What You Need to Know About Enterovirus D68

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Peds Geek M.D.

Brace Yourselves, Enterovirus D68 Is Coming (But It's Not the End of the World)

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Actually it’s already here. We’re seeing it in Iowa, as well as at least nine other states this season. It, among other illnesses, has been filling up our pediatric emergency room. One hospital in Missouri reported that of all the children hospitalized by the virus at their facility, around 15% are then admitted to the intensive care unit (most with underlying medical issues). The virus has a perfunctory name: Enterovirus D68 (EV-D68). And it’s causing what some doctors on Twitter are calling “asthmageddon.”

What are Enteroviruses?

Enteroviruses are a group of viruses that share certain genetic features, but are responsible for a huge range of illnesses. Hand, foot, and mouth disease and polio are both enteroviruses, but EV-D68 is neither of those. Enterovirus is also not ebola – but given that both are in the news and start with E, it might be easy to get them confused. EV-D68 is nothing like these illnesses. It’s much more like a cold, although a particularly bad one. EV-D68 causes cough and congestion, and sometimes wheezing, especially in those who already have asthma. The problem is that it can hit particularly hard and fast, which can be very dangerous for asthmatics and others, such as young infants, people with other cardiorespiratory problems, and immunocompromised individuals.

EV-D68 has been identified since the sixties, and has caused clusters of illness from time to time, but not usually on this scale. Why it has presently spread so rapidly and caused so much illness in such a short time is not well understood.

How is EV-D68 treated?

There’s no special medicine for EV-D68, no antiviral treatment, and no vaccine. In fact, testing for the virus would not be common unless there is a good reason, like a hospital admission. Like a common cold, EV-D68 is usually treated with supportive care. This means rest, fluids, nasal suctioning, and treating symptoms. If needed, fever can be treated with acetaminophen or ibuprofen, but (as I will blog about in the near future) many fevers don’t need treatment unless the child is uncomfortable. Antibiotics are used if a complication of EV-D68 (like pneumonia) happens, but like all viruses, antibiotics are not otherwise useful.

Should You Be Worried About EV-D68?

It's nice to have an expert down the hall to ask. “I don’t think there is any reason for parents to panic,” said Dr. Amaran Moodley, pediatric infectious disease specialist at Blank Children’s Hospital. “Most children who have this infection have a flu-like illness that gets better after a few days. If your child has asthma that has been severe or poorly controlled, or has an underlying lung problem or weakened immune system then it is important to have them seen by their doctor before complications develop.”

It certainly doesn’t hurt to call your child’s doctor’s office if your child has any of these conditions, and develops a cold that’s worse than average. Reduce the spread of all respiratory illnesses by frequent hand washing, teaching your child to cover their mouth when sneezing or coughing (and modeling it, too), and avoiding others while sick.

Be aware, not worried.

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