5 lessons learned from this year’s enterovirus D68

Even though cases of enterovirus D68 are still being confirmed — including a second case this week in  Camden County — infectious disease experts say the bug is on its way out. Enteroviruses such as D68 are seasonal, with outbreaks typically running from July to October.

Dr. Mary Anne Jackson from Children’s Mercy Hospital in Kansas City spoke about enterovirus D68 at the Infectious Disease Conference in Philadelphia. Her hospital was the first to report cases of the virus. She shared five lessons from the acute outbreak in her area.

1. “This is the largest national outbreak in the US ever reported with enterovirus D-68.”

But enterovirus D68 is not new -– it’s been on the radar since 1962. That means there have probably been smaller, regional outbreaks that didn’t send up red flags and may have contributed to greater immunity in some communities during this outbreak.

2. “The spectrum of disease is unclear at this point — but it’s likely very broad.”

That means patients present with a wide range of symptoms – from a sniffle to a fatal infection. To date, there have been no confirmed cases of EV D68 in adults, because adults probably develop an immunity to the virus that protects them from the most severe symptoms. Only when acute symptoms present do hospital send samples to the Centers for Disease Control and Prevention for confirmatory testing, which can take one to two weeks.

3. “The burden of disease is varying, so those people who are seeing a surge in respiratory infections, need to have a team approach.”

“Burden of disease” refers to a public health measure about the costs of a disease for the individual and for society. What makes this enterovirus different from many is the way that the disease manifests in respiratory symptoms, says Dr. William Schaffner, professor of preventive medicine at Vanderbilt University in Tennessee. Enteroviruses more typically present in the intestinal tract.

4. “Not everything is EV-D68.”

Jackson said this time of year is when influenza – and rhinoviruses like those that cause the “common cold” — should take priority because they have a much longer history of fatalities. Aaron Milstone of Johns Hopkins Medical System pointed out that influenza is a much bigger killer. In Baltimore, he is seeing a “blurring” or overlap between EV-D68 and seasonal respiratory viruses.

5. “The last piece relates to acute limb weakness. We need doctors to recognize if they’re seeing a child present with any limb weakness, they need to see a pediatric neurologist and a pediatric infectious disease specialist.”

Jackson and other experts at the conference said the link – if there is one – between limb weakness (also called flaccid paralysis) and EV-D68 is not understood at this point. Of the three cases of flaccid paralysis that showed up at Mercy Hospital this summer, none tested positive for EV-D68. Bottom line: “Parents shouldn’t be fearful, they shouldn’t be watching for paralysis at all,” said Jackson.

To date, the virus has been confirmed in 45 states and has caused five deaths, including a 4-year-old in New Jersey.