Amanda Oldt has the latest information — presented Monday at the 2014 AAP National Conference and Exhibition in San Diego — on the outbreak of enterovirus D68 that has now hit 48 states:
As of Oct. 10, there are 691 cases of EV-D68 across 48 states in the United States and there have been at least five deaths in patients who tested positive for EV-D68.
EV-D68 causes acute respiratory symptoms — runny nose and cough — often with wheezing and difficulty breathing, especially in children with a prior history of wheezing or asthma. But there is a sign of illness that is missing in a majority children who are sick with this virus: fever. With other viruses that cause similar and severe respiratory symptoms, such as influenza, fever (indeed, high fever) is a prominent feature.
Another part of the enterovirus D68 story that’s causing great concern is neurologic: the virus has been associated with extremity weakness and even paralysis in some children. Other enteroviruses are known to cause rare cases of neurologic conditions, including encephalitis and motor neuron disorders. The children who have presented recently with polio-like flaccid paralysis (polio is an enterovirus) and who tested positive for EV-D68 appear to have had preceding respiratory or gastrointestinal illness. It’s therefore possible that flaccid paralysis, like other illnesses that occur days or weeks after an initial bacterial or viral infection (rheumatic fever, toxic synovitis, and Guillain-Barré syndrome for example) might be a “post-infectious” immune process that follows infection with EV-D68.
There are currently no specific treatments for enterovirus infections; antiviral medications appear to be ineffective. Oldt suggests the mainstays of prevention:
Pediatricians should encourage parents to educate their children about hand washing, instruct parents to keep children out of school or daycare when ill, provide asthma action plans to patients with a history of wheezing and administer influenza vaccine to reduce risk of another respiratory infection.