Concern Over Enterovirus D68 Amidst Death of Asymptomatic Child
Oct 07, 2014

The United States is currently experiencing a nationwide outbreak of enterovirus D68 (EV-D68) associated with severe respiratory illness. From mid-August to October 6, 2014, there have been a confirmed total of 594 people in 43 states and the District of Columbia diagnosed with the infection and five of those patients have since died.  While the role that EV-D68 infection played in four of these deaths is still being investigated at this time, the latest fatality of a four-year old boy from New Jersey is confirmed to have been associated with EV-D68.  As more cases appear across the country, and more questions arise about the symptoms – or lack of symptoms in the latest fatal case – parents are understandably growing concerned. What is this unfamiliar virus that is threatening the health of their otherwise healthy children?

The truth is that there are more than 100 types of enteroviruses which are fairly common through the summer and fall in the United States. In general, a mix of enteroviruses circulates every year, and different types can be common in different years. It’s estimated that 10 to 15 million enterovirus infections occur in the United States each year resulting in tens of thousands of hospitalizations.

But what has drawn the public’s attention is that EV-D68 is extremely prevalent of all the types and is causing severe respiratory illness.  While the three strains of EV-D68 circulating this year are not new, and small numbers of EV-D68 have been reported regularly to the CDC since 1987, the number of confirmed EV-D68 infections this year is much greater than what has been reported in previous years.

It’s also important to realize that different enteroviruses can cause different illnesses, such as respiratory illness, febrile rash, and acute neurological diseases such as aseptic meningitis which results in swelling of the tissue covering the brain and spinal cord, encephalitis which results in swelling of the brain, and acute myelitis and paralysis. While severe respiratory illness has been the most common result of EV-D68 infection, the CDC is aware of two published reports of children with neurologic illnesses in confirmed patients with EV-D68 infection. This, of course, is concerning and has resulted in frequent alerts and updates from the CDC in regard to the spread and symptoms of EV-D68.

Symptoms of Infection and Who Is At Risk

EV-D68 infections can cause mild symptoms such as fever, runny nose, sneezing, cough, and body and muscle aches, to severe symptoms which may include wheezing and difficulty breathing. And yet, in the case of Eli, can even cause no apparent symptoms at all.  It should be noted that almost all of the CDC-confirmed cases of EV-D68 infection this year have been among children, many of which suffer with asthma or a history of wheezing. In general, infants, children, and teenagers are more likely to become sick as a result of an enterovirus infection because they don’t yet have immunity from previous exposures to these viruses. On the other hand, while adults can get infected, they’re more likely to have little or no symptoms.

Transmission and Prevention

Since the virus can be found in an infected person’s respiratory secretions, and is likely spread from person to person when an infected person coughs, sneezes, or touches a surface that is then touched by others, the best way to help prevent EV-D68 is by following these steps:

• Wash hands often with soap and water for 20 seconds
• Avoid touching eyes, nose and mouth with unwashed hands
• Avoid close contact such as kissing, hugging, and sharing cups or eating utensils with people who are sick, or when you are sick
• Cover your coughs and sneezes with a tissue or shirt sleeve, not your hands
• Clean and disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick
• Stay home when you are sick

For children with asthma, who are at risk for severe symptoms from EV-D68 and other respiratory illnesses, they should be sure to:

• Discuss and update their asthma action plan with their primary care provider.
• Take prescribed asthma medications.
• Keep reliever medication on hand.
• Get a seasonal flu vaccine.
• Ensure child’s caregiver and/or teachers are aware of how to help if a child experiences any symptoms related to asthma.

Anyone suffering with respiratory illness or who develops new or worsening asthma symptoms should contact their doctor right away if they are having difficulty breathing.

Diagnosis

EV-D68 can only be diagnosed by doing specific lab tests on specimens from a person’s nose and throat.  While many hospitals and some doctor’s offices can test sick patients to see if they have enterovirus infection, they can’t necessarily test to determine the type of enterovirus, like EV-D68. The CDC and some state health departments can do this sort of testing, but it is currently only recommended that clinicians consider this for patients when the cause of severe respiratory illness is unclear.

Treatment

Unfortunately, there are no specific treatments, antiviral drugs or vaccines to protect against EV-D68. For mild respiratory illness, it’s best to treat symptoms with over-the-counter medications.  For those who suffer with severe respiratory illness, hospitalization may be required for intensive supportive therapy.

What the CDC Has Been Doing

Dr. Anne Schuchat of the Centers for Disease Control and Prevention and Dr. Gregory Conners of Children’s Mercy Hospital in Missouri spoke with PBS last month to provide more details on how they have identified this growing concern with EV-D68.

[youtube=http://www.youtube.com/watch?v=xlMCgWUtR2M#t=279]

The CDC will continue to collect information to better understand how widespread EV-D68 infections may be within states and how populations may be affected. By working with state and local health departments, as well as communicating with clinical and state laboratories, they continue to identify and investigate outbreaks, while also helping to improve detection and enhance surveillance.

For more current updates, check out the information they have available here:   

• CDC Enterovirus D68 in the United States, 2014 website
• CDC Enterovirus D68 general website
• CDC Enterovirus D68 for Health Care Professionals website
• Enterovirus D68 in the United States: Epidemiology, Diagnosis & Treatment, COCA Call, September 16, 2014
• Severe Respiratory Illness Associated with Enterovirus D68 – Multiple States, 2014, Health Alert Network, September 12, 2014
• Severe Respiratory Illness Associated with Enterovirus D68 – Missouri and Illinois, 2014, MMWR, September 8, 2014

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