On top of the Ebola scare, we now have enterovirus D68 infecting children and producing polio-like symptom, including limb paralysis in some.
The poliomyelitis epidemic in the United States dates back to 1894. At the height of this viral illness (first cases were in Vermont) in 1952, which produced limb paralysis, there were 60,000 cases, 3000 of them fatal. In 1953, Jonas Salk developed the injectable Salk vaccine for polio and the cases dropped by 85 percent to 90 percent two years later. In 1961, this was replaced by the trivalent Sabin oral polio vaccine, cheaper and easier to administer. 1979 saw the last case of polio in the USA and the last case of smallpox in the world.
What is EV-D68 infection?
Enterovirus D68 is a non-polio enterovirus (one of more than 100 enteroviruses), which was first detected and identified in California in 1962. Every year, there are 10 to 15 million persons infected by non-polio enteroviruses in the United States. The other non-polio viruses are the Coxackievirus A and B, Echoviruses, and the other Enteroviruses. The EV-D68 infection has been reported in the Philippines, Japan, and the Netherlands.
How many cases are there?
The US Center for Disease Control and Prevention reported that from Mid-August to October 4, 2014, 538 persons in 43 states have been confirmed to have EV-D68 respiratory infection. More cases are expected to be reported. The virus appears to primarily affect infants, children and teens, causing limb paralysis and other neurologic symptoms in about 40 percent of them, and a few deaths. Only a quarter of the patients are adults.
Why are the kids more susceptible?
Infants and children are more easily infected by the enterovirus because, unlike the older people, they have not been exposed to these viruses in the past and have not acquired immunity from them yet. They are also less concerned, less conscious, and less careful.
What are the symptoms?
EV-D68 mimics the Flu. The mild symptoms are cough, sneezing, runny nose, body and muscle aches, fever, and malaise. The severe symptoms include shortness of breath and wheezing (like asthmas), and limb paralysis in some cases. It is not known at this time if those deaths and the limb paralysis (like in polio, also due to an enterovirus) were caused directly by the EV-D68. Those with a history of asthma were found to have a higher risk of developing EV-D68 infection.
How does the EV-D68 spread?
Like other respiratory illnesses, the EV-D68 can be found in the patient’s secretions, like saliva, sputum, and nasal mucus. The virus is transmitted from person to person easily when the infected individual coughs, sneezes, or touches an item or surface that is then touched by others, much like in the common cold or the Flu. When the contaminated fingers touch the face, nose, or mouth of these other persons, the virus gets into their system and infects them.
Why is EV-D68 a greater challenge?
Clinically diagnosing EV-D68 infection is a big challenge because most hospitals do not have the tests that can distinguish between EV-D68 and hundreds of similar enteroviruses, and also because in some patients, it does cause any symptoms at all. The are more than 100 enteroviruses and 100 rhinoviruses. The Multiplex PCR test that sequences these viruses does not specifically pinpoint which virus it is. Rhinoviruses are more common during late fall and winter. So, we are in the midst of enteroviruses in August and September, making EV-D68 a great probability. Actually EV-D68 was rare. In 2008, there were only tiny clusters of this viral infection. Why this infection flared up this time around is still a mystery. This year it became rampant and more violent. The EV-D68 must have mutated and evolved into a more formidable strain that is more easily transmissible, making it more prevalent worldwide. The cases are expected to decline in the Fall, according to the CDC, which accepts specimens for testing from hospitals which do not have the testing capability.
Could this be Polio?
One consolation is that this is not Polio, because if it were, there would be hundreds of children on iron lungs (respirators). Why majority of the children infected with the EV-D68 does not develop paralysis or neurological symptoms is still a mystery. By the time limb weakness appears, the virus could be gone from the body, another reason for the elusive nature of the virus. Most of the infected kids with EV-D68 the neurological symptoms are getting better, but whether they will recover completely or not is still too early to tell.
In the case of Polio, 95 percent of the patients had no symptoms, 4 percent had mild symptoms, 1 percent had nonparalytic neurological signs, and one in 1000 had paralysis. While many children needed iron lungs to breathe because the virus had cause paralysis of their breathing muscles also, they were the minority.
What should parents be alert for?
Those taking care of children must be vigilant for Flu-like symptoms (coughing, sneezing, runny nose, tiredness, body and muscle aches, malaise) especially with fever and upper respiratory signs, breathing difficulty, or limb (arm or leg) weakness. Those with asthma are somehow more prone to catch the EV-D68, and must be closely monitored. If in doubt, it is best to err on the safe side by seeking immediate medical consultation. While there is no vaccine or cure for EV-D68 infection, early medical supportive care can prevent complications and a more serious situation. Based on the 2008 to 2010 experience, the median length of hospitalization ranged from one and a half day to five days. A caveat for parents and guardians: Do NOT use aspirin or aspirin-containing medication for children, to prevent the deadly complication called Reye’s syndrome.
How can we prevent EV-D68 infection?
Since there is no specific test, vaccine, anti-viral drugs, or cure for EV-D68, prevention is the major tool we have to prevent this dreaded viral illness. To begin with, a healthy lifestyle (habit and behavior) is essential to have a strong immune system, a fundamental primary layer of protection against illnesses. Those infected could help by staying home and by being careful and considerate, by covering their face when they cough or sneeze, washing their hands often, and not touching common items others might touch (doorknobs, hand rails, toys, computer keyboard, cellphones, etc). They should avoid handshakes, hugging, or kissing. In general, good daily hygiene is vital to prevent infections. Hand washing at least 8 times a day, cleaning countertops, dining tables, etc., avoiding touching the eyes, nose, or mouth with unwashed hands, turning away from people who are coughing or sneezing, and not touching what they have touched, are effective in minimizing exposure to viruses and bacteria. When there is an outbreak in school, children should stay at home. It is best to educate all family members, especially the kids, on these preventive measures. EV-D68 is nothing to sneeze about.
A Happy Thanksgiving to all our readers and their loved ones.
***
Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States. Email: [email protected]
