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Staying Informed and Healthy: Enterovirus D68 and Illness Prevention in Kids

Kids in hospital; health officials urge parents not to panic, wash hands

Kali Sakai

Published on: September 12, 2014

No sooner did I send my wee and wide-eyed kindergartener off to school this month than reports of a virulent respiratory virus surfaced, ripping through the Midwest and hospitalizing kids. It has now likely surfaced in Washington state. I usually score about 9 out of 10 on the ‘nervous germaphobe parent scale.’ But regardless of where you land, here are some important points to know about this virus and suggestions on how to stay well during prime-time cold and flu season.

What is Human Enterovirus EV-D68?

This virus has quickly thrust itself into the national spotlight, demanding the attention of concerned parents, doctors and experts at the Centers for Disease Control and Prevention (CDC). EV-D68 typically causes common cold-like symptoms, like runny nose, sneezing, mild fever, cough and achiness

What makes it different from other viruses?

Its effect on kids with asthma, allergies and other respiratory issues is of real concern. "This virus seems to provoke, in some kids, more significant respiratory distress and breathing difficulties. It’s [also] cropping up in clusters in certain regions," says Wendy Sue Swanson, M.D., writer of the popular Seattle Mama Doc Blog and a pediatrician at Seattle Children’s Hospital and the Everett Clinic.

Hundreds of children in Missouri and Illinois have been, and continue to be, hospitalized daily, some admitted to intensive care units. As of today there have been no reported deaths resulting from this virus.

Where will it travel?

The virus has been reported already in a number of states. Earlier this week, Mark Pallansch, director of the CDC's Division of Viral Diseases, told CNN that the number of hospitalizations reported could be "just the tip of the iceberg in terms of severe cases." Washington state will likely join the list too: As of Thursday morning, Seattle and King County Public Health announced that Seattle Children's Hospital is investigating a "cluster of patients with severe respiratory illness who tested positive for a possible enterovirus infection." [UPDATE: Cases have been confirmed at Seattle Children's.]

But getting a definitive answer of exactly when it jumped state lines takes time. "In a hospital setting, you can do a viral study to find out if a child has an enterovirus. But you can’t right there confirm if it is specifically Enterovirus EV-D68. It’s the CDC who’s doing that," Swanson says. That takes further analysis and time, which can mean delays in understanding what or where the infection really is.

Can it be treated?

While there is no preventive vaccine or medicine to treat enteroviruses directly, medical attention is needed if there is difficulty breathing or if there are significant changes in condition, such as if a child initially only shows mild cold symptoms then suddenly begins wheezing or coughing in an alarming way.

Contrary to popular belief, a child can also be quite sick even without the tell-tale sign of a high fever. "That’s not going to be a good indicator of this virus," Swanson says. "[So] if at any point you are concerned about the way your child looks, is breathing, or the sound of their breathing, that is certainly a sign to check in with the child’s provider."

"It's important for families to make sure asthma symptoms are under control, and to see a healthcare provider if a person with asthma develops a respiratory illness that worsens asthma symptoms," says Jeff Duchin, M.D., Chief of Communicable Disease and Epidemiology at Public Health — Seattle & King County. This also includes kids with reactive airways and cough-variant asthma or wheezing.

Sickness season on the doorstep

This outbreak of EV-D68 is just the beginning of the cold and influenza season. "We do see a lot of viral upper respiratory infections this time of year, particularly in kids who are preschool and school age," Jeremia Bernhardt, M.D., a Seattle-area family physician, says. "The way these viruses spread is through close contact, coughing, sneezing, touching common surfaces and hand contact. Children simply have a tendency to infect each other."

Even though enterovirus is a completely different virus, it has similar symptoms to influenza, an illness that 5–20 percent of the national population contracts yearly, according to the CDC. It typically strikes beginning in October and runs through May. But unlike an enterovirus, influenza can be prevented by a vaccine.

"Now is the perfect time for everyone over the age of 6 months to get a flu vaccine," Bernhardt advises. "This is especially important for parents of kids under 6 months, pregnant women and people with chronic respiratory issues like asthma." The flu vaccine is now widely available at local doctors’ offices and pharmacies but takes at least 2 weeks inside a person’s immune system to prime the body to fight the virus. Additionally, everyday precautions can be taken by parents and kids to avoid illness.

More updated information on the Enterovirus EV-D68

Centers for Disease Control and Prevention

Seattle and King County Public Health

Seattle Mama Doc

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