End of Summer, School, and Sick Kids

Late last week many of you likely came across a story about Enterovirus D68 and how it is affecting school children in states across the middle of the U.S. I have to admit, I am a bit behind on this topic, but not having children is the likely reason for me to have missed it (well that and the fact that I average less than eight hours of television per week). Latest Center for Disease Control (CDC) estimates confirm a total of just over 100 cases spread across ten states, with that estimate likely being a bit low due to confirmation process. What struck me about this virus were two things. First, I haven't heard of this before, and secondly, it seems to affecting children with asthma at a greater rate and more severely than other children. What is an enterovirus, and how is it spread? More importantly, what can children and adults do to help lessen the spread of this virus?

An enterovirus is a single-stranded RNA virus that is part of a genus containing twelve different species of viruses. Within each species, though, there can be a wide variety of serotypes (variations), but all have high mutation rates. In this case, the name ‘enterovirus D68’ represents the variant of this particular genus of viruses, the 68th. Overall, this genus of virus actually contains some of the worst offenders when it comes to humans, both in severity (polio to hepatitis A) and in breadth of contagion (common cold – the Rhinovirus).

The CDC estimates that 10 to 15 million people each year are infected with the enterovirus, but with majority of these being the rhinovirus (common cold), this statistic is generally one that does not raise concern. What is raising concern is the spread of enterovirus D68, and this is for two reasons.

First, while we first discovered this particular serotype decades ago, it has not been commonly occurring. More importantly, it appears to disproportionately affect those with asthma. Those with asthma or other respiratory conditions are generally more prone to suffer more severe effects from external factors, not only viruses but also pollen and smoke. Smoke makes me cough, but if you have asthma, smoke can cause wheezing or an asthma attack.

A similar situation is what parents are seeing with this virus. While many likely shrug it off as the common cold or flu, CDC Chart of States Reporting Enterovirus D68 Caseswith the child exhibiting symptoms that are most akin to a cold or allergies, children with asthma may experience trouble breathing or wheezing. This is when parents are suggested to act. And recently, they have been.

Overall the scope of the virus is likely underestimated since many will see less severe symptoms, not enough to seek medical treatment. Hospitals and labs aren't likely reporting the full scope since the virus isn't one that is required to be tested for by the CDC. However, the image to the right shows the states reporting infections as of Monday with the lower image showing states reporting as of today. Yes, it is spreading, much like the common cold and flu does each year, and currently health officials are expecting this trend to increase before it finally tapers off with the onset of winter.

What do you do? The main concern right now seems to be with children with asthma. Touch base with your primary care provider and keep in mind what to do if your child is experiencing labored or troubled breathing or wheezing. Milder symptoms are going to be most common amongst children in general and like the cold, with plenty of fluids and rest, they will run their course with little worry. For more severe cases, supportive care is really the most that can be done. Medications to relax airways and supplemental oxygen are most common with the most critical needing ventilators.

In general, there are a couple things to keep in mind. First, enterovirus D68 is making a lot of headlines, but it is generally a mild virus that acts much like the common cold. While all parents will want to be watchful of their children and symptoms, asthmatics are most at risk. Lastly, like the common cold, there is no vaccine or treatment beyond supportive care, so prevention techniques, like frequent hand washing and sanitizing surfaces are important things to keep in mind.

_Author: Kevin Gilmore

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