Friday, October 17, 2014

Enterovirus D68

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.

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