What Parents Need to Know About Enterovirus

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By Kristine Crane

The enterovirus, also known as EV-D68, was first identified in the U.S. in 1962 and then lay dormant for some 30 years. Since 2008, small clusters — ranging from four to 30 cases — have periodically cropped up throughout the country but none with the vengeance of the recent outbreak. Kansas City, Missouri, has been particularly hard-hit, with hundreds of children hospitalized at Children’s Mercy Hospitals and Clinics. Mary Anne Jackson, the hospital’s director of infectious diseases, shares her thoughts on what you need to know about the virus.

Are you at risk?

Children between ages 4 and 12 are most at risk, Jackson says. “We saw our peak right after school started. It’s a good opportunity for viruses to be passed to one another,” she says. “It took about two weeks to ramp up, three weeks to peak out, and now we seem to be on the downward trend.” Young children are most at risk because their immune systems haven’t been exposed to as many diseases as older children and adults, and schools are germ fields. Jackson adds that between half and three-quarters of kids with the virus have asthma.

Common symptoms

Symptoms of the enterovirus resemble those of the common cold: runny nose, sore throat, congestion, and a cough that peaks between day three and five and resolves between day seven and 10. What distinguishes EV-D68 from the common cold and other respiratory viruses, however, is that it causes difficulty breathing. “There isn’t a parent out there who doesn’t say, ‘I need to have them evaluated now’ upon hearing that cough,” Jackson says. But generally, the virus does not cause a high fever.

Preventative measures

The same measures used to prevent colds and flu apply to enterovirus: hand-washing – for 20 seconds, with soap and water. “It’s a good opportunity to remind people about hand-washing and teach younger children to wash their hands,” Jackson says, adding that it’s hard to head off viruses such as this because they would require an antiviral, which does not currently exist; nor does a vaccine. Avoid contact with people who are sick, and disinfect surfaces such as doorknobs.

Treatment

Stay well-hydrated, Jackson says, and use saline drops in your nostrils. Kids can go to school as long as they don’t have a fever and are eating and drinking comfortably, she adds. If kids are having difficulty breathing, bring them to the emergency room, Jackson says, adding that most of the 700 children who have come to the hospital with symptoms of the virus (an estimated 70 percent will likely be confirmed for it) have been stopped at the ER without the need to be hospitalized.

Not widespread in adults

"We’ve not had much adult disease," Jackson says. "Adults are having such a mild disease that they don’t have to come to the doctor. That makes you think some adults have some type of protection already. Maybe something like this has circulated in the past — just not in the same volume that we’ve seen here." Still, adults with asthma and other respiratory conditions such as emphysema are most at risk of contracting the virus.

Enterovirus vs. other infections

Winter flu season is just around the corner, and the tendency will be to confuse EV-D68 with these infections, Jackson says. “Don’t miss the forest for the trees.” One child she treated last week, for example, had been mistakenly diagnosed with EV-D68 but actually had whooping cough. Unlike influenza, the enterovirus does not carry bacterial infections such as sinus infections or pneumonia, she adds. People who have had or been exposed to the enterovirus should get the flu vaccine, provided they don’t have a fever.