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What You Need to Know About Enterovirus D68

By DR. MALCOLM THALER

Enteroviruses are ubiquitous in the environment and frequently cause mild viral symptoms that resolve in a few days without any specific treatment. But this latest epidemic — Enterovirus D68 (EV-D68) — is different, causing significant respiratory symptoms in some children that are sometimes severe enough to require hospitalization in an ICU setting.

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Here are the basic facts about EV-D68 and what you should do if you think your child has it:

What are the symptoms of EV-D68?
In most children, the symptoms are no different than those of the common cold: runny nose, sneezing, cough, achy muscles and a low-grade fever. But some affected children, particularly those with an underlying lung disease (e.g., asthma) have complained of wheezing, chest pain and difficulty breathing. Adults can get the disease as well, but it's almost always mild.

Why is EV-D68 causing problems now?
The EV-D68 virus has been around for a long time. It was first identified in California in 1962. Since then, it has caused small outbreaks throughout the world, including one in New York City in 2009. Why this recent outbreak has become so much more concerning is not well understood.

It may reflect a mutation in the virus that makes it either more dangerous or more easily transmissible, but we don't know for sure. We do know, however, that enteroviruses do mutate easily and frequently.

What do I do if I think my child has EV-D68? Can it be treated?
If your child only has symptoms of a cold, there is no cause for concern. But if your child has difficulty breathing, contact your health care provider immediately. Although there is no specific treatment for EV-D68 — for example, something analogous to an antibiotic for a bacterial infection — proper supportive care can greatly improve your child's comfort and ensure a happy outcome.

How can I protect my child from getting EV-D68?
There is no vaccine currently, so the only steps you can take are the same as you would take to prevent a cold:

* Avoid close contact with people who are sick, and protect others by keeping your child home from school if he or she becomes ill.

* Wash your child's hands (and your own) frequently with soap and water.

* Try to keep your child from touching his or her face.

* Clean and disinfect surfaces that are touched frequently, such as toys and doorknobs.

I've heard that EV-D68 may cause paralysis. Is this true?
We don't know. There have been a few reports of children developing muscle weakness and even paralysis, but a link to EV-D68 has not been firmly established. The virus is related to the poliovirus, so the possibility does exist, but even if this turns out to be the case, the risk appears to be quite low.

Is the epidemic going to get worse?
It will almost certainly get better very soon, and there are already signs it is tapering off. Enteroviral illnesses typically peak in September and October and then quickly decline. This strain may prove different, but right now there is no reason to expect it will hang around through the winter. For more information, visit the CDC Web page on Enterovirus D68.

--Dr. Thaler

Readers -- Are you worried about EV-D68? Do you know anyone who has contracted the virus? What steps do you take to avoid catching a cold or the flu? Do you get a flu shot every year? Leave a comment below and let us know.

Malcolm Thaler, M.D., is a physician at One Medical Group. He enjoys being on the front lines of patient care, managing diagnostic and therapeutic challenges with a compassionate, integrative approach that stresses close doctor-patient collaboration. He is the author and chief editor of several best-selling medical textbooks and online resources and has extensive expertise in managing a wide range of issues, including the prevention and treatment of cardiovascular disease, diabetes and sports injuries.

Thaler graduated magna cum laude from Amherst College, received his M.D. from Duke University and completed his residency in internal medicine at Harvard’s New England Deaconess Hospital and Temple University Hospital. He joined One Medical from his national award-winning internal medicine practice in Pennsylvania and was an attending physician at The Bryn Mawr Hospital since 1986. He is certified by the American Board of Internal Medicine.

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