Yes, That's Right!

In the United States alone, Enteroviruses annually impact an estimated 30-50 million people – both children and adults – with hundreds of thousands either hospitalized, left permanently injured or having lost their life as a result of the destructive nature of this virus family. 

So why haven’t we heard of it before now?

Because enteroviruses are sneaky and long forgotten!  They appear within multiple other types of diseases or conditions, like the common cold, hand, foot and mouth disease, heart failure, polio, acute respiratory infections, central nervous system infections, aseptic meningitis, Crohn’s Disease and even type 1 diabetes to name a few.  Studies have shown there to be over 100 human Enterovirus genotypes, many of which are highly contagious and with no known treatment.

More recently, there have been increased outbreaks of the enterovirus infections both in the United States and globally, such as:

  • In 2014, over a thousand adults and children across the country impacting all 49 states and the District of Columbia were hospitalized with a respiratory illness known as Enterovirus 68.  The CDC indicated that there were likely millions of Enterovirus 68 infected individuals as well who did not seek medical treatment or get tested for the infection.  14 patients were confirmed to have died during this outbreak and over 130 patients became paralyzed from acute flaccid paralysis.
  • In 2015, Enterovirus 71 caused a large outbreak worldwide, with concentrated impact in children in Asia, especially China, as it occurred 2 decades ago, where the virus was associated with a severe neurologic disease called brainstem encephalitis and also caused death.
  • As of August 2016, the CDC reported 50 confirmed cases of Enterovirus 68 across 24 states with similar cases of acute flaccid paralysis diagnoses being reported. The CDC indicated that there were likely millions of Enterovirus 68 infected individuals as well who did not seek medical treatment or get tested for the infection. 
  • Responses here through this EVF site and our Facebook page have confirmed numerous outbreaks and deaths associated with Enteroviruses worldwide as well.

Although millions of people are infected annually with an enterovirus, most have only mild symptoms of the infection that only lasts about a week and resolves with no chronic problems.  However, for those at higher risk – especially infants, children and teens – one or more symptoms may develop and can be fatal.


Most Common Types of Enteroviruses

Over 26 diseases or conditions have been associated with Enteroviruses as either the root or contributor to the condition.  Based on the physical structure of the virus, the tissue cultures in which they grow, and their pathogenesis in humans and experimental animals, Enteroviruses can be acute or chronic, and are generally classified into four primary groups:

  • Polioviruses
  • Coxsackie A, B
  • Echovirus
  • Numbered Enteroviruses such as 68 and 71


Facts about the Polioviruses:

  • The polioviruses – PV1, PV2, and PV3 - are a group of enteroviruses that cause poliomyelitis, also called polio or infantile paralysis. This is a highly infectious viral disease that may attack the central nervous system and is characterized by symptoms that range from a mild non-paralytic infection to total paralysis in a matter of hours. It is important to note, however, that most of poliovirus infections are asymptomatic, just as with all enteroviruses.
  • Paralytic polio symptoms are similar to non-paralytic polio, with weakness in one or more of the following muscle groups:
    • Spinal, where patients have prolonged prodrome, with features of aseptic meningitis followed by 1-2 days of weakness and eventually paralysis.
    • Bulbar, involving the brainstem, cranial nerves which control swallowing and vocal chords functions.
    • Polio encephalitis, which is principally reported in children and unlike other forms of polio, causing seizures and spastic paralysis.
  • During the first few days of paralytic polio, exercise increases the severity of the disease as well.
  • Currently, there are no known cures for polio and it recommended protection is through receiving the polio vaccine as recommended by your physician.


Facts about Coxsackie A, B and Echovirus:

  • Non-polio viruses include Coxsackie A, B and Echoviruses:
    • Coxsackie A viruses are mainly associated with human hand, foot and mouth disease, acute hemorrhagic conjunctivitis, herpangina and hepatitis.
    • Coxsackie B viruses can cause signs and symptoms similar to a common “cold” but these viruses can also lead to more serious diseases by spreading through the body beyond the initial line of defense, including but not limitedto:
      • Myocarditis or inflammation of the heart
      • Pericarditis or inflammation of the sac lining of the heart
      • Meningitis or inflammation of the membranes that line the brain and spinal cord, and the brain itself (encephalitis)
      • Pancreatitis or inflammation of the pancreas
    • Echoviruses are a cause to over 33 types of the nonspecific viral infections, mainly found in the liver or intestine area, and can cause nervous disorders. 
  • The typical symptoms of both Coxsackie and Echoviruses are fever, a mild rash, and mild upper respiratory track (URT) and/or gastrointestinal illness.


Facts about Enterovirus 68:

  • Enterovirus 68, also known as Enterovirus D68 or EV-D68, in one of the more that 100 non-polio enteroviruses and was first identified in California in 1962.
  • Enterovirus 68 has been associated with paralysis and is being investigated as a cause like polio symptoms.
  • Symptoms include:
    • Mild symptoms include runny noses, sneezing, cough, body aches, fever and muscle aches.
    • Severe symptoms include respiratory illness, wheezing and difficulty breathing.
  • Since EV-D68 typically impacts respiratory functions, infected persons spread the virus through coughing, sneezing, or touching surfaces that are then touched by others.
  • In general, infants, children and teenagers are at highest risk to EV-D68 and become ill most often.  Children with asthma can be at higher risk as well to respiratory illness caused by Enteroviruses.


Facts about Enterovirus 71:

  • Enterovirus 71 (or EV-71) is notable as one of the major cause agents found in human hand, foot and mouth disease, and is associated with severe central nervous system disease and myocarditis in fewer patients. 
  • Although first isolated and characterized from cases of neurological disease in California in 1969, little is known to date about EV-71 infection in the U.S. since no diagnostic test is available.


The unsettling fact about Enterovirus is that it can spread to various organs and persist in the body for years … potentially causing disease long after the initial infection.