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UPDATE: Answers on the Enterovirus

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UPDATE: Questions abound on the enterovirus, which has hit hundreds of children in more than 10 states.

Public health officials say may be caused by an uncommon virus similar to the germ that causes the common cold.

What is an enterovirus?

  • Enteroviruses are very common viruses
  • There are more than 100 types of enteroviruses - EV-D68 is just one type
  • It is estimated that 10-15 million enterovirus infections occur in the US each year
  • Most people infected with enterovirus have mild symptoms or no symptoms at all, while other infections can be serious.
  • Peak times for enterovirus infection include the late summer and early fall

Source: Missouri Department of Health & Senior Services http://on.mo.gov/WyCr3j

What is makes Enterovirus D68 different?

  • We know less about EV-D68 than we do about other enterovirus types
  • Enterovirus D68 is rarer and is associated more with respiratory illness than with the febrile rashes and neurologic conditions linked to other enteroviruses
  • The spectrum of respiratory illness caused by EV- D68 can range from mild to severe -- with severe requiring intensive care and mechanical ventilation in some cases
  • New onset wheezing or worsening of asthma have been linked to this strain of enterovirus.
  • It was first isolated in California in 1962 and has been rarely reported since then -- although clusters have shown up in Asia, Europe, and the U.S during 2008-2010.

Source: CDC http://1.usa.gov/1ojSRUX

How does EV-D68 spread?

  • Sneezing, coughing, and close personal contact -- it is very easily transmissible and appears to spread through close contact with infected people -- much like other types of enterovirus.
  • The new school year is likely helping the virus be transmitted since children are together for long periods of time at school

Source: Dr. William Schaffner, Vanderbilt University

Is there a vaccine for EV-D68?

  • There is no vaccine to prevent it and there are no specific treatments, but doctors can provide supportive care to make sure the child can breathe, make sure their fluids are okay, and that they are comfortable
  • We end up just waiting out the virus until it does its damage, goes away, and the child gets better.

Source: Dr. William Schaffner, Vanderbilt University

Where are we seeing cases?

  • The CDC is working to investigate clusters reported from 12 different states -- a report out from the CDC today provides detail on clusters identified in Kansas City, Missouri, and Chicago, Illinois.

Source: CDC Press Briefing 9/9/2014

How are cases being confirmed?

  • Some states have the facilities to conduct the polymerase chain reaction test used to confirm cases, but not all do. The CDC can provide this support where needed.
  • Commercially available tests may not be specific to this type of enterovirus
  • Although it can be helpful to know if this type of enterovirus is circulating within a particular community, it probably wouldn't change the type of care the child gets at a hospital.

Source: CDC Press Briefing 9/9/2014

When should parents seek medical treatment for their children?

  • Most children won't need to go to the hospital, but a small proportion do
  • Parents should take their children to the doctor of the child appears to have trouble breathing
  • Children predisposed to asthma are the ones who are more likely to be affected

Source: CDC Press Briefing 9/9/2014

  • The vast majority will get better completely and in a few days be back to school as though nothing happened.

Source: Dr. William Schaffner, Vanderbilt University

How do we reduce the risk of infection?

  • Wash hands often with soap and water for 20 seconds, especially after changing diapers;
  • Avoid touching eyes, nose, and mouth with unwashed hands;
  • 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;
  • Stay home when feeling sick, and obtain consultation from your health care provider.

Source: Missouri Department of Health & Senior Services http://on.mo.gov/WyCr3j

 


 

Outbreaks of an uncommon virus are sending hundreds of kids to emergency rooms and clinics, doctors say.
The Centers for Disease Control and Prevention says health officials in 10 states have asked for help in deciding whether something unusual and dangerous is going on. Many of the illnesses appear to be caused by enterovirus D68 or EV-D68 — a distant cousin of the polio virus — which causes respiratory symptoms and appears to be worse in children with asthma.

“I don't believe we've ever had an outbreak this extensive before,” says Dr. William Schaffner, an infectious diseases expert at Vanderbilt University. But it's also hard to tell because doctors usually don't test patients with respiratory viruses to see which one they have.
“It seems to produce illness with a more severe component (such as) difficulty breathing,” he said. “But the vast majority of these kids will get better.”

Schaffner says he hopes the outbreak will start to wane within the next week or so. CDC says enteroviruses of all sorts cause about 10 to 15 million infections in the United States each year. They often show up in late summer and spread when kids start school.

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