Enterovirus D 68

Recently, a patient asked me if it might be advisable to home school her child to protect her from the recent outbreak of enterovirus D68 (EVD68).  I smiled and pointed out that she had driven to my office for her child’s visit despite over 30,000 US traffic fatalities annually.  We accept reasonable risks in life for achievable benefits that outweigh the very small possibility of danger.  There are many, many advantages for our children if they are able to attend school with their friends, for example.

EVD68 is one of over 100 non-polio enteroviruses; it was first identified in 1962 and known as a human pathogen since 1987, mostly occurring from late summer to early fall.  It is spread by contact of mucous membranes (eyes, mouth) with respiratory secretions from an infected person.  It mutates as do most viruses and this year’s “model” seems to be particularly contagious (easily spread) and virulent (worse symptoms).  Since August cases have been reported in all 50 states including a Hamilton NJ 4 year old who, tragically, died.  Please note that the child died “with” but not necessarily “from” the infection.  It is also noteworthy that there have been reports of EVD68-infected children developing symptoms of weakness or even paralysis; however, these episodes have been transient and it is far from clear that EVD68 is the cause of those occurrences.

Most EVD68 infections cause typical URI/”cold” symptoms–mild fever, congestion, cough, body aches.  Many children may not develop even that.  There is no medication to prevent or treat infection.  I advise my patients to drink plenty of fluids, rest, take OTC analgesics and to call me if symptoms worsen to rapid breathing (1 breath/second for a time period greater than 1 hour) or labored breathing (skin sucking in between ribs or above clavicles–“retractions”).  Asthmatics are at greater risk.  Following CDC guidelines, I advise my asthmatics to faithfully take their maintenance medications, be sure that rescue medications are up to date and that we have updated their asthma action plans, get their flu shots, and call me for worsening symptoms.

Meanwhile, on a global level, the CDC is being proactive: collecting data from the states to better understand the spread of the illness, communicating with public health agencies worldwide to monitor progression internationally, working with entities like GenBank to study causes of this strain’s virulence, assisting localities and healthcare professionals to disseminate accurate information for better awareness including better access to diagnostic tests, and working to develop better testing technology.

Anything else?  Perspective.  Keep our heads.  In the driving case I sited above we know there are risks.  If we wear our seat belts, follow local traffic rules(unlike a certain nameless pediatrician), observe speed limits and NEVER drink and drive, we are doing what we can to be safe.  With EVD68 the best treatment is prevention–careful hand washing/sanitizing; cover coughing with tissue or one’s elbow; disinfect home surfaces regularly–including doorknobs and toys.  Be careful.  But live life.  Have fun.

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