Friday, September 19, 2014

The Centers for Disease Control and Prevention (CDC) has confirmed the presence of enterovirus D68 (EV-D68) in Washington state, including King County. The CDC testing confirmed that a King County child hospitalized at Seattle Children’s Hospital has respiratory illness associated with EV-D68.

“Confirmation of this case indicates that EV-D68 is likely circulating in our community and regionally, and we could see additional cases over the coming weeks,” said Dr. Jeff Duchin, Chief of Communicable Disease and Epidemiology at Public Health – Seattle & King County. “However, we can’t predict at this time how severe or how long an EV-D68 outbreak might be locally. Outside of Seattle Children’s Hospital, our monitoring does not show an increase in patients hospitalized for asthma in King County.”

The results of the testing also show that EV-D68 is not alone in causing serious respiratory illness. The tests indicated that a variety of common cold viruses that cause uncomplicated infections in most children can cause severe disease in asthmatics and those with underlying lung diseases. Although influenza virus was not detected in these children, flu season is just around the corner and influenza is the only viral cause of severe respiratory infections that is preventable through vaccination.

Many people who get sick from EV-D68 have only mild symptoms, like runny nose or coughing with or without fever. Parents should be watchful for any signs of wheezing or worsening asthma and seek medical help promptly if breathing difficulty occurs. Children and adults with asthma should be sure to take their medications as prescribed and have an asthma control plan with their health care provider. They should contact their healthcare provider promptly if asthma symptoms worsen even after taking medication.

There is no specific treatment or vaccine for EV-D68 infections. Testing is done to determine when the virus is present in the community, but is not helpful for individual patients and is not needed or available in non-hospitalized cases.

Influenza is a cause of widespread respiratory infections each year, and is especially serious in children and adults with underlying asthma and other lung diseases and chronic medical conditions. Influenza vaccine is an effective way to prevent this important cause of respiratory viral illnesses and hospitalizations and everyone should remember to get the flu shot this season.

Enterovirus D68 (EV-D68)

Infographic from the CDC about how to prevent enteroviruses
A larger version of this infographic is available from the Centers for Disease Control and Prevention (CDC).

What are enteroviruses?Enteroviruses are very common viruses that can cause respiratory illness, fever and rash, and neurologic illnesses, such as aseptic meningitis (swelling of the tissue covering the brain and spinal cord) and encephalitis (swelling of the brain); there are more than 100 types of enteroviruses.

Approximately 10 to 15 million enterovirus infections occur in the United States each year. Most people infected with enteroviruses have no symptoms or only mild symptoms, but some infections can be serious. Infants, children, and teenagers are most likely to get infected with enteroviruses and become sick.

Enterovirus D68 (EV-D68) is causing outbreaks of respiratory infection in multiple U.S. states this year. The outbreaks are resulting in significant numbers of children requiring emergency department visits and hospitalizations, primarily for difficulties with breathing and severe asthma. Children with asthma appear to be more susceptible to serious illness from EV-D68. CDC testing confirmed the presence of enterovirus D68 in two children hospitalized at Seattle Children’s Hospital with respiratory illness from King County and elsewhere in the state.

How does enterovirus spread?

Because EV-D68 has been uncommon in the past, the ways it spreads are not as well- understood as other enteroviruses. EV-D68 causes respiratory illness, and the virus can be found in respiratory secretions such as saliva, nasal mucus, or sputum. The virus likely spreads from person to person when an infected person coughs, sneezes, or a person touches contaminated surfaces.

What are the symptoms of EV-D68?

EV-D68 has been reported to cause mild to severe respiratory illness (runny nose, cough, difficulty breathing) with or without fever. A minority of people may have more serious infections, particularly children with pre-existing asthma. Because EV-D68 has previously been uncommon in the US, we are still learning about the illness and risk factors for infection. As we learn more, information about EV-D68 infection will be updated. Most people with other enterovirus infections have mild illness that does not require medical care or evaluation.

Use the same judgment as usual about when to take a child to see a health care provider

Anyone who has difficulty breathing or who appears seriously ill should be evaluated promptly by a healthcare provider. Children with asthma should be sure to take their medications as prescribed and have an asthma control plan with their healthcare provider for use during infections and when asthma worsens. Given the potential for increasing EV-D68 circulation, parents and teachers should be alert for trouble breathing and wheezing, especially in kids with asthma. If a child is exhibiting these symptoms and symptoms worsen despite treatment, he/she should be evaluated by a healthcare provider right away. Children with non-severe enterovirus infections do not need to see a health care provider and do not need to be tested.

How is EV-D68 treated?

There is no specific treatment for EV-D68 infections. Some people with severe respiratory illness caused by EV-D68 may need to be hospitalized and receive intensive supportive therapy. Because children with asthma may be at increased risk for more serious EV-D68 infections, it is a good idea to be sure asthma symptoms are under control. Testing for EV-68D is not needed and does not change the care given to infected patients.

How can enterovirus infection be prevented?

There is no vaccine for enterovirus infections. With potential increased circulation of EV-D68 in the community, clusters of respiratory illness in schools are likely to occur. To decrease the risk for enterovirus infections and outbreaks:

  • Wash hands often with soap and water for 20 seconds (alcohol hand gel is not as good as hand washing for enteroviruses)
  • Avoid touching eyes, nose and mouth with unwashed hands
  • Avoid contact with ill people
  • Do not go to school while ill. If fever is present, children should be kept home for at least one day after fever is gone without the use of fever reducing medicines like Tylenol.
  • 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
  • Children with asthma should be sure to take their medications as prescribed, have an asthma control plan with their healthcare provider for use during infections and when asthma worsens. If symptoms worsen despite treatment, contact a healthcare provider promptly.

Influenza and other respiratory viruses also can cause serious illness in persons with asthma or other underlying lung disease

A variety of common respiratory viruses that cause uncomplicated infections or colds in most children can cause severe disease in asthmatics and those with underlying lung diseases. Flu season is just around the corner and influenza is the only viral cause of serious respiratory infections that is preventable through vaccination. Influenza causes widespread respiratory infections and hundreds of hospitalizations locally each year and is especially serious in children and adults with underlying asthma and other lung diseases and chronic medical conditions. Influenza vaccine is an effective way to prevent this important cause of respiratory viral illnesses and hospitalizations. All persons should remember to get the flu shot this season.

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