Enterovirus D-68

As of Thursday, Oct. 9 there have been 678 confirmed cases of enterovirus D68 (EV-D68) in 46 states and Washington D.C., according to the Centers for Disease Control and Prevention. We spoke to Dr. Delaney Gracy, Chief Medical Officer at Children's Health Fund, M.D., M.P.H., and mom of a 6-year-old, to learn the in's and out's of this viral infection.

Parents: What is enterovirus D68?Dr. Gracy: "It's one of over 100 kinds of non-polio enteroviruses. They're called enteroviruses because they do their initial replication in the intestines. But different kinds can affect almost any organ system– the skin, the heart, different parts of the body.

"Most enteroviruses have a seasonal pattern and follow a predictable manifestation in the body. So EV-D68 is one that specifically has respiratory and flu-like symptoms. The outbreak that we're seeing right now of D68 is just one of the more prevalent types that we're seeing this year.

"It was first isolated in 1962 and scientists have tracked it because it can, in some people, have a more severe manifestation compared to other milder enteroviruses. So, most years there are a few cases reported to the CDC, so it's not like something we've never seen before. It is unusual that we're seeing so many cases, and that's why it's in the news."

Parents: Why are kids at a greater risk for getting it? Dr. Gracy: "Like most viruses, once you've been exposed you develop immunity to it. And because this virus has been around for a long time, most adults were likely exposed to it when they were younger and have some degree of immunity now. So it's the kids that tend to be unexposed, don't have immunity to it and get sick from it. And because for whatever reason it's more common in the population this year we're seeing more kids sick from it."

Parents: How worried should I be about my child contracting this?Dr. Gracy: "Keep it in perspective. It's incredibly significant for the families whose children have been infected, and I don't want to downplay that at all, but it's not something people should be overwhelmingly worried that their child will get because the vast majority of times that they do, it's quite manageable.

"It's still not recommended that we do any particular screens for it because knowing that you have it doesn't really change the treatment. It's important to contextualize that number. It's not that 678 people in the whole country have EV-D68. More people probably have it and their symptoms are like mild colds or moderate flu-like symptoms."

Parents: The symptoms are pretty similar to a typical cold or flu. How do I know if I should take my child to the doctor or hospital?Dr. Gracy: "The most common presentation of it is runny nose, cough, sneezing, and aches. Don't use fever as a guide because some kids have had significant respiratory problems and no fever.

"What you would watch for, and this is the case with any cold or any illness, is if your child is having difficulty breathing and how much trouble they're having breathing. If they seem short of breath and they're wheezing, but otherwise they're O.K. then you should call your doctor and have them go in and get looked at. If they're having severe breathing problems, you should call an ambulance or take them to the emergency room. Whether or not EV-D68 is the cause, you should take them to the ER anytime you see those symptoms. Remember that even though there is an outbreak of EV-D68 right now, that's not the only cause of respiratory problems–it could be pertussis or asthma that your kid hasn't been diagnosed with before."

Parents: How can I prevent my child from getting this?Dr. Gracy: "Wash hands a lot, for at least 20 seconds every time. It's passed through direct contact, through droplets, sneezing, coughing. So if possible, avoid close contact–not too much hugging–but that, of course, can be very difficult with kids. Don't share cups or utensils. Disinfect your surfaces and the toys they play with frequently. Remind them not to touch their face if they're old enough. It also can be passed through stool, so kids needs to wash their hands after they use the toilet or after you change a diaper."

Parents: Children with asthma seem to be at a great risk of contracting this, how can I help them specifically stay healthy?Dr. Gracy: "Try to keep them away from others that you know are sick. Stay on top of your asthma action plan, and if they're supposed to be taking a controller you definitely want to be doing that because that helps their lungs stay strong and resilient, and if they're exposed to something they can fight it off better. Make sure they always have their rescue inhaler with them wherever they are. The kids that have gotten really sick from this tend to get sick quite quickly, within 24 hours or so."

Parents: Are there any sort of natural immune boosters that can help prevent it?Dr. Gracy: "In the literature I've read I haven't seen anything specific. But take care to keep your kids' bodies functioning well and normally. Be sure they're getting enough sleep; make sure they're eating well and staying hydrated–all of those things that you try to do to stay healthy all the time."

Parents: Does getting the flu vaccine have any related benefit?Dr. Gracy: "No, it wouldn't. They're two totally different infections. But absolutely we still recommend that everyone get the flu shot because it's about to be flu season. Of course, one could argue that if your body was worn down from the flu then you could be more susceptible to something like EV-D68."

Parents: Is there a link between this virus and the Polio-like paralysis some children have experienced?Dr. Gracy: "They're still investigating those cases. There were a few clusters of kids who developed weakness in their arms and/or legs and were ultimately also diagnosed with EV-D68. They haven't established if the enterovirus caused those problems, so they're still investigating that. But this is not polio, this is a different kind of virus. It's from that original same class, but nobody's talking about a resurgence of polio in the U.S.

"Along that same thread, if your child does have unexplained weakness in their arms or legs absolutely go get them checked out especially if they have cold symptoms at the same time, and definitely bring that up with your doctor."

Parents: When is the outbreak expected to die down?Dr. Gracy: "Hopefully over the next couple of months. It tends to be a late summer and fall infection. This year's a little off for it being so common and some people being infected so seriously with it, but that's still the normal pattern with it and that's the hope and expectation."

This interview has been condensed and edited. 

Photo of sick child courtesy of Shutterstock.