Dr. Jeff Hersh: The enterovirus is not new

Dr. Jeff Hersh: The enterovirus is not new

By Dr. Jeff Hersh

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Q: Where did this new enterovirus that is going around come from?

A: Although enterovirus D68 (EV68) was first specifically identified in 1962, it has surely been around for a long time before that. Enteroviruses (a type of picornavirus) in general are very common; there are over 100 different subtypes, including three serotypes of poliovirus.

There have been many regional outbreaks of EV68 over the years; small outbreaks are reported almost every year. EV68 can occur at any time, but it most commonly “goes around” during the summer and/or fall. It is not clear why the outbreak this year has been so large; there have been hundreds of verified cases and surely many thousands of cases overall (testing for EV68 is only done for epidemiological monitoring so most cases are not specifically identified, especially those with only minor symptoms).

EV68 is transmitted from person to person either directly via secretions (airborne from coughing or sneezing or from direct contact with saliva, mucus or sputum from the infected patient) or indirectly from infected patient to an inanimate object (called a fomite, which is often a toy, doorknob or other object; depending on the conditions, EV68 can survive for hours or even up to a day or more on certain objects) to a new patient. Then after a short incubation period (usually just a couple of days) the new patient either remains asymptomatic (common for adults) or develops symptoms.

Most people infected with EV68 that develop symptoms have only mild cold symptoms such as cough, runny nose, sneezing, body aches, etc.; interestingly, fever occurs in only a quarter of patients. Children 6 months to 16 years old, especially those 4 to 6 years old, seem to be at the highest risk of developing symptoms. This may be because kids these ages are more often in settings where it is more likely for them to become infected (such as school or daycare), but have not yet been exposed to as many other enteroviruses as older children and adults.

Children with underlying respiratory conditions (such as asthma) are at the highest risk of developing more severe symptoms such as a triggered “asthma flare” or other breathing problems, which can sometimes be serious enough to require hospitalization or even intensive care. There have been several deaths attributed to secondary complications from EV68 infection, and at least a couple in otherwise healthy kids. There have also been some cases of paralysis possibly linked to this infection, although these seem so far have mostly been only partial paralysis (muscle weakness) and seem to have been temporary.

For the large majority of patients with only minor cold-like symptoms, increasing fluid intake (such as grandma’s homemade chicken soup) and ensuring patient comfort is all that is required. However, patients with more severe symptoms may require aggressive supportive care, possibly including supplemental oxygen, treatments for an asthma flare or other respiratory support (even including intubation and a machine to help them breath). There are no specific medications for this viral infection, and there is presently no vaccine to prevent it.

Since most patients only have cold-like symptoms, and there is no specific treatment for EV68, testing is usually only done for epidemiological tracking of outbreaks. This specialized testing is not widely available; it is typically done at specialized testing centers such as the Centers for Disease Control and Prevention.

Because EV68 is spread person to person, infection control measures are important to minimize the number of people affected. This means frequent hand washing (noting that this is a challenging thing to get kids to do), as well as cleaning of fomites; most common disinfectants are adequate to kill this virus on surfaces, so toys, doorknobs, etc. should be frequently cleaned, especially in settings where person to person (particularly child to child) transmission is likely, such as in daycares, preschools, etc. Keeping sick children home until they are asymptomatic is also beneficial to control outbreaks.

Parents of children with asthma or other underlying respiratory problems, or other conditions that may make them more susceptible to severe complications (such as immune compromise, heart disease, other conditions) should discuss with their healthcare provider what signs and symptoms to be on the lookout for, and what early actions should be taken if the child begins to manifest breathing symptoms. Any child with breathing compromise should be emergently evaluated. Early intervention can be lifesaving.


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