Enterovirus 68 can be a serious or fatal illness for some vulnerable patients.
What is Enterovirus 68?
Enterovirus 68, also known as EV-D68, EV68, HEV68, and enterovirus D68, was first found in 1962 in California. Up until recently, it had been a rare virus. Other enteroviruses include polioviruses, echoviruses, and coxsackieviruses, but unlike the rest of these, EV68 has “acid lability and a lower optimum growth temperature”. It is these factors that give it features similar to the rhinovirus. When there are cases, they tend to occur “late in the enterovirus season”, generally in “warm months, from spring to autumn”. The patients most at risk for EV68 are young children under 5 and those with asthma; however, asthmatic adults and those with immunosuppression can also become infected. As of August 2014, the Midwest region of the United
States had clusters of the respiratory disease. By the middle of September and October, it had spread to other states and parts of Canada. Some of the younger patients developed muscle paralysis, and there were some deaths as well, but “paralysis accounts and deaths have not yet had a proven link directly to the virus”. The early symptoms of EV68 are like the “common cold”. Later, more serious symptoms, such as difficulty breathing, dehydration, and reduced alertness, or even respiratory failure, may occur. Abdominal pain, skin rashes, and soft stools are also possible. The CDC, as of October 2014, was investigating the cases of “paralysis and/or cranial dysfunction”.1
Most of the people who have EV68 will have “mild symptoms…and…recover completely”. Children with the virus will generally present with coughing and trouble breathing, similar to asthma, even if they had not had asthma before. There were more cases at the start of the school year, due to patients being in close proximity to other people. According to Dr. Mary Anne Jackson, “it’s going to have to infect enough of the population…to provide immunity and…burn itself out”. Children who had breathing problems, such as wheezing and asthma before the virus, have had more severe symptoms of EV68.2 Like any respiratory illness, the virus is spread by mucus, sputum, and saliva via touching an infected surface, sneezing, or coughing. The virus can be diagnosed through lab tests.3
Treatment and Outlook
Antibiotics are of no help with EV68, as the cause is viral and not bacterial. There is no vaccine, nor is there an antiviral medication for it. “Supportive care” is the treatment for enterovirus 68, which includes “supplemental oxygen” and albuterol, and other medications that can “relax and open the air passages of the lungs”. Some children need ventilators. Most mild cases can be treated with fluids and rest. It is necessary to seek a doctor or hospital if there is labored or rapid breathing.4 The best protection from enterovirus 68 is washing hands with soap and water for at least 20 seconds, avoiding touching the face, avoiding kissing or sharing utensils with sick people, covering sneezes and coughs with a sleeve or tissue, disinfecting surfaces, and staying home when feeling sick.5 The mystery remains why this rare disease has had such an increase in 2014. It is unknown if the virus has changed to a more dangerous form, or if it is just spreading more widely than in the past.6
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