other enteroviruses, such as meningitis, encephalitis and flaccid acute myelitis.
All enteroviruses spread by contact with the feces of an infected person; ocular, nasal and oral secretions (such as saliva, nasal mucus or sputum); and the liquid of blisters caused by the virus. Some people with enterovirus have no symptoms but can still transmit the virus to other people. In general, enterovirus cases increase in summer and autumn.
There is no vaccination or specific treatment against enteroviruses. People with mild illness usually only need treatment for their symptoms. However, some diseases caused by EV-A71 and EV-D68 may be severe enough to require hospitalization.
The state health department has been monitoring this situation closely since the beginning of spring. In addition to investigating the outbreak, the department has issued alerts to health care providers about the virus screening process and improved guidance for child care centers on infection prevention.
Symptoms of enteroviral complications or acute flaccid myelitis
Parents and guardians should contact a health care provider if they or their children have:
- Severe symptoms such as sudden weakness of arms and legs, difficulty breathing, unstable walking, severe headache, stiff neck or convulsions.
- Dizziness, wobbliness or abnormal jerky movements that worsen at night.
- Fever with any other symptoms of concern.
To protect yourself and others from enterovirus
- Wash your hands often with soap and water for at least 20 seconds.
- Take special care to wash your hands after using the toilet and changing diapers.
- Avoid close contact with sick people and do not share cups or utensils.
- Clean and disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick.
- Cover your coughing and sneezing.
- Avoid touching your eyes, nose, and mouth with unwashed hands.
- Stay home when you are sick and keep the children at home from school or daycare for 24 hours after the end of the fever or they drool uncontrollably and have sores in their mouths.
Colorado has already experienced less common enterovirus outbreaks. In 2014, the enterovirus D68 caused an outbreak of respiratory disease in Colorado children and was associated with 11 cases of acute flaccid myelitis. In 2003 and 2005, enterovirus A71 caused epidemics similar to those in Colorado: eight cases of central nervous system infections occurred in each of these years.
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