A
couple of months ago, while my husband and I were watching the news, a
story came on about a scary new virus in the Midwest that was causing
many children to be hospitalized. He turned to me and said "Your phones
will be ringing off the hooks about this tomorrow." He was right of course. Whenever the media widely circulates a story it is hard not to get concerned.
That
virus now has been identified at Enterovirus D-68 and it has
subsequently spread to most of the country. We do have cases here in California.
Every
year, enteroviruses and rhinoviruses cause millions of respiratory
illnesses in children. This year, EV-D68 has been one of the most common
type of enterovirus identified, leading to increases in illnesses among
children. It affects those with asthma most severely. This strain last
circulated back in the 1960s so older adults already have some immunity.
Viruses
can be frightening. Every year different ones make the rounds and
infect millions of people. With most viruses, the majority of the people
with the illness have mild or moderate cases, but unfortunately there
are a number of people with severe cases. Fatalities do occur. These are
the folks of course who make the news. Luckily we have vaccines
developed to protect us from some common viruses such as Influenza. Alas
there is no current vaccine for this strain of enterovirus. Because
most patients with the most common viruses are untested and unreported,
it is hard to get a full sense of the accurate numbers.
We
likely have seen some cases in the office. We did in fact have a few
patients that needed to be admitted with severe cases of wheezing that
seemed a bit unusual. Luckily everyone has fully recovered.
In
our office when we are suspicious about flu, we often do run the test
because with a diagnosis in hand, we can offer a medication like Tamiflu
that might shorten and ease the symptoms. Identifying the actual virus
would eliminate any uncertainty but testing for this enterovirus would
be of limited use; we don't really have anything to offer beyond
supportive care.
Testing
for the enterovirus has also not been simple. Unless someone was
actually in the hospital, the CDC wouldn't run the test. We actually did
try to test of few of our sicker children in the office but didn't
succeed. Just this week however (October 14th,) the CDC has
started using a new and faster test. This new lab test will allow the
CDC to rapidly process the more than 1,000 remaining specimens received
since mid-September. As a result, the number of confirmed EV-D68
cases will likely increase substantially in the coming days. These
increases will NOT reflect changes in real time or mean that the
situation is getting worse.
The CDC expects that, as with other enteroviruses, EV-D68 infections will likely begin to decline by late fall.
The parameters for knowing when to be seen are the same as they are for any virus illness.
There
are some ways that you can be proactive. If your child has a history of
wheezing, have a current asthma action plan that you are familiar with.
Have unexpired medication on hand.
If
you have a very young infant, avoid crowds. Politely ask anyone who has
any signs of illness to "Please step away from my baby." Wash hands
with soap and water and friction.
Alcohol
hand sanitizers are a good start, but enterovirus is not as
susceptible to those as it is to soap. Teach your kids a hand washing
song that might help encourage them to take a bit longer with it.
