A severe respiratory illness is knocking the wind out of Midwesterners, sending hundreds of children coughing and wheezing to the hospital. The primary suspect in the outbreak is the seldom seen Enterovirus D68 (EV-D68), kin to the common cold’s viral culprit.
The U.S. Centers for Disease Control and Prevention has identified EV-D68 in 19 of 22 intensive care patients from Missouri and 11 of 14 in Illinois. EV-D68 targets the upper respiratory tract and causes breathing difficulties. First discovered in the 1960s, EV-D68 has rarely been reported in the U.S. population. From 2009 to 2013 the CDC recorded only 79 cases of the virus but this year there have already been more confirmed cases than in any previous year.
At the University of Chicago's Comer Children's Hospital where the 11 Illinois cases were identified, there has been an unusually high number of children with cold symptoms and breathing problems this summer, according to Rachel Wolfson, an intensive care unit physician who treats patients there. Some children in her care only needed nebulizer treatment yet others were substantially more ill. One patient’s lungs were in such bad shape that the doctors needed to connect the child to a blood oxygenator. Despite the debilitating effects of EV-D68, so far no one has died during its current immergence.
At the CDC, Mark Pallansch is one of many virologists investigating the viral suspect in order to confirm if it is driving the current rise in respiratory illness. We asked him and Wolfson to explain what researchers and doctors are finding and whether EV-D68 may be on the rise.
[An edited transcript of the interview follows.]
What is an enterovirus?
Pallansch: Enteroviruses are a family of more than 100 viruses that cause a diversity of illnesses. The CDC reports more than 10 million enterovirus-related illnesses every year. Generally, their afflictions are common and mild. People with Enterovirus D70, for example, develop conjunctivitis. But some types—including poliovirus, which causes paralysis—are dangerous. Others can cause SARS, and viral meningitis. Researches are worried about EV-D68 because it can severely disturb the respiratory system.
How does it spread?
Pallansch: EV-D68 spreads the same way that many other enteroviruses do, through contact with infected people, such as being in the line of fire of a cough or sneeze. Adults are much less likely than children to contract EV-D68 because of their stronger immune systems. Children can also catch the virus by touching a surface like a doorknob that may have the virus on it and then rubbing their eyes.
Like other similar enteroviruses, EV-D68 spreads through contact with infected feces as well. This may be most likely to occur in small children, but infections that spread this way occur most often in underdeveloped countries where sanitation is poor. Washing your hands is key to preventing the spread.
Will it go nationwide?
Pallansch: Every day different states contact the CDC reporting new cases of respiratory illness that may potentially be EV-D68. So far about a dozen states have reported cases.
It’s too early to know if we’re watching a spread or if it has already happened and we’re just figuring out that it’s happened. If the CDC can identify EV-D86 as the definite cause behind the severe respiratory illness seen in the Midwest, then its next step is to figure out whether EV-D68 infections have been increasing in recent years or whether EV-D68 cases have stayed the same but now scientists have better tools for detecting them.
Who is most at risk?
Wolfson: School-aged children are most likely to contract the virus, although not everyone with EV-D68 becomes severely ill. Individuals with a history of asthma are more likely to develop serious respiratory complications, but many previously healthy children are also catching the virus.
It’s impressive how many kids are getting severely ill from this virus. We’re full.
The number of respiratory cases is unusually high for August and September. The rate is much closer to what the hospital expects to see mid-November when flu season is in full force. About one third of the patients tested positive for EV-D68, although more cases with similar symptoms are arriving each day.
Once you hear the same song a few dozen times you start to recognize the opening bars. So I’ve got a few calls all of which sound the same.
Keep children safe by washing your hands and having them wash theirs. None of the staff or other patients at Comer Children's Hospital has contracted the virus, which we attribute to meticulous washing.