Outbreak of Severe Virus Now in 22 States

At least 160 cases of a sometimes severe virus have been confirmed in 22 states, U.S. health officials say. The cause of the confirmed cases is enterovirus D68. It is part of a family of germs that cause the common cold. Most cases in this new outbreak are mild, with cold symptoms. But other people, especially children, have developed breathing problems. Many children have ended up in hospitals. The illness has been most severe for children with asthma. No one has died. Enterovirus D68 is spread by close contact with an infected person, or touching the same surfaces and then the nose or mouth. The Centers for Disease Control and Prevention (CDC) reported the latest numbers on September 19. The number of states and cases has expanded rapidly since the CDC first reported an outbreak at one Midwest hospital on September 8. The numbers may be much higher, Medscape Medical News reported. That's because doctors often don't order the test to confirm the cause of illness. HealthDay News also wrote about the outbreak.

What Is the Doctor's Reaction?

If you haven't started taking hand-washing really seriously, now's the time to start -- especially if you have children with asthma.

It's been all over the news: a bad virus sweeping the country that is landing hundreds of children in the hospital. The virus that is being blamed is called enterovirus D68.

Enteroviruses are very common. Every year, especially in the summer and fall, they cause 10 million to 15 million infections. The vast majority of these illnesses are mild -- colds, rashes, vomiting, low-grade fever, mouth sores. But sometimes, as is the case with this particular strain, they can be more serious.

We don't entirely understand why this strain is causing so much trouble -- or why it is particularly affecting children. It may be simply that children haven't lived as long as adults. This means they have had less time to build up immunity to enteroviruses in general. Whatever the reason, it's clear that enterovirus D68 does cause more trouble for children, especially those with asthma.

This illness can cause cold symptoms that then lead to trouble breathing. Sometimes affected children need oxygen. Many of the children who get sick enough to end up in the hospital have asthma. Not only do they get sick from the virus, it causes their asthma to act up.

As of the end of last week, there were 160 confirmed cases in 22 states. There are almost certainly many more than 160 cases, and the virus is likely in more than 22 states. Special tests need to be done to know for sure what exact virus is making children sick. These are tests that doctors don't always do on sick children. The tests that confirm it is enterovirus D68, as opposed to another kind of enterovirus, can be done in only a small number of laboratories. This can take a long time. 

What Changes Can I Make Now?

As I said above, the best thing you can do is wash your hands. Enterovirus D68 doesn't get spread through the air. It's spread through contact with body fluids like saliva and nasal secretions (snot). Washing your hands regularly can help decrease the chance of catching all sorts of illnesses, including this one.

It's also a good idea to:

Stay away from sick people to the extent possibleStay home if you are sickRegularly wipe down common surfaces, such as doorknobsAvoid sharing cups and utensilsTeach children to cover coughs and sneezes with the inside of the elbow instead of the hand

Since we are in flu season, these are great things to do anyway.

If you have a child with asthma, it's really important that he or she take all medicines as prescribed, especially "controller" medicines. These are the ones that are meant to prevent symptoms. Very often, families get a bit lax with those over the summer, when many children with asthma get better. Families figure the controller medicines aren't needed, and they stop them. If that was the case in your family, start those medicines up again. They could make all the difference if your child catches this virus.

It's also important to be watchful of any child who gets a cold. Chances are it's just a cold, and nothing serious. But look out for any trouble breathing. Children who have trouble breathing may:

Cough very oftenBreathe fast or heavyHave trouble talkingLook pale

If you notice any of this, bring your child to get medical attention right away.

What Can I Expect Looking to the Future?

I hope that this virus will pass as we move out of fall. I also hope that, with increased awareness, people will take the best steps to prevent this illness and get children the care they need quickly. 

But when we move out of fall, we will still be in flu season. So even if the news says that enterovirus D68 isn't as big a threat anymore, keep up with the hand-washing and other suggestions.  Get your flu shot, too. Winter is a bad time for viruses. The habits you learn for preventing enterovirus D68 can go a long waytoward keeping you and your family as healthy as possible.

By Claire McCarthy, M.D.
Harvard Medical School

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