Enterovirus D68: What You Need to Know

The news that children in Michigan, Rhode Island and New Jersey have died from the Enterovirus D68 (EV-D68) has struck fear in many local parents and experts warn the Enteroviruses and flu pose a greater risk to residents here than another health threat, the Ebola virus, which is spreading rapidly in West Africa.

EV-D68 is an upper respiratory virus that is usually mild and common cold-like in presentation but can also be serious in some cases, requiring hospitalization. Since Enteroviruses are most common in the summer and fall months their incidence should decline as fall becomes winter but in the interim parents should be vigilant in monitoring their children.

Here are some questions and answers about the virus:

Who is at risk for contracting EV-D68?
Children are at higher risk than adults for becoming infected since they have not often developed immunity to it as adults have. Children with asthma seem to be at higher risk for serious complications from the virus.

How can you prevent your kids from coming down with the virus?
The CDC (Centers for Disease Control and Prevention) recommends regular hand washing, avoiding contact with people who are sick and staying home if you're sick, covering coughs and sneezes and disinfecting home and school surfaces well and regularly. Washing hands or using an alcohol hand sanitizer is especially important before eating and after coughing or sneezing and before touching the eyes, nose, and mouth.

Dan Weiser, M.D., is a pediatric oncologist and medical director of the intra-abdominal solid tumor service at the Children's Hospital at Montefiore. His patients who have cancer are more susceptible to bugs and viruses, as treatment for their disease makes them immune-compromised. "I tell the parents of my patients to follow standard hand hygiene recommendations as well as other routine infection-prevention techniques such as sneezing and coughing into the elbow. To protect healthy individuals, children with a presumed contagious illness should stay away from other people and not share cups or eating utensils."

What are the signs and symptoms of EV-D68?
EV-D68 is a non-polio virus that causes a fever (although not always), runny nose, sneezing, coughing, muscle and body aches, and possibly temporary muscle paralysis in some patients. Symptoms are very similar to the common cold and somewhat similar to the flu. A few children who tested positive for EV-D68 this summer developed a polio-like virus, but it's not clear if this was caused by the virus or not.

Extra precautions should be taken for asthmatic children. According to the CDC, EV-D68 is transmitted through contact with infected persons who cough, sneeze, or touch a surface that is then touched by others who are susceptible to the virus. Sue Ugliarolo, Director of Scarsdale Friends Nursery School, said, "I will send children home if multiple symptoms exist. A child with a runny nose who is happy, running, and eating is different from a child with a runny nose who is lethargic, cries easily, and has no appetite." She added, "We do take temperatures at school with an ear thermometer. Children who are not well are miserable at school." Mrs. Ugliarolo stresses to preschool parents that they need to be partners in helping to keep the school environment healthy. The guidelines of the school outline how parents can determine if a child is well enough to attend school. "It's important that parents feel like they can be open and honest with us in regards to their children's health," she continued. "I've seen kids at school who say they vomited their breakfast that morning and here they are in school, only to be sent home and be out over the next several days."

When should you worry (or when should you call the doctor)?
Occasionally, children develop wheezing and become very short of breath. If either of these symptoms occur, you should have your child promptly examined. If your child has asthma, be sure they take their medicines regularly and have their inhalers handy.

Can a doctor test for the virus?
According to the CDC, as of October 10, 2014, there have been 691 confirmed cases of the virus across the nation. Most doctors offices and laboratories don't have the ability to test for and diagnose specific enteroviruses. There are likely many more than 691 cases of EV-D68, but only severe cases that have required hospitalization have been laboratory-confirmed. Mild cases of the virus subside on their own and are not laboratory-tested.

Is there treatment?
Treatment consists of supportive care at home in mild cases or in a hospital in more severe cases if there are breathing problems. Anti-viral medications have not been shown to be effective in fighting EV-D68.

What about the flu? Should children still get the vaccine?
Though parents are focused on this new virus, it is important to remember that influenza sickens more children every year than enteroviruses, including D68. The CDC ranks influenza as one of the top ten causes of death in children. If you haven't scheduled a flu vaccine appointment yet, consider doing so as cases have started being reported. It's very important to vaccinate your children against measles and other common, avoidable diseases. Dr. Judy Stone, an Infectious Disease physician and blogger with the Scientific American Blog Network, emphasized, "It's important to keep the risk of Enterovirus in perspective--influenza, whooping cough, and measles are far more worrisome, and are preventable with immunizations." In fact, once virtually eradicated in this country, there were 592 cases of measles in the U.S. as of August 1st; measles can be fatal in children.

Are you concerned about EV-D68? Is your school doing anything different in terms of hand washing or sending kids home even if they "only" have colds? Please share in the comments below.