Sometimes, I receive notifications from health authorities that cause me to take particular notice. Recently, the Center for Disease Control and Prevention (CDC) has issued an advisory to health care providers about a viral infection known as enterovirus D68 (EV-D68). Enterovirus D68 is a member of the Picornaviridae family, a group of viruses which includes the virus that causes polio. It’s similar in nature to the rhinovirus, the cause for most common colds. Normally characterized by mild symptoms, the infection can, rarely, cause severe respiratory illness requiring hospitalization, especially in children.
EV-D68 is not a new virus; it was first discovered in 1962, and seasonal outbreaks have occurred before in the United States. In 2014, I wrote an article about one such outbreak which led to almost 1,400 cases and over 100 severely ill kids, some of whom died. Since then, a few cases have been reported every year.
This time, however, the CDC confirms at least 84 cases between March and early August. This is hardly a pandemic, but it’s more than have been reported in the past three years. As most children experience only symptoms mimicking a cold or have no symptoms at all, there have probably been many more that have gone unidentified.
Given the generally benign nature of enterovirus infection, why are practitioners warned to be on the lookout? As Enterovirus D68 is in the same family as polio, it can cause a small percentage of affected children to develop a condition known as Acute Flaccid Myelitis (AFM), an inflammation of the spinal cord in the region of the neck. It’s a serious complication that can lead to long-term paralysis. “Increased vigilance for A.F.M. in the coming weeks will be essential,” the C.D.C. cautions.
D68 and more than 100 other non-polio enteroviruses are thought to result in up to 15 million infections every year in the United States. Outbreaks tend to occur in late summer and early fall (that is, right about now). My 2014 article reporting on EV-D68 was published September 2nd. This year, with 84 cases in the spring and early summer, the worst may yet be to come. As such, you should know how to identify it.
SYMPTOMS OF EV-D68
In most kids, an EV-D68 infection will appear just like a cold, with sore throat, nasal congestion, and sneezing. In rare cases, however, Enterovirus D68 can progress to include fever, nausea, vomiting, and shortness of breath. Victims look like extremely nauseous asthmatics. In the worst cases, ventilators are necessary to maintain breathing.
Other symptoms seen in severe situations involve damage to the nervous and musculoskeletal system, (the previously-mentioned Acute Flaccid Myelitis). These children will experience a sudden onset of arm or leg weakness. Muscles lose tone and reflexes disappear. Other signs include drooping eyelids, facial weakness, slurred speech, and difficulty swallowing. Asthmatics seem to do worse.
Testing for it involves a battery of lab tests, spinal taps, and other studies, so the average citizen will have to rely on worsening respiratory and neurological signs to make the diagnosis.
TREATMENT AND PREVENTION
Like the common cold, there is no cure at present for the illness. Treat early symptoms like nasal congestion as they occur, and, in normal times, get a child with signs as described above to the hospital.
Parents can help avoid enterovirus infections in good times or bad by practicing good respiratory hygiene and instilling it in their children at an early age. This is a time-honored and proven strategy reinforced through painful lessons during the pandemic.
If you’re the parent:
• Perform hand hygiene before and after contact with infected kids and contaminated surfaces or other items. Wash soiled hands with soap and warm water for 20 seconds (best) or clean your hands with alcohol-based hand sanitizer (second-best).
• Wipe down all surfaces, such as kitchen counters or doorknobs, with an appropriate disinfectant (dilute 1:10 bleach solution will do).
• Isolate sick individuals away from common areas, as you would with any airborne infection.
Instruct the patient to:
• Cover their mouth and nose with tissues and dispose of those tissues safely. If tissues or other barrier aren’t available, teach them to sneeze or cough into their elbow or shoulder.
• Wear a mask if they’re coughing or sneezing a lot, especially in crowded indoor areas.
• Keep them at least six feet away from healthy people. This is the distance that air droplets can spread from a cough or sneeze.
To some, the above may seem like overkill, especially after a long, painful pandemic., The damage that could be caused by the consequences of EV-D68, however, is long-lasting and, often, permanent. The fact that the virus has a tendency to strike children makes it even more tragic.
Hopefully, Enterovirus68 will stay what it is, a rare virus that pops up from time to time in a small group. Knowledge of the symptoms, however, will help the family medic identify severe cases and better succeed in dealing with the disease.
Joe Alton MD
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