Enterovirus D-68 Rapidly Spreading Across The Country
By Amanda Loomer and Sharon Ramsey // September 27, 2014
RARE RESPIRATORY VIRUS SEND CHILDREN TO HOSPITAL
A rarely seen viral infection is sending hundreds of children across the country to the hospital with severe respiratory symptoms. The culprit: enterovirus D-68 (EV-D68).
Most of these hospitalized patients have been admitted to the intensive care unit for treatment with oxygen and breathing medications, and some have required mechanical ventilation. All were children and teenagers.
Fortunately, no deaths have been reported so far.
The illness begins with the sniffles, and in some patients progresses rapidly to severe breathing difficulties requiring emergency treatment. The worst cases seem to occur in those with an underlying illness such as asthma. Sixty-eight percent of those hospitalized in the current outbreak have a history of asthma or wheezing.
The federal Centers for Disease Control and Prevention (CDC), which is helping states with diagnostic testing and surveillance, is warning doctors and parents to be on the alert.
NOT A NEW VIRUS
Enteroviruses are very common, with more than 100 strains causing about 10 to 15 million infections in the United States each year. Outbreaks typically peak in the late summer months. The EV-D68 strain responsible for the current outbreak is not new.
It was first identified in California in 1962, but was rarely seen again until small outbreaks surfaced from 2009-2012 in Japan, the Philippines, the Netherlands, and in clusters in the United States.
In August of this year, health officials in Illinois and Missouri first began reporting dramatic increases in emergency room visits for severe respiratory illnesses. From the first CDC reports in August, through September 25, 2014, 226 people in 38 states were confirmed to have EV-D68 through laboratory testing.
No cases have been reported in Florida as of September 25, however, it is highly likely that by the time this is posted on SpaceCoastDaily.com and subsequently published in Space Coast Medicine and Active Living magazine and distributed, cases will have been identified in our state.
These numbers fall far short of the true number of cases, and are likely to climb in the coming weeks as laboratory testing continues on a backlog of samples.
There is currently no quick test to diagnose EV-D68. Additionally, diagnostic testing is non-contributory to treatment and it is not mandatory to report known cases to the CDC; therefore, many cases are probably going undiagnosed and unreported.
SYMPTOMS MIMIC THE COMMON COLD
Common symptoms of enteroviruses may resemble the common cold, including fever, runny nose, sneezing, cough, and muscle aches. Other symptoms may include skin rash and mouth blisters. These symptoms can advance rapidly and children may get worse to the point of suddenly developing trouble breathing.
This virus has also been known to cause symptoms of mild to severe upper respiratory illness. According to the CDC, one-half to two-thirds of cases that progress to severe respiratory illness involve children with underlying conditions, such as asthma.
Children with asthma are particularly vulnerable to EV-D68 complications due to increased difficulty in responding to viral infections in addition to pre-existing respiratory difficulties.
Some severe and less commonly seen symptoms of enteroviruses include myocarditis (infection of the heart), pericarditis (infection of the sac around the heart), encephalitis (infection of the brain), meningitis (swelling of the tissue covering the brain and spinal cord), and paralysis.
CHILDREN AND TEENS MOST SUSCEPTIBLE
Children and teens are more susceptible to enteroviruses than adults. Viruses in general spread quickly in children due to their limited immune-system experience and because they share secretions with each other more readily.
Some recommended preventative measures include frequent hand washing with soap and water, covering your mouth when coughing, and staying at home even if symptoms seem like a mild cold. It is important to disinfect surfaces and toys, especially if you know that they have come in contact with sick children.
There is currently no vaccine or antiviral treatment for the disease, and antibiotics are ineffective. In order to relieve mild symptoms, over-the-counter medications can be taken for pain and fever.
Aspirin should not be given to children. Parents of children with asthma should ensure that they use their asthma medications as prescribed, and that the asthma is well controlled. Those with severe respiratory complications may need to be hospitalized since treatment involves supportive care with administration of fluids, oxygen and other measures.
Parents should not worry about runny noses and mild symptoms, but If a child has symptoms of a bad cold that seems to be progressing very rapidly to the point of difficulty breathing, report to an emergency room as soon as possible.
An affected child may require oxygen and further supportive care, particularly if they have underlying conditions, like asthma, which may produce further complications.
Health care providers should consider EV-D68 as a possible cause for severe acute respiratory illness, and report suspected clusters to local or state health departments.
For more information, please refer to the CDC website at www.cdc.gov.
ABOUT THE AUTHORS
Amanda Loomer and Sharon Ramsey are Doctor of Pharmacy candidates graduating from the University of Florida, College of Pharmacy in May of 2015. They have each gained pharmacy experience in hospital and community internships across the central Florida area. Amanda is currently on her Adult Medicine rotation and Sharon is on her Cardiology rotation at Health First Holmes Regional Medical Center.