Over the last two weeks we’ve received lots of phone calls from parents concerned about this wave of enterovirus (EV-D68) that seems to be picking up momentum as it is transmitted across state (16, so far) borders. The degree of alarm, however, seems out of proportion to what this virus actually is, and what it is actually doing to infected children.
In an otherwise excellent report on what we know and don’t know about EV-D68, Julia Belluz immediately (perhaps unintentionally) sounds the alarm:
A rare virus — enterovirus D68, also known as EV-D68 — is infecting children across the country and sending them to hospitals with severe respiratory infections and breathing problems. Though the virus doesn’t appear to be deadly, the Centers for Disease Control and Prevention (CDC) are warning doctors and parents to be on the lookout.
“This is a very unusual situation,” said Dr. Greg Storch, director of infectious diseases at St. Louis Children’s Hospital in Missouri. “We don’t fully know what to expect.
Enterovirus D68 is probably not so rare. It is your classic “justavirus” (you know: when your pediatrician tells you that your sick child just has a virus that, without treatment, will be gone in a few of days) from a group of “justaviruses” (actually, enteroviruses) which causes tens of millions of gastrointestinal and upper respiratory illnesses every year. Because doctors in offices and hospitals don’t routinely test for the actual causes of these usually mild viral illnesses, it’s hard to know exactly how many illnesses are caused by this “justavirus”. But I doubt EV-D68 is “rare”. We know that this virus seems to be most severe in children with asthma, causing varying degrees of respiratory distress and, in some of the most severe cases, respiratory failure (requiring intubation and ventilatory support in an ICU until the virus departs and the symptoms subside). Every year (often in Fall, but also in Winter and Spring), we see children with asthma who have severe exacerbations atypical of their usual asthma course triggered by an upper respiratory viral infection. We see children who never wheezed before who suddenly go from the mild runny nose of a typical cold, to a fever, cough, wheezing, and respiratory distress in a short period of time. Respiratory syncytial virus (RSV) causes this, but so can Human metapneumovirus infections, as well as bacterial suspects Chlamydia pneumoniae and Mycoplasma pneumoniae. Now we can add EV-D68 to the mix. And like EV-D68, we don’t really know how many lower respiratory infections are caused by each of these other organisms because we seldom have the need to test for them. We just know these and other “justaviruses” may be the cause and we treat symptoms accordingly.
Enterovirus D68 causes mild cold symptoms in most people. Other than good hand washing, mouth and nose covering when coughing and sneezing, and staying away from other people when sick, there is nothing else needed to prevent infection; a vaccine against EV-D68 will not be forthcoming.
And again, it should be stated that everyone seems to recover from this infection; no one has died.
The same cannot be said about another respiratory virus which is much more common –and deadlier — than EV-D68. This infection (and the deaths caused by it) can be prevented easily with a safe and effective vaccine. This infection should be what parents are really concerned about. We’ll talk more about it — and how simple it is to protect yourself and your family against it — tomorrow.