Enterovirus D68

By | Updated Oct 10, 2014 12:01 PM UTC

Americans are primed to fear the flu, and concerns about Ebola have consumers snapping up hand gels and face masks. U.S. health officials, however, are no less worried about a different virus, a stealthy, erratic child-killer that is poorly understood and can’t be reliably prevented or cured. Known as enterovirus D68, it has been found in five children who died suddenly, and researchers think it is responsible for leaving dozens of others paralyzed or gasping for breath as it rapidly spreads. Infectious disease experts are grappling with how to counsel frightened parents worried that every cold will turn deadly, while neurologists are looking for a way to identify and treat those most likely to develop severe complications.

The Situation

Enterovirus D68, or EV-D68, has been confirmed in 628 people across 44 states as of Oct. 8, less than two months after it mysteriously reemerged in the Midwest. The five dead children include a 4-year-old New Jersey boy who showed no sign of serious illness before he passed away in the night. A 10-year-old girl from Rhode Island who developed a bacterial infection and had EV-D68 in late September was the first reported death. She died within 24 hours of reaching the hospital. The virus is suspected of playing a role in the paralysis that developed in dozens of other children in the past two months, leaving them wheelchair-bound or without the use of their arms. The enterovirus season typically runs from late summer through the fall, giving hope that the spread of the infection may taper off soon.

The Background

The D68 enterovirus, a rare form of a ubiquitous germ, first appeared in the U.S. in California in 1962, when it was detected in four children with bronchitis and pneumonia. A few clusters of cases have emerged in the past half-century, without dire public-health consequences. Nobody knows why it’s so virulent this year. There were only 23 recorded cases from 1987 through 2005, too few for doctors to learn much about symptoms, with the biggest single year producing 11 patients in 2003. The virus shares biologic features with germs that cause the common cold, and in some people it triggers similarly mild symptoms – or none at all. Other enteroviruses infect 2 million to 4 million children annually in the U.S. They usually don’t cause serious illness; one exception is polio. A review of six EV-D68 outbreaks in Asia, Europe and the U.S. from 2008 through 2010 found that the hardest-hit patients needed mechanical ventilation and three died.

The Argument

The challenge for public health officials is to alert parents without inciting panic. Centers for Disease Control and Prevention officials say doctors should consider the virus a possible cause of any fast-developing severe respiratory illness, even when there is no fever. They advise parents to head for a doctor or emergency room with children who are having trouble breathing. While there is no treatment for the virus itself, there is equipment to help victims breathe and methods to ease symptoms. Public health officials say the most important message is to try to limit viruses from spreading through contact or the air by washing hands for at least 20 seconds throughout the day, covering coughs and keeping anyone who feels ill home from school or work. On the research front, confirmation of the link between EV-D68 and paralysis would trigger a crash effort to develop medicines and vaccines, a task that could take years.

The Reference Shelf

  • Bloomberg News Q&A on Enterovirus D68.
  • The U.S. Centers for Disease Control and Prevention is updating a fact sheet on Enterovirus D68 every Wednesday. It convened a panel discussion about diagnosis and treatment in September and published a report about earlier outbreaks in 2011.
  • Bloomberg News reported that pinkeye was the only symptom of infection before the death of the New Jersey preschooler and detailed the efforts of more than 50 doctors at the country’s top hospitals to find a drug or vaccine for the virus.
  • WebMD reported what parents need to know about EV-D68 and a victim’s father released a tribute to his son.

First published Oct. 10, 2014

To contact the writer of this QuickTake:
Michelle Cortez in New York at mcortez@bloomberg.net

To contact the editor responsible for this QuickTake:
Jonathan Landman at jlandman4@bloomberg.net