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Enterovirus D68: Learn the Facts

Sep 09, 2014
Enterovirus D68

Runny nose, cough and congestion are sweeping across central Ohio. You know this because you’ve seen it in the news, on social media feeds, and (if you’re like me) in your own home. It happens this time every year. Ragweed counts and mold spores rise, asthma and allergies act up, and virus-sharing kids return to school, get sick, and lovingly transmit their germs to moms and dads and the rest of the community.

But this year is different.

Here at Nationwide Children’s Hospital, we’ve seen a larger number of patients with respiratory complaints compared to a typical September. We’ve also seen more severe cases than usual, with many children wheezing and requiring admission to the hospital. Some need intensive care. And we aren’t alone in this observation. Reports from Alabama, Colorado, Georgia, Illinois, Iowa, Kansas, Kentucky, Michigan, Missouri, Oklahoma, and Utah tell similar stories.

Last week, the Center for Disease Control identified Enterovirus D68 (EV-D68) in Kansas City and Chicago, and yesterday the Iowa Department of Public Health reported the virus in their neck of the woods. Samples from central Ohio are still pending (as of this writing), but none of us should be surprised to hear the official announcement that EV-D68 has arrived. In fact, if public health officials are correct in their prediction (and I believe they are), this virus will eventually make its way across the entire country.

So what is Enterovirus D68?

Until now, EV-D68 was an uncommon member of the enterovirus family of microorganisms. You know a few of its relatives—Rhinovirus (culprit of the common cold), Coxsackievirus (famous for hand foot mouth disease) and the once-feared still-respected Poliovirus. Discovered in 1962, EV-D68 has kept a relatively low profile, causing only six small outbreaks between 2005 and 2011 in the Philippines, Japan, the Netherlands, and the United States. Because it was rare, few laboratories are set up to test for EV-D68, which explains why it took awhile to figure out which virus is making so many kids sick.

How is EV-D68 spread?

Although it has not been thoroughly studied, EV-D68 likely spreads through respiratory droplets and oral secretions. Enteroviruses are also know to infect the GI tract, so transmission through stool is also possible. Bottom line: the virus appears to spread easily through close contact with an infected person, and prevention strategies include staying away from sick people, covering coughs and frequent hand washing.

What symptoms does Enterovirus D68 cause?

The current outbreak of EV-D68 appears to be isolated to the respiratory tract. This means it causes runny nose, mild sore throat, cough and congestion. Children with asthma have a high risk of wheezing with this virus (as they do with all respiratory viruses). In addition, there have been many cases of children wheezing who do not have a history of asthma. Wheezing is caused by inflammation in the small airways of the lungs, and swelling in these passages restricts the flow of air. The result is a soft, high-pitched sound, especially heard when breathing out. EV-D68 has the potential to cause fever, abdominal pain, vomiting, diarrhea and rash, but so far these have not been prominent in the current outbreak. EV-D68 has also been implicated in past outbreaks of polio-like paralysis. This is extremely rare and has not been reported in any state at this time.

What causes similar symptoms? And how can we tell the difference?

Infection with any one of the many common respiratory viruses can result in similar symptoms. Allergies are another cause of runny nose, cough and wheezing this time of year. Since there is no universally available test for EV-D68, there is no sure way to differentiate it from other possibilities. Public health officials will send samples to the CDC in an effort to track the spread of the virus, but they won’t test everyone. Since there is no specific treatment for EV-D68 and since respiratory symptoms (regardless of cause) are treated the same, there is no reason to test everyone for this particular virus. If an outbreak of EV-D68 is identified in your area, and your child has symptoms typical of EV-D68, there is a good chance your child is infected with the virus.

Why are so many kids experiencing severe disease?

At this time, we don’t have a definite answer to this question. There are many possibilities. One likely explanation is that children in affected areas have not had previous exposure to this virus and do not have immunity against it. Scientists will continue to investigate the current outbreak, and future research will likely focus on the biology of EV-D68 infection. Until then, we only know what we see… that lots of kids are getting sick with severe respiratory symptoms, and the likely culprit is EV-D68.

How is EV-D68 treated? When should we go to the emergency room?

The vast majority of children will only experience mild upper respiratory symptoms similar to the common cold. These symptoms last about a week, and treatment is supportive: remove mucus from the nasal passages, ensure plenty of rest and encourage fluids. Children who develop wheezing, difficulty breathing, unusual rashes, persistent vomiting or prolonged fever should see a doctor. Really, if you have any concern at any time, it’s always a safe bet to touch base with your child’s primary care provider. Children with severe respiratory symptoms (wheezing, difficulty breathing) need to be seen right away. If your child is experiencing severe distress, call 911. Otherwise, call your doctor or have your child seen in an urgent care center or emergency department with special skill in treating pediatric patients. If your child only has cold-like symptoms, it really is best to touch base with your regular doctor first. By filling urgent care centers and emergency departments with children who have minor symptoms, it becomes more difficult to care for those who need immediate attention.

Should we panic?

Of course not. Runny nose, cough and congestion are common symptoms in the fall. You know this. And most kids with EV-D68 will do just fine and feel better in a few days. However, there is the potential for severe disease. Other than those with a history of asthma, there is no way to predict which children will have an escalation in symptoms, so keep a close eye on your child (you were going to do that anyway, right?). If he or she begins to have severe wheezing or difficulty breathing, call 911. If the symptoms are mild to moderate, call your regular doctor. If you are unable to reach your regular doctor (or if your regular doctor instructs you to go), then visit an urgent care center or emergency department with experience treating children. If you're in the Columbus area and need an Urgent Care, make sure to first check our Urgent Care wait times.

Is there a shot to prevent this?

Not at this time. But the rapid spread of a potentially-dangerous virus should serve as a wake up call for all of us. There was a time when viral-mediated diseases like smallpox and measles and polio wrecked havoc on American children. Thanks to immunizations, those days are largely behind us. However, if we let down our guard, the rapid-fire spread of EV-D68 is a clear example of how fast and furious infectious disease can roam through an unprotected community.

Nationwide Children's Hospital Enterovirus D68 (EV-D68) Infographic

Enterovirus D68 Infographic from Nationwide Children's Hospital.

Featured Expert

Nationwide Children's Hospital Medical Professional
Mike Patrick, MD
Emergency Medicine; Host of PediaCast

Dr. Mike Patrick is an Assistant Professor of Pediatrics at the Ohio State University College of Medicine and Medical Director of Interactive Media for Nationwide Children's Hospital. Since 2006, he has hosted the award-winning PediaCast, a pediatric podcast for parents. Dr. Mike also produces a national podcast for healthcare providers—PediaCast CME, which explores general pediatric and faculty development topics and offers free AMA PRA Category 1 Credit™ to listeners.

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