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Frequently Asked Questions - Enterovirus D68

Friday, September 12, 2014

Updated 10/6/14.

Children's Hospital of Richmond at VCU (CHoR) and other local health systems are seeing an influx of children with severe respiratory illness, possibly due to enterovirus D68 (EV-D68). This FAQ* will help you understand respiratory illness, EV-D68 and steps you can take to keep your family healthy.
*These are guidelines and should not be taken as medical advice. When in doubt, seek immediate emergency care or call 911.

What is a respiratory virus?

Respiratory viruses are viral infections that can cause common cold symptoms like fever, runny nose, sneezing, cough, rash or body and muscle aches. Rhinovirus, RSV and enterovirus are types of respiratory viruses. Children's Hospital of Richmond at VCU and other local health systems are seeing an influx of children with severe respiratory illness, possibly due to enterovirus D68.

What is enterovirus D68 (EV-D68)?

EV-D68 is a type of respiratory virus that causes respiratory illness and can worsen breathing problems in children, especially those with asthma. EV-D68 is one of many non-polio enteroviruses. This virus was first identified in California in 1962, but it has not been commonly reported in the United States.

What are the symptoms of EV-D68 infection?

EV-D68 can cause mild to severe respiratory illness. Most people will experience mild cold symptoms. Mild symptoms may include fever, runny nose, sneezing, cough, body and muscle aches. Severe symptoms may include difficulty breathing and wheezing. Children with asthma may have a higher risk for severe respiratory illness.

How does EV-D68 spread?

Since EV-D68 causes respiratory illness, the virus can be found in respiratory secretions, such as saliva, nasal mucus, or sputum. EV-D68 likely spreads from person to person when an infected person coughs, sneezes, or touches contaminated surfaces.

Why the sudden influx of respiratory illness in Virginia? Why was the virus seen earlier in other states like Colorado and Illinois?

Most children in our area started the school year on September 2, while children in states with multiple reported cases of EV-D68 started the school year in mid-August. Children share everything in school – from pencils, books and crayons – to germs. Respiratory illness in children typically peaks in September during back to school season. We believe the enterovirus is following that trend and has likely not hit its peak.

Do not be alarmed if your child comes home from school with a runny nose or other mild cold symptoms. Minor symptoms are common this time of year.

Seek immediate attention if your child has trouble breathing.

See Safety Reminder section at the end of this FAQ.

Who is at risk for EV-D68?

Like other enteroviruses, anyone can get infected with EV-D68. Among the recent EV-D68 infections in some states, children with asthma seemed to have a higher risk for severe respiratory illness. As of September 11, 2014, 68 percent of patients who tested positive for EV-D68 have asthma.

How is EV-D68 diagnosed?

Many hospitals and clinics, like CHoR, can test for enteroviruses. However, most cannot do testing to determine the specific type of enterovirus, like EV-D68. The Virginia Health Department and CDC provide testing to determine specific types of enterovirus.

What are the treatments for EV-D68?

There is no specific treatment for people with respiratory illness caused by EV-D68. For mild respiratory illness, you can help relieve symptoms by taking over-the-counter medications for pain and fever.

Safety Reminder: Aspirin should not be given to children.

 

Some people with severe respiratory illness may need to be hospitalized. There are no antiviral medications currently available for people who become infected with EV-D68.

How long does a respiratory virus like EV-D68 last?

The length and severity of illness from a respiratory virus like EV-D68 varies from person to person. Most people will experience mild cold symptoms (or no symptoms at all), feel better within a few days, and not require a visit to the doctor. Children who have difficulty breathing or experience asthma excerebrations (asthma attack) will need to be seen by a doctor.

At CHoR, we have seen severe cases with quick recovery times as well as cases with longer recovery times. We are learning that the virus isn't the problem as much as the body's response. Again, everyone is different and we encourage you to touch base with your child's pediatrician if you have specific concerns about your child's symptoms.

Does a positive EV-D68 diagnosis change a patient's treatment plan?

No. We will provide the same level of supportive care whether a child has an upper respiratory infection or a confirmed case of EV-D68.

What services are available at CHoR for children who become critically ill with respiratory illnesses including EV-D68?

CHoR is Central Virginia's only full-service children's hospital, and Virginia's only Level 1 pediatric trauma center. What does this mean? CHoR provides the highest level of pediatric care in the region, including 24-hour access to all pediatric specialties. Critically ill children with respiratory illnesses often require comprehensive care from a team of pulmonologists (lung doctors), critical care specialists (doctors who work in the ICU), infectious diseases specialists, respiratory therapists, nurses and other pediatric providers – all of whom are available at CHoR.

CHoR is also the only center in the region that provides ECMO (Extracorporeal Membrane Oxygenation), an often life-saving procedure that uses a machine to take over the work of the lungs and heart when a child's body needs rest and support.

How long is a person contagious (able to spread the virus)?

Respiratory viruses like EV-D68 can be shed (passed from a person's body into the environment) in your stool for several weeks or longer after you have been infected. The virus can be shed from your respiratory tract for 1 to 3 weeks or less. Infected people can shed the virus even if they don't have symptoms. A few easy steps can help protect your family from respiratory viruses like EV-D68 (see below).

How can I protect my family from respiratory viruses like EV-D68?

  • Wash hands often with soap and water for 20 seconds, especially after changing diapers.
  • Avoid touching eyes, nose and mouth with unwashed hands.
  • Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick.
  • Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick.
  • Since people with asthma are at a higher risk for respiratory illnesses, they should regularly take medicines and maintain control of their illness during this time. They should also take advantage of influenza vaccine since people with asthma have a difficult time with respiratory illnesses. Asthma can also be controlled by avoiding the triggers that can cause an attack, such as tobacco smoke.

Should I keep my child home from school?

Children with minor cold symptoms:

  • DO keep children home from daycare or school and monitor their condition. DO remind children to wash their hands and avoid touching their face.

Healthy children:

  • DO NOT keep children home from school. DO remind children to wash their hands and avoid touching their face.

Preschool age children with a history of asthma:

  • Consider keeping them home from daycare until this illness passes. Be sure to continue asthma medication as prescribed and contact your pediatrician with any concerns. DO remind children to wash their hands and avoid touching their face.

What precautions should I take if my child has asthma?

Children with asthma should take all of their regularly prescribed medications and have rescue medications on hand. Asthmatic children and their family members should also take advantage of the influenza vaccine since people with asthma often have a difficult time with respiratory illnesses. Asthma can also be controlled by avoiding the triggers that can cause an attack, such as tobacco smoke. If you have specific questions, contact your child's pediatrician or asthma doctor.

Is CHoR conducting research on this virus?

Physicians and scientists at CHoR and VCU Medical Center are working together to sequence the genome of the virus that is currently spreading in our area. Our research will help us to better understand how this otherwise mild virus infection provokes the airways of people with asthma to develop such an unusually severe reaction.

Are there confirmed cases of EV-D68 in Virginia?

Yes, there are confirmed cases in Virginia.

Are there confirmed cases in other states? (As if 10/6/14.)

From August 21 to October 6, 2014, a total of 594 people from 43 states and the District of Columbia have been confirmed to have respiratory illness caused by EV-D68.

Safety Reminder

Always call 911 if a child:

  • Is having significant difficulty breathing, is not breathing or is turning blue
  • Has sudden unconsciousness or cannot be awakened
  • Is having a seizure
  • Is having an allergic reaction with a swollen tongue and difficulty breathing
  • Has a worsening headache accompanied by sudden difficulty speaking, loss of vision or abnormal eye movements
  • Has persistent severe bleeding from a wound

FAQ sources

Centers for Disease Control

Dr. Bruce K. Rubin, pediatric lung doctor and physician-in-chief of CHoR.

Dr. Jose Munoz, pediatric infectious diseases doctor and medical director of performance improvement at CHoR.


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