A while ago, I reported on an outbreak of a mysterious viral disease that exhibited polio-like symptoms. At the time, around 23 children and young adults were afflicted with the disease. Some of them tested positive for enterovirus 68 (known as EV-68 or EV-D68), a member of a genus of viruses that includes over 66 different species that can infect humans. None of these children tested positive for the polio virus.
Polio is a crippling and potentially deadly infectious disease caused by the poliovirus, a human enterovirus, that spreads from person to person invading the brain and spinal cord and causing paralysis. Because polio has no cure, the polio vaccine is the best way to protect yourself and the only way to stop the disease from spreading.
The United States last experienced a polio epidemic in the 1950s, prior to the introduction of the polio vaccine 60 years ago. Today, polio has been eradicated from most of the planet, as the number of worldwide polio cases has fallen from an estimated 350,000 in 1988 to fewer than 223 in 2012—a decline of more than 99% in reported cases.
Predictably, the anti-vaccine community has decided to use this extremely rare virus to make specious claims about vaccines, pesticides, and who knows what else. Typical of these tropes, we pro-science types completely debunk it, thinking it’s dead and done. But like the metaphorical zombie, it arises again to eat the brains of anti-vaccine activists. So, here I go again.
Enteroviruses are a genus of several RNA viruses that are associated with numerous human and mammalian diseases. As of today, researchers have identified 71 different serotypes of human enteroviruses, although there is some variability in antigens within each of the different serotypes. Early in the research on these viruses, they were given separate names, such as polioviruses, Coxsackie A viruses, Coxsackie B viruses, and echoviruses. Today, the viruses, as they are identified, are given names in a system of consecutive numbers. Enterovirus 68, or EV68, or 68th in the list of these viruses, is the subject of this article.
Although many people make claims that enteroviruses are only transmitted from the stool of an infected person, it also can be found in respiratory secretions. Probably, the most famous enters enterovirus disease was poliomyelitis, but, of course, polio as become nearly extinct as a result of the polio vaccine.
Unfortunately, there are 64 non-polio enteroviruses that can cause disease in humans: 23 Coxsackie A viruses, 6 Coxsackie B viruses, 28 echoviruses, and 5 other enteroviruses. Several of these viruses, such as poliovirus, are transmitted through the oral-fecal route, but others can be transmitted through oral-oral routes like simple sneezing.
According to the CDC, there have been many non-polio enterovirus outbreaks across the world recently:
- Coxsackievirus A16 is the most common cause of hand, foot, and mouth disease (HFMD) in the United States.
- Coxsackievirus A6 was the most commonly reported type of enterovirus in this country from 2009 to 2013, mostly due to a large outbreak in 2012 of severe hand, foot, and mouth disease. Some of the infected people developed symptoms that were more severe than usual.
- Coxsackievirus A24 and enterovirus 70 have been associated with outbreaks of conjunctivitis.
- Echoviruses 13, 18, and 30 have caused outbreaks of viral meningitis in the United States.
- Enterovirus 71 has caused large outbreaks of HFMD worldwide, especially in children in Asia. Some infections from this virus have been associated with severe neurologic disease, such as brainstem encephalitis.
- Enterovirus 68 caused a nationwide outbreak in 2014 of severe respiratory illness in the United States.
So, enteroviruses are quite common, and have been associated with numerous outbreaks across the world. Of course, people like to claim it’s something else.
All about enterovirus 68
I first became aware of EV68 when I read a report, several years ago, from the CDC which described results from testing of 23 children in California who had presented with acute flaccid paralysis (AFP) with anterior myelitis (AE) – that is, a muscle weakness or paralysis along with an infection of the grey matter of the spinal cord. In general, these are symptoms of paralytic polio, though many other viruses can present with the same symptoms.
What did the analysis find?
- Most of the patients were tested, by the California Department of Public Health, for evidence of recent infection with numerous infectious agents, including EVs (including poliovirus), arboviruses, herpes viruses (HSV-1, HSV-2, VZV, and EBV), parechoviruses, adenoviruses, rabies, influenza A and B, human metapneumovirus, respiratory syncytial virus, parainfluenza 1–4, Mycoplasma pneumoniae, rickettsial pathogens, and free-living amoebas.
- The poliovirus was not discovered in any samples.
- Two patients were confirmed to have enterovirus 68, supporting the preliminary results from earlier this year (that I discussed).
- Full medical information was available for 14 of the 23 patients. Of those 14, 12 were vaccinated against polio while 2 had personal belief exemptions.
After all of this, what can we conclude?
First of all, AFP is extraordinarily rare, so rare that we might only see 1.4 cases per 100,000 population. In California, based on that incidence rate, we might expect to see much more than 23 individuals, so what we might be observing may not be an outbreak, but just a set of random unrelated events. Considering the established fact that the 23 cases were related to different, and mostly unrelated, viruses, this really just represents random “noise” from an epidemiological standpoint.
Second, polio was ruled out. This was not polio. These diseases are unrelated to polio. And the polio vaccine had nothing to do with it (given that 2 out of 23 people were unvaccinated, making the risk of AFP technically higher for unvaccinated individuals than vaccinated ones based on this limited sample).
In 2014, there was an actual outbreak of enterovirus 68 in the USA. The CDC reported that,
[infobox icon=”quote-left”]In summer and fall 2014, the United States experienced a nationwide outbreak of EV-D68 associated with severe respiratory illness. From mid-August 2014 to January 15, 2015, CDC or state public health laboratories confirmed a total of 1,153 people in 49 states and the District of Columbia with respiratory illness caused by EV-D68. Almost all of the confirmed cases were among children, many whom had asthma or a history of wheezing. Additionally, there were likely many thousands of mild EV-D68 infections for which people did not seek medical treatment and/or get tested.
CDC received about 2,600 specimens for enterovirus testing during 2014, which was substantially more than usual. About 36% of those tested positive for EV-D68. About 33% tested positive for an enterovirus or rhinovirus other than EV-D68.
EV-D68 was detected in specimens from 14 patients who died in the U.S. in 2014. State and local officials have the authority to determine and release information about the cause of these deaths.[/infobox]
Since the CDC described this as an “outbreak,” we can consider this to have been a fairly serious situation. In 2015 and 2016, there have been zero laboratory confirmed EV68 infections. So, the 2014 could be considered an isolated incident.
Cue the anti-vaccination squad
Dan Olmsted, anti-vaccine crackpot, made some lunatic claims about enterovirus 68 in a post at the Age of Lying about Autism blames pesticides. Olmsted, who wouldn’t know science if it gave him a hearty handshake and hug, claims that the massive use of pesticides “potentiates” EV68. Which might be interesting, except for the fact that there’s no evidence that such a pseudoscientific claim is accurate. And if there were pesticides that potentiated EV68 in 2014, what happened in 2015 and 2016? Oh, right, we eliminated all pesticides world wide in 2015. I forgot.
Olmstead, who thinks facts are something he pulls out of a pimple on his butt, believes that EV68 “disproves” Germ Theory, which states that some diseases are caused by microorganisms. Here’s thing about scientific theories – they are facts. And like the theory of evolution, the theory of gravity and the theory of plate tectonics, they are all facts that can only be dismissed with the same mountain of evidence that built them. And Olmstead’s ignorant dismissal of germ theory of disease because he sees something that doesn’t exist is truly pathetic. In fact, germ theory predicts that germs can change – and there are subtypes of EV68 that may have evolved in 2014 causing the outbreak. And it may have disappeared just as quickly because of a subsequent mutation. Olmstead, who foolishly thinks his deranged opinions are equivalent to scientific facts, thinks that science is static, so if we identified EV68, it can’t possibly evolve into a whole new subtype like, EV107B or whatever.
But Olmstead, who has fewer working neurons than my cat, cannot present a nanoparticle of evidence that supports his belief that EV68 is potentiated by pesticides. None. Nada. Nichts. He’s simply inventing an idea to support his own belief set, not real science.
But it’s worse. The illiterate fools at Natural News, who conflate the feathery dinosaur with the deity Orac, claim that the polio vaccine causes EV68. Again, though EV68 is related, generally, to polioviruses, it’s like saying your cat is related to a lion. Sure, they’re both felids, but I don’t think cuddling with an adult lion will be something that will end well. And once again, there isn’t a scintilla of evidence, published in a real journal, that says that EV68 results from some weird mutation of poliovirus. And it’s certainly not floating in the polio vaccine.
Moreover, and this may be beyond the ignorance of the anti-vacine crowd, but if we hypothesize that EV68 is related to the polio vaccine, what happened in 2015 and 2016? Did we suddenly stop vaccinating every kid? No.
We’ve noticed that the anti-vaccine squad is once again pushing the enterovirus 68 story as being a reason to not vaccinate. Let’s make this clear –they’re unrelated. Finis.
- Ayscue P, Van Haren K, Sheriff H, Waubant E, Waldron P, Yagi S, Yen C, Clayton A, Padilla T, Pan C, Reichel J, Harriman K, Watt J, Sejvar J, Nix WA, Felkin D, Glaser C. Acute Flaccid Paralysis with Anterior Myelitis — California, June 2012–June 2014. Morbidity and Mortality Weekly Report. 2014 September;63:1-4. PubMed PMID:
- Oberste MS, Maher K, Schnurr D, Flemister MR, Lovchik JC, Peters H, Sessions W, Kirk C, Chatterjee N, Fuller S, Hanauer JM, Pallansch MA. Enterovirus 68 is associated with respiratory illness and shares biological features with both the enteroviruses and the rhinoviruses. J Gen Virol. 2004 Sep;85(Pt 9):2577-84. PubMed PMID: 15302951.