What to do about EV-D68?

Dr. Dave Fairbanks

What is EV-D68?

It is not a new secret spy plane or even a terrorist chemical weapon.

Enterovirus-D68 - is a respiratory virus that has attacked over 1000 children in 12 states, landing many of them in the hospital.

EV-D68 belongs to a family of small RNA viruses that are normally spread by fecal to oral route - thus their name "entero. . ." Transmitted by not washing hands adequately after contamination by even the smallest amount of poop and then touching railings, toys or other surfaces and then touching one's face or mouth. Coxsackie virus or "Hand, Foot and Mouth Disease" and the "common cold" are some of the more common of a hundred similar viruses that normally infect an individual throughout one's lifetime. These viruses can remain alive on surfaces for days until they come in contact with another. They are responsible for an estimated 10 -15 million of viral infections a year in the U.S.

EV-D68 is a variant that has been particularly active this year infecting children and adults alike in states from the east spreading westward with high numbers of cases in bordering states including Colorado and Utah. It is especially more contagious as it also spread by the coughing and sneezing. Doctors do not know why EV-D68 is worse this year it is not a new virus and has been around since the 1960s.

"It's worse in terms of scope of critically ill children who require intensive care. I would call it unprecedented. I've practiced for 30 years in pediatrics, and I've never seen anything quite like this," said Dr. Mary Anne Jackson, division director for infectious diseases at Children's Mercy Hospital in Kansas City, Missouri.

Most of the children hospitalized have a history of asthma or wheezing. EV-D68 seems to make worse any underlying breathing problem not controlled with medication. Mark Pallansch, Director of the CDC's Division of Viral Diseases, has stated the number of hospitalizations reported so far could be "just the tip of the iceberg in terms of severe cases." This is because it is not something we usually test for and in fact the test is not commonly available even in Billings and is very expensive.

What are the symptoms?
Many people may not even know they are infected as symptoms may mimic a cold with coughing, fever and sometimes a rash. However, if you or one of your family members experiences difficulty breathing, you should seek medical attention.

How Is EV-D68 treated?
Since EV-D68 is a virus, antibiotics, which are used to fight bacteria, won't work. No specific treatment is currently available for EV-D68. However, your doctor may prescribe an antibiotic for you if you are at risk for, or develop further complications such as pneumonia.

There is currently no vaccine. So prevention is the best way to avoid infection.

Getting your annual flu shot so that you don't become infected with influenza, which may weaken your immune systems response to the virus is an excellent prevention strategy.

Who is at risk?
Anyone in any of the following groups:
You smoke or have any underlying respiratory disease
You are under the age of 6 or over the age of 50
You have chronic diseases of your heart, lungs, or kidneys
You have diabetes
Your immune system does not function properly
You live in a nursing home or other chronic-care housing facility
You are in close contact with children 0 to 23 months of age

What can I do?
In addition to medical treatments for EV-D68, there are some measures you can take to stop the spread and recover more quickly:

Stay home - don't infect your co-workers
Stay in bed - rest helps the body to regenerate more quickly
Drink plenty of liquids
Ibuprofen to control fevers and muscle aches

Preventing the spread of EV-D68
Even though you may feel the symptoms over your entire body, the virus lives primarily in the lungs. It is an acute respiratory disease and spreads easily from person to person. When an infected person sneezes and coughs, someone else may breathe in the airborne droplets of fluids containing the virus. The virus also can enter the body through the membranes of the eyes, nose, and mouth.

Here are some tips for reducing your chance of getting the virus:
Wash your hands frequently with soap and water for 20 seconds
Especially after changing diapers
Avoid touching your face, nose or mouth with unwashed hands after handing surfaces in common areas
Avoid contact with sick individuals who have cough or respiratory symptoms
Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick
Carefully clean dishes, utensils, and glasses immediately after use
Cover your mouth when you sneeze or cough
Disinfect frequently touched surfaces such as doorknobs, railings and toys
Stay home if you are sick

Because EV-D68 can lead to complications, it is very important that you talk to your healthcare professional if you believe you have symptoms and aren't getting better.

Additional tips may be found on the web at
CDC http://www.cdc.gov/non-polio-enterovirus/about/EV-D68.html
NIH http://www.nlm.nih.gov/medlineplus/news/fullstory_148261.html

David W. Fairbanks, M.D. is Board Certified in Family Practice, and a fellow of the American Academy of Family Practice. He currently serves as the Chief of Staff and Emergency Room Director at South Big Horn County Hospital and a provider in the emergency room at Powell Valley Healthcare. He is the Medical Director for the Physician Assistant Program at Rocky Mountain University of Health Professions and an Adjunct Faculty for Anatomy and Physiology at Utah Valley University.

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