With the arrival of Ebola in the United States, the outbreak of enterovirus D68 (EV-D68) has fallen a bit off the nation’s radar. Though the ongoing outbreak in West Africa and the severity of the illness once it’s contracted is leading to mounting public concern in Dallas, where the first Ebola patient was diagnosed in America, it’s the latter infectious disease that has directly affected more patients in this country by at least two orders of magnitude.
As of the beginning of this month, the Centers for Disease Control (CDC) had verified over 500 cases of infection with the virus. Part of a family of viruses that commonly spread in late summer and early fall (ones that I frequently see in my office this time of year cause hand, foot and mouth disease), EV-D68 has caused an upper respiratory illness of varying severity in affected patients, mostly children. Those with the most severe symptoms, which have led many to be hospitalized, have typically been patients which a history of asthma or wheezing.
The outbreak began in Missouri and Illinois, but has now spread to almost all the continental United States. In addition to those cases confirmed by laboratory testing, there are almost certainly many more whose symptoms presented as little more than a straightforward cough or cold. I am quite sure that a large number of the children I have seen with uncomplicated respiratory illnesses lately have had it, but as there is little benefit from testing for the virus under those circumstances, doing so is discouraged to avoid overwhelming already busy labs.
Though the vast majority of children sickened by the virus have recovered, albeit after receiving intensive care in some cases, there have been four deaths in which the deceased tested positive for EV-D68. One patient, a ten-year-old girl in Rhode Island, died of sepsis caused by Staphylococcus aureus, a bacterium that can cause a variety of infections, most commonly of the skin. Though a lab has also confirmed the presence of the virus, its role in her death is unclear.
Also unclear is a new concern about a small number of patients experiencing weakness or paralysis of the limbs, possibly related to EV-D68. Though these symptoms in some way resemble polio, which is caused by a virus in the same family, it is important to remember that this illness is not polio, which has been eradicated in the United States since 1979 thanks to successful vaccination campaigns. While some children hospitalized for paralysis tested positive for EV-D68, not all have, and many have already recovered sufficiently to be discharged from the hospital.
Any time there is a new outbreak of infectious disease, it can be alarming. Though EV-D68 itself was first identified more than 50 years ago, the number and severity of some cases this year has been unusual. But, as I’ve counseled many worried parents, most patients won’t come down with anything more than an illness that looks like the common cold, and many won’t have any symptoms at all. Even for patients whose sickness is more severe, nearly all will recover fully. As scary as contagion can seem, nobody should be panicking, no matter which virus happens to be making the headlines.