the virus sweeping Dayton

By: Dr. Patricia Abboud

What is this new virus that is sweeping the country and making kids really sick?

Rhinovirus is one of several viruses we can test for in the hospital. It is essentially ‘the common cold’. In the news we are hearing a lot about human enterovirus D-68 (HE-D68) which is a ‘cousin’ of rhinovirus.

We typically see rhinovirus in the winter and enterovirus in the summer. HE-D68 was first diagnosed in 1962 and is rarely reported in the United States. The CDC (Center for Disease Control) is not quite sure why we are seeing it this year.

HE-D68 is found in the respiratory secretions (e.g., saliva, sputum, or nasal mucus)

What are the signs/symptoms?

Like the common cold we develop cough, runny nose, sneezing and fever.

Typically colds take about 7-10 days before we start to feel better.

What makes this virus so bad and when should I seek medical attention?

• If wheezing develops and persists, this is worrisome for HE-D68
• You should seek medical attention:
• Persistent high fever
• Increased work of breathing
• Wheezing
• Children with asthma are particularly vulnerable due to the risk of wheezing associated with the virus.

What are we seeing in Dayton and at Dayton Children’s?

We are seeing for the first time, unprecedented amount of rhinovirus being diagnosed this time of the year. Because of the testing techniques, we are almost 100 percent confident that we are really seeing HE-D68. With the ‘traditional rhinovirus’ being a winter illness, we are confident that this summer our children are suffering from HE-D68.

Rhinovirus cases identified in Kansas City and Chicago was eventually confirmed with further testing at the CDC as the HE-D68. The CDC will confirm our testing as well.

The numbers:

• From August 1^st through September 8^th we’ve diagnosed 330 cases of rhinovirus in the community this year. There have been 22 admissions to the PICU for respiratory illnesses in thus far.
• Last year this time we diagnosed 97 cases (which seems to be our average).
• As compared to Colorado with 900 cases from August 18^th through September 4^th.

Most of the diagnosis is in the Emergency room with most children discharged to home with supportive care (hydration, Tylenol/Motrin, decongestants, breathing treatments).

A small percentage get admitted to the hospital depending on how sick they are.

An even smaller number have been admitted to the PICU. To date we have had one child on a ventilator. The kids that are coming to the ICU are requiring significant oxygen support, breathing 2-3 times the normal rate for their age and as a consequence do not eat or drink like they should and are dehydrated.

Who is at risk?

• ANYONE! Adults are getting sick too, but it is the children that are requiring hospitalization and advanced medical care.
• Young infants tend to be at a higher risk for respiratory distress from MOST viral illness. We often hear about RSV or bronchiolitis in the winter causing significant breathing problems. EV-D68 certainly can lead to wheezing and increased work of breathing and distress.
• Those with lung problems, asthma, and children with special medical needs in general tend to get sicker from any viral illness, this is what we are seeing more of in our hospital.
• ‘People in groups’. What I mean by that is schools, daycares, and social gatherings.

How do I prevent this?

• There is NO Vaccine
• Hand washing!!! So easy. Full minute, sing your ABC’s a couple of times.
• Cough into elbow and not your hand
• Avoiding sick contacts as much as possible
• For asthmatics, make sure your inhaler is easily accessible and seek medical attention if symptoms continue to worsen. Have a plan.

We noticed a surge in the diagnosis of rhinovirus in August and most experts are correlating this with the return of school and the cohorting of children. As health care providers we are being asked to consider the diagnosis of HE-D68 in any child with acute, unexplained severe respiratory illness.

Be safe and practice good hygiene to stay healthy. Unfortunately, the winter is still ahead of us where we traditionally see the increase in hospitalized children from viral illness.

We have created a flier to help you educate your patients and families on when to seek treatment in the emergency department at Dayton Children’s.

Reference: www.CDC.gov

Dr. Abboud is a pediatric intensivist at Dayton Children’s and the mother of three kids. As part of the “Dr. Mom Squad,” Dr. Abboud blogs about her experiences as both as doctor and a mom and hopes to share insight to other parents on issues related to both parenting and kids health. Learn more about Dr. Abboud!