CDC: Enterovirus D68 continues to spread across US

Stanley Goldstein, MD, FAAAAI

With the onset of the school year across the United States, so too it is the onset of increasing viral respiratory infections among school-aged children. New to the class of viruses causing this is the enterovirus D68. The typical enterovirus season runs from July through October. This year the spreading of the virus has coincided with the start of the new school year. Recent cases have been reported in children aged 6 months to 16 years, with most patients around aged 4 and 5 years.

Typically enterovirus D68 causes upper respiratory symptoms such as cough, runny nose, sneezing, body and muscle aches, and possibly low-grade fever. However, some individuals with underlying medical conditions such as allergy, asthma and weakened immune systems may experience severe complications such as shortness of breath, rapid breathing, wheezing and or difficulty in breathing.

If a child has asthma, physicians should work with parents to make sure an asthma action plan is updated, that children are taking their prescribed daily asthma controller medication and that they have the availability of their rescue medication. If children develop worsening asthma symptoms, they should follow the steps of their asthma action plan. Physicians should encourage parents to contact them right away if the symptoms do not improve.

The virus can be found in an infected person’s respiratory secretions such as saliva, nasal mucus or sputum. It likely spreads from person to person when an infected person coughs, sneezes or touches contaminated surfaces. There are no specific treatments; however, parents should be instructed to protect their child and themselves by taking the following precautions:

• Wash hands often with soap and water for 20 seconds.
• Avoid touching eyes, nose, and mouth with unwashed hands.
• Avoid kissing, hugging and sharing cups or eating utensils with people who are sick.
• Disinfect frequently touched surfaces such as toys and doorknobs, especially if someone is sick.
• Tell children to cover their mouth with a tissue when they cough. If no tissue is handy, they should be taught to cough into the crook of their elbow or upper sleeve instead of their hand.

Andy Nish, MD

Over the past month plus, enterovirus D68, or EV-D68, has caused illness in at least 22 states in the US, with over 160 confirmed cases. The virus itself was initially discovered in 1962 but has rarely caused outbreaks, and illness has usually occurred in a handful of people. The enterovirus shows some characteristics of rhinoviruses, which cause the common cold.

Enterovirus illness does, in fact, usually start off like a cold, with runny nose, sore throat, cough and fever. At times rash and pain in the abdomen may occur. What makes EV-D68 more concerning is that it may progress to a more severe illness with breathing problems, which may lead to respiratory failure, kidney problems and decreased levels of consciousness. Rarely, symptoms such as paralysis may occur. It should be noted that the usual course of illness is not severe, and that most people who become ill with EV-D68 do not require hospitalization and do recover completely.

People at highest risk for EV-D68 are those younger than 5 years and children with asthma, in addition to adults with asthma and immune problems. For all of us it makes sense to take common precautions, such as avoiding those who are sick and washing hands frequently. Those who are potentially ill with EV-D68 and will be around a large number of people or someone whose immune system is low, should consider wearing a face mask.

There is no specific treatment for EV-D68, and there is no vaccine at this time, so avoidance is your best bet. Symptoms and specific issues such as respiratory failure can be addressed. As with so many illnesses, your best offense is a good defense.

Patients should work with their doctors to make sure their asthma is optimally controlled, which will improve their chances of doing well if they were to become sick.