There have been many news reports of the recent outbreaks of enterovirus d68 across the US this year. This weekend, the news is full of a young preschooler dying in NJ from this virus. As of 10/3/2014, the CDC has confirmed 538 cases in 43 states. And many are predicting it is going to get much worse. In general, enterovirus is very common with an estimated 10 to 15 million infections each year. There are more than 100 strains, with d68 being the most dangerous.
Typically, EV-D68 (as it is commonly known) causes mild to severe respiratory symptoms. Symptoms include fever, runny nose, sore throat, sneezing, cough, rash, abdominal pain, diarrhea and muscle aches. These symptoms make it virtually indistinguishable from the “common cold”. In more severe cases, wheezing and shortness of breath can occur. This is why it tends to be particularly more severe in asthmatics as well as children under 5 years of age. In more sever cases, the disease can progress to pneumonia, decreased urine output, change in mental status, dehydration and respiratory failure. Although this is not a “polio-like” virus, there is some debate whether is can cause a paralysis like polio. There have been some recent cases where symptoms of paralysis have been seen. However, for the most part, these were more often cases of muscle weakness and reversible. In the outbreak in California earlier this year, most kids with “paralytic” symptoms recovered but there are still a few with lingering muscle weakness that has been gradually improving over time.
Usually, the enterovirus season runs from July through October. What is not typical about the current one is that we have not seen it so widespread across the US in past years. Because it has not been so widespread, many people have not been infected with in the past and their susceptibility is higher. The current outbreak coincided with the start of the school year making this a potential large-scale outbreak. EV-D68 is spread through respiratory droplets, such as when someone coughs, sneezes, or touches a surface that was touched by someone who was infected. For the most part, infected patients are not tested for EV-D68. The CDC recommends testing only for those with severe respiratory infections and there is no clear cause.
How is EV-D68 treated?
– it is a virus and there is no medication to cure it. It is something that just needs time to run its course, like the common cold.
-it is important to drink plenty of fluids. Dehydration can be one of the complication factors of this disease. It is very important to stay well hydrated. If a patient is able to eat, any fluids are fine. However, if a patient is not eating, electrolytes need to be replaced as well. Depending on the age of the patient, pedialyte or Gatorade can be used. There are also many recipes for homemade replacement solutions as well.
– Over the counter medications can be taken for symptom relief, such as Tylenol for fevers. It is probably best to ask your doctor’s advice first.
– In more severe cases, hospitalization may be needed.
– If you or the patient is asthmatic, use your asthma medications. Many of the respiratory complications we see with EV-D68 are in asthmatics who are not using their inhalers as they should.
– The most important treatment is PREVENTION! Frequent hand washing with soap and water is key. Sick patients should try to stay away from others and cover their mouths when they sneeze or cough. Clean all surfaces that were touched by someone who was infected.
It is important to keep in mind that most cases of enterovirus are mild. It may be scary watching the news but if we all take precautions, we can help limit the outbreak. And if ever in doubt, ask your doctor.
Copyright secured by Digiprove © 2014 Linda Girgis, MD, FAAFP
