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Enterovirus D68: What You Must Know

By Dr. Ben Kleifgen, First Steps Pediatrics and Adolescent Medicine September 25, 2014
The following article was written by Dr. Ben Kleifgen, a pediatrician with First Steps Pediatrics and Adolescent Medicine in Beaver. He graduated from Temple University School of Medicine and completed his pediatric residency at the University of Arizona in Tucson.

Going back to school is exciting, but kids often get mild, short-lived coughs and colds during this time of year. However, this year’s cold season is making headlines. By now you may have heard frightening reports about a “new” virus causing severe respiratory symptoms among children in the Midwest. The virus is called enterovirus D68 (EV-D68). Astute parents have been asking me about this new disease and what they should do. I wanted to address some concerns that parents might have. Here are some of the facts about enterovirus D68 (EV-D68). Keep in mind that the situation is currently evolving, so we may know more about the illness in the upcoming weeks. The information in this article comes from the CDC’s official media release and weekly report.

What Is EV-D68?
First of all, this virus is not truly “new.” EV-D68 was first identified in 1962. Although EV-D68 rarely causes disease, the enterovirus family is extremely common. There are over 100 types of enteroviruses, which cause 10-15 million infections annually. (Your children may have experienced hand-foot-mouth disease, which is caused by a type of enterovirus.) Enteroviruses tend to affect infants and children in the summer and fall.

This August, the CDC received reports of clusters of severe respiratory illness in children from hospitals in Kansas City, MO and Chicago, IL. The children ranged in age from 6 weeks to 16 years. Most of them did not have a fever, and no deaths have been reported. Other states reporting clusters of respiratory diseases include Missouri, Colorado, Illonois, Iowa, Ohio, Kansas, Georgia, and Oklahoma.

What Are the Symptoms of EV-D68?
The extent of the disease caused by EV-D68 is not fully known. However, in a typical case, symptoms develop rapidly (within hours). The first symptoms are the same as the common cold: cough, runny nose, and sniffles. The hallmark of EV-D68 is wheezing and difficulty breathing. Most children do not have significant problems breathing, and they will typically get better after 7 days or so. However, some children develop more severe breathing problems, especially if they have asthma. Kids with wheezing can be treated with medicine given in a breathing treatment (nebulizer). In a few cases in Kansas City and Chicago, more intensive care was needed, such as oxygen. However, severe cases are rare. It is important to understand that doctors only tested the children who were already very sick, so they found a high proportion of EV-D68 infections in that group. However, they did not test many of the hundreds of children with similar but less severe symptoms. It is likely that most kids with this infection do not get very sick.

What's the Best Way to Protect Your Kids?
There is no specific treatment or vaccine for the virus. Antibiotics will not have any effect at all. The virus seems to be spread through saliva and mucus, either directly from another person, or via household surfaces. Use common sense protection, such as washing hands for with soap and water for 20 seconds, disinfecting frequently-touched surfaces such as doorknobs and toys, avoid sharing utensils, and avoid rubbing your eyes or mouth with unwashed hands. Avoid exposing children to cigarette smoke, especially if they have asthma. Not every child who wheezes when they have this virus will go on to develop asthma.

If you are concerned your child has EV-D68, here are a few things to keep in mind. It is very common for kids to get colds and coughs during this time of year, and they usually resolve on their own. Antibiotics are not helpful in treating a cold. EV-D68 will look similar to other colds, except your child may have more prominent breathing trouble. If she is wheezing or working hard to breathe, call your doctor. She may benefit from breathing treatments. If your child has asthma, use your nebulizer or inhaler treatments the way your doctor instructed.

Testing for the virus is not likely to be of any use. The test that specifically identified EV-D68 is only performed at a few centers, and the tests available to most pediatricians will only be able to identify the virus as one of several cold viruses. Even if the virus is identified, it does not influence how it is treated. And remember that enterovirus is not the same as influenza virus, so everyone over the age of 6 months should still receive their flu shot this fall.

Remember, this is general information that applies to most children. It is not meant to substitute for the medical advice of your healthcare provider. Please talk to your pediatrician if you have any specific questions or concerns about your child.