Top 5 Takeaways

  1. Surge in Respiratory Illnesses: There’s been an increase in acute respiratory illness (ARI) and asthma/reactive airway disease (RAD) among children and adolescents in the summer of 2022, linked to rising detection of rhinovirus/enterovirus (RV/EV), particularly Enterovirus D68 (EV-D68).
  2. Previous Patterns: EV-D68 has caused biennial outbreaks of severe respiratory illness and acute flaccid myelitis (AFM) in 2014, 2016, and 2018. The pattern was disrupted in 2020, likely due to COVID-19 mitigation measures.
  3. Symptoms and Severity: EV-D68 primarily affects young children, with symptoms like cough, nasal congestion, wheezing, and dyspnea. It can exacerbate asthma/RAD and is associated with AFM, a severe condition leading to muscle weakness and paralysis.
  4. Surveillance Data Analysis: Data from three sources – the National Syndromic Surveillance Program (NSSP), National Respiratory and Enteric Virus Surveillance System (NREVSS), and New Vaccine Surveillance Network (NVSN) – indicate an increased percentage of ARI and asthma/RAD emergency department visits and positive RV/EV and EV-D68 test results in 2022.
  5. Public Health Implications: Clinicians are advised to consider EV-D68 in cases of acute respiratory illness and AFM in children and adolescents. Increased vigilance and preparedness for future outbreaks are crucial.

Original Article Author and Citation

Corresponding Author

Kevin C. Ma,

Suggested Citation

Ma KC, Winn A, Moline HL, et al. Increase in Acute Respiratory Illnesses Among Children and Adolescents Associated with Rhinoviruses and Enteroviruses, Including Enterovirus D68 — United States, July–September 2022. MMWR Morb Mortal Wkly Rep 2022;71:1265–1270. DOI: .


After low circulation during the COVID-19 pandemic, surveillance data from summer 2022 indicate increased detection of RV/EV and EV-D68, concurrent with more emergency department visits by children and adolescents for acute respiratory illness and asthma/RAD. This increase aligns with past patterns of EV-D68 outbreaks, often associated with substantial resource demands in hospitals and increases in AFM cases.


The study analyzed weekly data from three sources: NSSP for emergency department visits, NREVSS for RV/EV test results, and NVSN for RV/EV and EV-D68 detections in pediatric patients. The analysis focused on trends from 2018 to 2022, comparing with previous years, and stratified by age group and geographic region.


The findings highlight a significant rise in medically attended ARI and asthma/RAD exacerbations, potentially linked to increased RV/EV circulation, especially EV-D68. The seasonality and patterns of EV-D68 and associated AFM cases are not fully understood, emphasizing the need for ongoing surveillance. The COVID-19 pandemic’s impact on health care behaviors and testing practices adds complexity to the analysis.


Healthcare providers should be aware of EV-D68 as a potential cause of severe respiratory illness and AFM in children and adolescents. Increased surveillance and preparedness for EV-D68 outbreaks are essential, especially in the context of changing virus circulation and population immunity dynamics post-COVID-19.

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