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Outbreaks, Alerts & Hot Topics: What Do a Wheeze and a Mosquito Have in Common?

There are a couple of viruses (besides measles) that have been in the news lately: enterovirus-D68 and dengue virus.

Enterovirus-D68 (EV-D68): A Respiratory Virus on the Rise

On Sept. 11, 2026, the Kansas Department of Health and Environment (KDHE) released a Health Alert describing a rise in pediatric emergency department visits for children with acute respiratory illnesses coupled with wheezing.1 The alert highlighted an increase in wastewater detection of EV-D68. Enteroviruses are a huge genus of viruses causing a variety of illnesses, including infections caused by poliovirus and coxsackie viruses. EV-D68 is one of the serotypes of enteroviruses.

Clinical Impact and Current Local Activity

EV-D68 most commonly causes asymptomatic or mild illnesses in the summer-fall seasons. However, it can cause severe presentations of acute respiratory illnesses, including significant respiratory distress, wheezing and hypoxemia, and may result in hospitalization and intensive care, especially among patients with asthma.2,3 This virus follows a biennial pattern, with larger outbreaks occurring in even-numbered years. This pattern was disrupted during the COVID-19 pandemic, but has since re-emerged.4 Currently, a local surveillance study of children and adults in the community has identified 14 cases of EV-D68 in 2026 through early October. This is in comparison to 2024 and 2025 where six and seven cases were identified, respectively.

EV-D68 spreads via respiratory droplets generated by coughing and sneezing and can also be transmitted through contaminated surfaces via fomites. Prevention relies on respiratory hygiene measures (covering cough, wearing a mask when ill, isolate if sick, etc.) and practicing good hand hygiene.2,5,6 Given the increasing activity, clinicians should remain aware that EV-D68 can cause significant respiratory illness and increased hospitalization in children.

When a Respiratory Virus Affects the Nervous System

In addition to respiratory disease, EV-D68 has been associated with acute flaccid myelitis (AFM). AFM is characterized by the acute onset of flaccid limb weakness, loss of muscle tone, diminished reflexes, along with spinal gray matter abnormalities on imaging.7-9 The condition is commonly preceded by an illness in the affected patient, but develops days to weeks after prodromal illness onset.2,9 As of Oct. 2, 2026, there have been 11 confirmed cases out of 26 patients under investigation, compared to 17 confirmed cases out of 36 patients under investigation in the entire year of 2025.8 While many pathogens can cause AFM, enteroviruses, particularly EV-D68, are among the most commonly implicated.7 Because this entity is clinically indistinguishable from poliomyelitis, AFM is a reportable condition to local public health authorities.1,7 Treatment for AFM is not standardized, but may include corticosteroids, IVIG, and/or plasmapheresis with variable levels of recovery following diagnosis.10

Dengue Virus: An Outbreak Close to Home

Now let’s turn our attention to dengue virus. We discussed this at the start of the summer in the context of the worldwide community coming to Kansas City for the FIFA World Cup. This update is because there is currently a dengue outbreak occurring in Florida from locally acquired infections as opposed to travel-associated infections. As of Oct. 8, 2026, Florida has reported 283-293 locally acquired cases.11,12 This is in contrast to 606 locally acquired cumulative cases in Florida between 2010 and 2025.13 So far there has been one reported death from this current local outbreak of dengue in Tampa, Florida.14

Transmission and Clinical Presentation

The dengue virus has four different serotypes (DENV-1 through DENV-4). Dengue is transmitted by the bite of infected mosquitoes (Aedes aegypti and Aedes albopictus). Following an incubation period of three to 14 days, infected individuals may develop symptoms, although most infections are asymptomatic and only 25% will have symptoms. Notably, both symptomatic and asymptomatic individuals can transmit the dengue virus to mosquitoes one to two days before symptom onset and through the seven-day viremic period. Non-mosquito transmission is rare.15

Recognizing Severe Disease

Symptomatic infection starts as a nonspecific viral illness (febrile phase) with fever, joint pain, headache, myalgia, retro-orbital pain, rash and facial erythema. When defervescence starts, increased vascular permeability can occur and the patient enters the critical phase. A subset of patients in the critical phase progress to dengue with warning signs (abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, hepatomegaly, increasing hematocrit with decreasing platelets), and some develop severe dengue, which can be life-threatening. Diagnostic testing includes IgM and PCR testing. Treatment is supportive.15

Why It Matters Locally

Dengue should be considered not only in patients returning from endemic areas of the world, but also, currently, in patients with recent travel to Florida.

Take-Home Message

What do a wheeze and a mosquito have in common? They can both be associated with viruses capable of causing outbreaks. While EV-D68 and dengue virus are very different pathogens, clinicians should be aware of current epidemiologic trends and include these infections in their differential diagnoses when appropriate.

 

Resources:

State and Local AFM Contacts for Clinicians

AFM Information for patients and families, English language (AAP Healthy Children)

AFM Information for patients and families, Spanish language (AAP Healthy Children)

Dengue Case Management, Centers for Disease Control

References:

  1. Network KHA. Rise in Kansas pediatric emergency department visits. September 11, 2026. Accessed October 8, 2026. https://www.kdhe.ks.gov/m/newsflash/Home/Detail/2151
  2. Committee on Infectious Diseases AAoP. Enterovirus (nonpoliovirus) (group A and B coxsackieviruses, echoviruses, numbered enteroviruses). In: Kimberlin DW, Banerjee R, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2024–2027 Report of the Committee on Infectious Diseases. American Academy of Pediatrics; 2024.
  3. Clopper BR, Lopez AS, Goldstein LA, et al. Enterovirus D68–associated respiratory illness in children. JAMA Netw Open. 2025;8(5):e259131-e259131. doi:10.1001/jamanetworkopen.2025.9131
  4. Grizer CS, Messacar K, Mattapallil JJ. Enterovirus-D68 - a reemerging non-polio enterovirus that causes severe respiratory and neurological disease in children. Front Virol. 2024;4. doi:10.3389/fviro.2024.1328457
  5. Centers for Disease Control. Preventing respiratory illnesses. Updated August 18, 2025. Accessed October 8, 2026. https://www.cdc.gov/respiratory-viruses/prevention/index.html
  6. Centers for Disease Control. About enterovirus D68. Updated December 4, 2025. Accessed October 8, 2026. https://www.cdc.gov/non-polio-enterovirus/about/about-enterovirus-d68.html
  7. Lopez AS, English R, Rogers SL, et al. Acute flaccid myelitis surveillance — United States, January 2020–December 2025. MMWR Morb Mortal Wkly Rep. 2026;75(26):329-336. doi:10.15585/mmwr.mm7526a1
  8. Centers for Disease Control and Prevention. AFM cases and outbreaks. Updated October 6, 2026. Accessed October 8, 2026. https://www.cdc.gov/acute-flaccid-myelitis/cases/index.html
  9. Red Book online outbreaks: acute flaccid myelitis. Red Book Online. American Academy of Pediatrics. Updated October 6, 2026. Accessed October 8, 2026. https://publications.aap.org/redbook/resources/15446/Red-Book-Online-Outbreaks-Acute-Flaccid-Myelitis
  10. Centers for Disease Control and Prevention. Clinical guidance for the acute medical treatment of AFM. June 5, 2024. Accessed October 8, 2026. https://www.cdc.gov/acute-flaccid-myelitis/hcp/clinical-guidance/index.html
  11. Centers for Disease Control and Prevention. Current year data (2026). Updated October 8, 2026. Accessed October 8, 2026. https://www.cdc.gov/dengue/data-research/facts-stats/current-data.html
  12. Florida Health. Florida arbovirus surveillance week 39: September 27-October 3, 2026. Accessed October 8, 2026. https://www.floridahealth.gov/wp-content/uploads/2026/10/fl-arbovirus-report-w39-2026.pdf
  13. Centers for Disease Control and Prevention. Historic data (2010-2025). Updated October 8, 2026. Accessed October 8, 2026. https://www.cdc.gov/dengue/data-research/facts-stats/historic-data.html
  14. Tanne JH. Dengue: woman dies in Florida’s largest outbreak in years. BMJ. 2026;395:e101048. doi:10.1136/bmj-2026-101048
  15. Dengue. In: Committee on Infectious Diseases AAoP, ed. Red Book: 2024–2027 Report of the Committee on Infectious Diseases. American Academy of Pediatrics; 2024. Accessed October 8, 2026. https://doi.org/10.1542/9781610027373-S3_004_001

 

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