Hundreds of thousands of Americans with young children must be thinking the fall flu season of 2014 is something right out of a science fiction-horror movie. Picture this as a movie plot: hundreds of kids from 43 states come down with a strange, heretofore little-known virus called Enterovirus-D68 (EV-D68 for short), with five of the children, dead, and some others experiencing paralysis. A fifth death of a child who had EV-68 was reported on Saturday, Oct. 4.
Those are the early October numbers as released by Center for Disease Control scientists, who are also quick to point out, that although the samples from these four patients who died tested positive for EV-D68 the virus could have had nothing to do with their deaths.
Non-polio enteroviruses are common viruses. There are about 100 recognized strains. And they cause about 10 to 15 million infections in the United States each year. Tens of thousands of people are hospitalized each year for illnesses caused by enteroviruses. Anyone can get infected with non-polio enteroviruses. But infants, children, and teenagers are more likely to get infected and become sick. That's because they do not yet have immunity (protection) from previous exposures to the viruses.
This particular type of enterovirus — EV-D68 — is uncommon but hardly new. It was first identified in California in 1962, but then was almost never seen until 2009 to 2012, when there were outbreaks in Japan, the Philippines and the Netherlands, and small clusters of cases in the United States. In the U.S. the National Enterovirus Surveillance System received 79 EV-D68 reports during 2009–2013. However, it is possible that the relatively low number of reports might be because EV-D68 is hard to identify.
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The strain of the virus in these current cases is not new and is the same as earlier EV-68 cases in the United States and in other countries. It's unclear why it's making people sicker and how it's spreading, but respiratory viruses spread very easily. Cold season typically peaks in September when children return to school, and the enterovirus cases may be following a similar pattern.
EV-D68 is one of more than 100 non-polio enteroviruses. As a class of virus, Non-polio enteroviruses are very common viruses. Hundreds of viruses can cause classic cold-like symptoms. There's EV-D68 and RSV or respiratory syncytial [sin-sish-uhl] virus, a contagious viral disease that may infect a person's lungs and breathing passages. There are also rhinoviruses, adenoviruses, metapneumoviruses and influenza. RSV is in a family of viruses called paramyxoviruses. There are also coronaviruses, relatives of the bugs that cause SARS and MERS. Every year, respiratory syncytial virus or RSV sends 75,000 to 125,000 children to the hospital and kills as many as 200 every year, numbers that are a little fuzzy because hospitals are not required to report deaths from RSV.
Anyone can get infected with non-polio enteroviruses. But infants, children, and teenagers are more likely to get infected and become sick. That's because they do not yet have immunity (protection) from previous exposures to the viruses.
Most people who get infected with non-polio enteroviruses do not get sick. Or, they may have mild illness, like the common cold. But some people can get very sick and have infection of their heart or brain or even become paralyzed. Infants and people with weakened immune systems have a greater chance of having these complications. You can get infected with non-polio enteroviruses by having close contact with an infected person. You can also get infected by touching objects or surfaces that have the virus on them then touching your mouth, nose, or eyes.
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It is not clear why the sudden outbreak of this virus has occurred. But its continued spread likely relates in part to the return of school as children spend more time together. This trend is similar to the increase in cases of influenza that are seen when students go back to the classroom after winter break. The virus spreads from one person to another when an infected person coughs, sneezes, or touches surfaces.
There are no available vaccines or specific treatments for EV-D68, and clinical care is supportive. Health care providers should consider EV-D68 as a possible cause of acute, unexplained severe respiratory illness; suspected clusters or outbreaks should be reported to local or state health departments.
From mid-August to October 3, 2014, CDC or state public health laboratories have confirmed a total of 538 people in 43 states and the District of Columbia with respiratory illness caused by EV-D68. This indicates that at least one case has been detected in each state listed but does not indicate how widespread infections are in each state.
As of this writing, there are no known vaccines or antiviral treatments for EV-D68. The main kind of care is just supportive, so paying attention to symptoms and making sure people get proper fluids and help breathing, if necessary. Enterovirus D68 can cause mild-to-severe symptoms depending on the risk factors of the infected person, such as having a weakened immune system. Mild symptoms include:
• body and muscle aches
• cough
• difficulty breathing
• fever
• runny nose
• sneezing
• wheezing
These respiratory symptoms can lead to further complications such as pneumonia and even respiratory failure.
EV-D68 can also cause symptoms that are common with other enteroviruses, such as:
• abdominal pain
• diarrhea
• skin rashes
Dr. Anne Schuchat, director of CDC's National Center for Immunization and Respiratory Diseases, believes that in most cases, EV-68 runs its course in a week. EV-D68 is considered by medical experts to be rare. As to why this particular strain is turning up now and landing kids in hospitals? That is unknown.
Source material: The best and most thorough site for information about EV D68 is through the CDC. Go to http://www.cdc.gov/non-polio-enterovirus/about/ev-d68.html