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Enterovirus D68 (EV-D68) testing in cases of Acute Flaccid Paralysis

Thunder Bay District Health Unit is reminding health care providers to be vigilant in the recognition and reporting of suspected and confirmed cases of acute flaccid paralysis (AFP), which is a characteristic of poliovirus infection.
On September 9, 2022 the Centers for Disease Control and Prevention in the United States released a health advisory about an increase in pediatric hospitalization in patients with severe respiratory illness who also tested positive for rhinovirus (RV) and/or enterovirus (EV). Upon further testing some specimens were positive for enterovirus D68 (EV-D68).
Ongoing U.S. surveillance has noted a higher proportion of EV-D68 positivity in children who were RV/EV positive compared to previous years. EV-D68 primarily causes acute respiratory illness, however it has also been associated with acute flaccid paralysis (AFP). AFP is a reportable disease of public health significance in Ontario. This is an important surveillance requirement to monitor for potential cases of polio, but may also detect other causes of AFP including EV-D68.
Thunder Bay District Health Unit would like to request that practitioners consider EV-D68 in the differential diagnosis among presentations of AFP and for any illness in children with neurologic symptoms suspected to be associated with viral illness.


Symptoms of AFP include rapid onset of weakness or paralysis, characterized as flaccid without other obvious causes. When AFP is associated with paralytic polio the most characteristic feature is its asymmetric distribution which affects some muscle groups, but not others, with fever present at onset.


Persons of any age with acute neurological presentations suggestive of AFP should have laboratory investigations performed to detect a viral cause. This includes testing for both Enterovirus and polio. Enterovirus testing indications, guidelines and specimen collection information can be found on the Public Health Ontario Lab website.
Please fill out PHO’s general test requisition. Indicate relevant clinical and exposure related information as appropriate, and notify Thunder Bay District Health Unit.


AFP is designated as a Disease of Public Health Significance. All suspected and confirmed cases must be reported to the Thunder Bay District Health Unit by the next working day by fax, phone or mail.
  • Fax: (807) 625-4822
  • Phone: 625-8318 or toll-free at 1-888-294—6630, ext. 8318
  • Mail: 999 Balmoral Street, Thunder Bay, ON P7B 6E7
For more information, please visit TBDHU’s webpage for Health Care Providers.

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Thunder Bay District Health Unit · 999 Balmoral Street · Thunder Bay, On P7B 6E7 · Canada