What do I need to know about Enterovirus D68?

By now, you've probably heard of Enterovirus D68 or EV-D68. Twelve states are currently investigating clusters of enterovirus illnesses: Alabama, Colorado, Michigan, Georgia, Ohio, Iowa, Illinois, Missouri, Kansas, Oklahoma, Kentucky and Utah.

At the end of August, the Missouri State Health Department issued an alert and reported that a children's hospital in Kansas City had admitted over 300 cases of acute lower tract respiratory disease. Of greatest concern, 15 percent of these patients required admission to an intensive care unit.  Of 22 samples submitted to the Centers for Disease Control and Prevention, 19 were positive for EV-D68.

Children hospitalized with respiratory symptoms in Chicago, Iowa, and Colorado have also tested positive for the virus. EV-D68 is often hard to distinguish from its relatives so the virus could be in other states as well. To date, only children have been affected and no deaths have been reported. It is assumed that EV-D68 like other enteroviruses, is spread directly by secretions from infected patients or indirectly from contact with contaminated objects.

So why enteroviruses now? As many parents have experienced, there is a seasonality to their children's illnesses.  Runny nose with cough and croup comes in the fall; colds, sometimes with wheezing comes in the early winter; flu comes in the late winter into the spring; and illnesses associated with fevers and rashes, often blisters involving the mouth, palms and soles come in the summertime.  These illnesses cycle on a seasonal basis as a result of the comings and goings of specific viruses.  In the fall, we see parainfluenza virus, in the early winter respiratory syncytial virus, in the late winter influenzavirus, and enterovirus in the warm weather.

The enteroviruses group consists of several related viruses that cause a host of different diseases, but all occur mostly in the warm weather.  Polio is perhaps the best known of the enteroviral diseases.  Before effective vaccination, children would develop an acute, febrile, summertime disease.  About 1 to 2 percent of these children would develop paralysis during the late phase of this infection.

Coxsackie A virus and enterovirus 71 (found mainly in Asia) cause hand, foot, mouth disease, a self-limited viral illness characterized by blisters or vesicles in the mouth, on the palms, and on the soles. Other types of enteroviruses cause a mild brain infection (encephalitis) in young children. These viruses often cause summertime epidemics because these viruses are rapidly spread from one person to another.

EV-D68 was first described as a human pathogen in a small group of California children in 1962.  These patients developed runny nose, cough and wheezing, or pneumonia.  Since then, this virus has appeared sporadically over the years, mainly in the western part of the U.S., and infecting only small numbers of children.

Will it reach the Philadelphia region? Like the early stages of the SARs and MERs epidemics, the extent and severity of the current outbreak of EV-D68 is not known.  While a large number of children have been hospitalized, data from large scale testing of the population is not available.  As a result, it is not known what percentage of infected children require hospitalization or the prevalence of the virus in the population.

As with most respiratory viral infections, EV-D68 begins with cold symptoms: runny nose, cough and fever.  Children with these symptoms who develop respiratory difficulties such as wheezing, shortness of breath or increased work of breathing should be evaluated by a healthcare professional. At present, no effective antiviral therapy or vaccine exists.

It may sound old and trite, but having children wash their hand frequently (with soap and water or hand sanitizers) and cover their face when coughing or sneezing are the best preventatives.  The CDC also provides these tips:

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