Enterovirus D68: What Parents Need to Know

Medically Reviewed by Hansa D. Bhargava, MD on October 24, 2014

Editor's note: This story was updated on Oct. 24, 2014, with new case numbers and more information.

Sept. 9, 2014 -- A fast-spreading virus related to hand-foot-and-mouth disease is hospitalizing kids across the country.

The virus, called enterovirus D68 or EV-D68, was first discovered in 1962 in California. But until now, it has only been tied to smaller clusters of disease around the U.S.

This is the first time it’s caused such widespread misery, and it seems to be particularly hard on the lungs.

As of Oct. 23, the CDC and state public-health labs have confirmed more than 970 cases of EV-D68 in 47 states and Washington, D.C. Nearly all of the cases have been in children.

Health officials expect that EV-D68 cases, like cases of all enteroviruses, will “likely begin to decline by late fall,” the CDC says. Some states have reported that EV-D68 infections are decreasing, according to the agency.

Some children with EV-D68 have died, but it’s unclear if the virus directly caused their deaths or was a contributing factor. Health officials are investigating.

A few children hospitalized with EV-D68 have also developed unexplained paralysis in their arms and legs, officials say. The CDC is doing further tests to figure out the cause of the paralysis.

“This could be just coincidental, so we can’t leap to the conclusion that enterovirus D68 is the cause of this paralysis,” says William Schaffner, MD, an infectious disease expert at Vanderbilt University in Nashville, TN. “It’s right at the top of our list of suspects, but we haven’t nailed it yet.”

“Many of us will have EV-D68,” says Michael Fine, MD, director of the Rhode Island Department of Health, in a statement. “Most of us will have very mild symptoms, and all but very few will recover quickly and completely. The vast majority of children exposed to EV-D68 recover completely.”

We reached out to pediatricians and infectious disease specialists to find out what parents should know about this respiratory illness.

What are the symptoms of D68 infection?

Most viral infections start out with a fever, cough, and runny nose, but D68 doesn’t seem to follow that classic pattern, says Mary Anne Jackson, MD. She's the division director of infectious disease at Children’s Mercy Hospital in Kansas City, MO, the hospital where the first cases were identified.

“Only 25% to 30% of our kids have fever, so the vast majority don’t,” Jackson says. Instead, kids with D68 infections have cough and trouble breathing, sometimes with wheezing.

They act like they have asthma, even if they don’t have a history of it, she says. “They’re just not moving air.”

Why so many cases now?

The typical enterovirus season runs from July through October, says Jackson.

What’s unusual about this one is that it’s a virus that hasn’t widely spread through the U.S. before.

“If you have a new virus that has not widely circulated, most people are going to be susceptible,” Jackson says.

The spreading of the virus coincided with the start of the new school year. Many hospitals noticed a big uptick in cases when kids went back to their classrooms.

“In order for this virus to stop, it’s going to have to infect enough of the population to provide immunity and essentially burn itself out,” Jackson says.

Who's at greatest risk?

Recent cases have been in children ages 6 months to 16 years, with most hovering around ages 4 and 5, the CDC says.

And while many kids are coming down with milder symptoms, the virus seems to be hitting children with a history of breathing problems particularly hard.

Two-thirds of those hospitalized at Children’s Mercy had a history of asthma or wheezing, Jackson says.

“We made sure that primary care providers are in touch with their patients with asthma, so those have an active asthma plan and know what to do if they get into trouble,” she says.

How is the infection treated?

Because it’s caused by a virus, and not bacteria, antibiotics don’t help.

There is no vaccine to prevent it and no antiviral medication to treat it, says Andi Shane, MD. She's the medical director of hospital epidemiology and associate director of pediatric infectious disease at Children’s Healthcare of Atlanta.

She says the virus is treated with supportive care.

“The main thing is giving supplemental oxygen to the children who need it,” she says. Children may also get medications, such as albuterol, which help relax and open the air passages of the lungs.

Those with the most critical cases have needed ventilators to help them breathe.

When do kids need medical attention?

Most kids who get D68 infections will have a milder course of disease that just needs extra TLC, including lots of rest and plenty of fluids.

But it’s time to head to the doctor’s office or emergency room “if there’s any rapid breathing, and that means breathing more than once per second consistently over the span of an hour. Or if there’s any labored breathing,” says Roya Samuels, MD. She's a pediatrician at Steven & Alexandra Cohen Children’s Medical Center in New Hyde Park, N.Y.

Labored breathing, Samuels says, means kids are using smaller muscles around the chest wall to help move air in and out of their lungs.

“If you see the skin pulling in between the ribs or above the collarbone, or if there’s any wheezing, those are clear signs that a child needs to be evaluated,” she says.

How do you catch it?

The bad news is that enteroviruses, which are thought to cause between 10 million and 15 million infections in the U.S. each year, are pretty hardy, says Stephen Morse, PhD. He's an infectious disease expert at Columbia’s Mailman School of Public Health, in New York City.

The “entero-“ part of their name means the viruses can survive stomach acid and infect the gut, as opposed to their cousins, the rhinoviruses, which can’t.

He says these germs can live on surfaces for hours and maybe as long as a day, depending on the temperature and humidity.

“It is a pretty tough virus,” he says.

The virus can be found in saliva, nasal mucus, or sputum, according to the CDC.

Touching a contaminated surface and then rubbing your nose or eyes is the usual way someone catches it. You can also get it from close person-to-person contact.

Protect yourself with good hand-washing habits. Tell kids to cover their mouth with a tissue when they cough. If no tissue is handy, teach them to cough into the crook of their elbow or upper sleeve instead of their hand.

Common disinfectants and detergents will kill enteroviruses, Morse says, so clean frequently touched surfaces like doorknobs and toys according to manufacturers’ directions.

Show Sources


News release, CDC.

Mary Anne Jackson, MD, division director of infectious disease, Children’s Mercy Hospital, Kansas City, MO.

Andi Shane, MD, medical director, hospital epidemiology;  associate director of pediatric infectious disease, Children’s Healthcare of Atlanta.

Roya Samuels, MD, pediatrician, Steven & Alexandra Cohen Children’s Medical Center, New Hyde Park, NY.

Stephen Morse, PhD, professor of epidemiology, Mailman School of Public Health, Columbia University, New York.

William Schaffner, MD, infectious disease specialist, Vanderbilt University, Nashville, TN.


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