Monday, October 13, 2014
Enterovirus 68: Talking points
I discussed the recent emergence of EV68 in the U.S. and its association with respiratory illness in children. Naturally, there has been a lot of media interest and parental concern. In addition, the Centers for Disease Control and Prevention released a new MMWR earlier today that describes the two best characterized EV68 outbreaks in Kansas City and Chicago. Of note, the CDC report necessarily describes only the sickest patients with EV68, those admitted to the hospital and tested. Like most viral illnesses, we expect the vast majority of infected children to either not develop symptoms or develop less severe symptoms that might require a visit to a clinic but not require hospitalization. Personally, I have replied to dozens of e-mails, attended internal meetings and completed several interviews with the media, so I thought I’d share a few general discussion points that have come up more than once today.
1) What is EV68? Enterovirus 68 (EV68) is not a new virus, but over the past few years it has caused outbreaks of respiratory distress in the fall. These outbreaks are similar to what we see later in the year with influenza and RSV. What’s different is that this is happening earlier in the fall and with a rarer virus.
2) Who does this virus infect? In the current outbreak, most patients are children under 16 with a prior history of asthma or wheezing. Symptoms include rapid onset of cough, wheezing and difficulty breathing. EV68 rarely causes fever. Most children with suspected EV68 infection respond quickly to supportive care that includes breathing treatments, such as inhalers prescribed by a health care provider.
3) What should I look out for? If your child or family member (or friend) develops rapid onset cough, wheezing or difficulty breathing, please contact their health care provider. While most patients do not require hospitalization, children can develop symptoms rapidly, so a quick call or visit to a health care clinic might be necessary.
4) Is there an antibiotic I can take or a vaccine? No, there are no currently available antiviral medications that treat EV68. There is also no vaccine. However, that does not mean that your child can’t be treated. Children with severe respiratory distress can receive several forms of breathing treatments that reduce their symptoms and get them on the road to recovery.
For hospital epidemiologists and other health care workers:
1) EV68 is only rarely associated with high fevers. Thus, presence of fever is not an effective question for screening visitors for illness. Thus, facilities currently experiencing an outbreak of EV68 or an uptick in viral respiratory illnesses, should consider restricting access to visitors under the age of 15 or 16 (the oldest confirmed cases in the CDC report). Of course, exceptions should be made in certain situations.
2) HCW who are ill or suspect they might have a viral respiratory illness should follow their hospital policies concerning work attendance. As we’ve mentioned before, presenteeism (coming to work sick) is a big problem, so avoid it if at all possible.
Disclaimer: This post is not intended to provide specific health care advice to an individual patient or health care facility. Please contact a doctor or other health care provider if you have specific questions about your or your child’s health. Also, I will not respond to specific comments asking questions about the care of individual patients. Finally, don’t trust any health care advice you receive over the internet. Oh, and all of this information will be obsolete and expire by tomorrow.
Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands). This post originally appeared at the blog Controversies in Hospital Infection Prevention.
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