What You Need to Know about Virus Sweeping the Midwest

Enterovirus D68 is not deadly, but watch symptoms closely

Child Coughing

Updated 10/10/2014

Advertising Policy

A rare virus similar to the common cold is infecting U.S. children across the Midwest and West.

While the virus is rarely deadly, some children — especially those with asthma or other cardiorespiratory diseases — are at risk for developing serious problems.

We talked with pediatric pulmonologist Giovanni Piedimonte, MD, Chairman of Cleveland Clinic Pediatric Institute and Physician-in-Chief of Cleveland Clinic Children’s, to find out what parents need to know about this rare strain of Enterovirus called Enterovirus D68.

Q: What is your advice for parents?

A: Do not panic! Symptoms in most cases are mild and typically subside in a few days. Even in the most severe cases, doctors can support breathing and other vital functions of children attacked by the virus until they overcome the acute phase of the infection. 

Q: How worried should parents be?

A: Parents should remain calm and understand that this virus is similar in many ways to the common cold virus. Although rarely isolated in the United States, Enterovirus D68 has been known to virologists for more than 50 years, is known to cause mild-to-severe respiratory infections in children and occasionally peaks into an epidemic. Severe consequences are exceedingly rare.

On the other hand, if your child develops flu-like symptoms and seems to be getting worse, do not hesitate to contact your pediatrician or report to the closest emergency room, as the symptoms may evolve rapidly and the child may need oxygen and other medical interventions. Waiting too long to seek medical care puts a child infected with Enterovirus D68 at higher risk to develop a severe oxygen deficit and require intensive care. 

Q: What can be done to prevent the virus?

A: Wash or disinfect your hands and your children’s hands after contact with any potentially infected object or with other individuals with flu-like symptoms. In particular, wash or disinfect your hands after handling diapers. As much as possible, do not touch your eyes, nose or mouth if your hands are not clean.

As far as we know, this virus is not airborne and is transmitted only by contact. Therefore masks are very unlikely to be protective. No vaccine or other prevention is available to protect against Enterovirus D68. Also, once the infection starts, no therapy has been shown to be effective. 

Advertising Policy

Q: What are the symptoms?

A:  Symptoms of Enterovirus D68 infection include cough, runny nose and shortness of breath. Fever is present in only a minority of cases. Children with asthma or other chronic airway obstruction are likely to experience a worsening of wheezing and an increased need for their rescue medications such as albuterol.

If your child develops these flu-like symptoms and seems to be getting worse, you should call your pediatrician or go to the closest emergency room.

Q:  Is there something specific parents should watch for?

A: Symptoms of Enterovirus D68 infection are virtually indistinguishable from those caused by other more common respiratory viruses like influenza or respiratory syncytial virus (RSV). A diagnosis of Enterovirus/rhinovirus respiratory infection can be done only in specialized hospitals. The confirmation of Enterovirus D68 strain can be made only at the Centers for Disease Control (CDC) in Atlanta,  which collects the specimens sent from around the United States via local health departments. 

Q: What are the dangers if the virus isn’t treated immediately?

A: There are several reports of rapid evolution of severe respiratory symptoms in young patients infected by Enterovirus D68. This can cause a rapid drop of the oxygen transported by the blood, which needs to be immediately supplemented to the patient via a mask or other delivery systems.

The virus triggers inflammation and muscle spasm that dramatically reduce the airway caliber, especially in children with preexisting asthma or other chronic respiratory conditions. In the most severe cases, the airway needs to be intubated to allow adequate oxygen and mechanical breathing support. A few cases also have required extra-corporeal membrane oxygenation

Q: When is it time to go to the doctor?

A: Anything more than mild nasal congestion with a mild cough should be at least discussed with a pediatrician during this epidemic phase.

If the cause is Enterovirus D68, the child may develop significant airway narrowing and a rapidly progressing lack of oxygen within a few hours. If this happens the child should already be in a medical facility, where health care providers can monitor the child’s vital signs, support oxygenation, and if necessary, intubate the child as a defense against respiratory failure.

Children with preexisting cardiorespiratory diseases, such as asthma, chronic lung disease of prematurity (also called broncho-pulmonary dysplasia, or BPD), cystic fibrosis, interstitial lung disease or congenital heart defects, should be seen by a pediatrician as soon as flu-like symptoms start. Time is of the essence!

Advertising Policy

Q: Why is the virus spreading?

A: Enteroviruses typically peak in late summer and early fall. However, several other common respiratory viruses can be present in the community at the same time, and the “back to school” time coincides around the globe with the peak of community-acquired respiratory infections. Furthermore, respiratory infections are frequently poly-microbial. In other words, multiple viruses can together attack the same patient and/or open the door to bacterial infections by weakening the host defense mechanisms. 

Q: How is Enterovirus D68 different?

There is no solid evidence that Enterovirus D68 is any different from other more common viruses like rhinoviruses, influenza/parainfluenza, or RSV, except for the frequency of severe cases that require hospital or even intensive care admissions.

Children with preexisting respiratory diseases are intrinsically prone to respiratory viruses because their airways are hyperreactive (“twitchy”) and inflamed, or because their lung volume is reduced by diseases like BPD or interstitial lung disease.

Indeed, more than two-thirds of severe cases confirmed by the CDC to be infected by Enterovirus D68 were known to have chronic asthma.

Asthmatic children infected by these viruses can experience a sharp increase in the need for rescue medications to open their narrowed airways, and may also require anti-inflammatory steroids, which can be taken with pills or administered intravenously.