Enterovirus D68 is a rare, growing virus that affects children and some adults throughout the world. This virus is prevalent in Central American countries like Ecuador and with the ongoing inconsistency of border control, D68 has found its way on to US soil. The virus was first identified in California in 1962 and the incidence of infection has stayed rare until this year, when a massive outbreak of D68 occurred in the United States. The CDC reports 691 people infected across 46 states. Of the 691 patients, five fatalities were reported and 27 cases were reported with muscle weakness and/or paralysis.
D68 is highly contagious and is transmitted through contact with an infected person’s respiratory secretions, saliva, mucous, and/or sputum. Symptomatically, D68 may appear initially like a cold, but will escalate to a worsening disease state. Common signs and symptoms of this virus include cough, runny nose, fever, wheezing, and/or rash. Other less common signs and symptoms are decreased alertness, decreased urine output, dehydration, respiratory failure, severe skin rashes, abdominal pain, soft stools, muscle weakness, and/or paralysis. More severe cases have been correlated with muscle weakness and paralysis within 48 hours of contracting this Enterovirus. Patients who have contracted D68 may or may not present with fever. In fact, only 25-30% of the infected population experienced fever with this virus. D68 mainly targets children six months of age to sixteen years old with mostly four- and five-year-olds contracting this condition.
Currently there are no drugs or vaccines available to treat or prevent D68. Supportive therapy is still the standard of care. Steroids, Intravenous Immune globulin, and plasma exchange have been used in some cases, but none of which have proven to be significantly effective. Oxygen, albuterol nebulizers, and/or a type of ventilation system should be kept readily accessible to treat the respiratory symptoms associated with the D68 virus.
In September 2014, Children’s Mercy Hospital in Kansas City, Missouri reported three-hundred possible cases of D68, which ranks as the highest number of infected individuals found in one facility. The CDC recommends that the best approach to the D68 problem is preventative care. Some examples of how we can prevent catching D68 include: making sure to wash your hands for at least twenty seconds; avoid touching your eyes, nose, mouth with unwashed hands; and avoid close contact such as kissing, hugging, sharing cups, and/or sharing eating utensils. Georgia has had three confirmed cases of D68. All three patients are children and have all been treated for the illnesses at the Children’s Hospital of Georgia in Augusta. HCA hospitals out west are in the works of coming up with protocols to maximize care for these patients. It is beneficial for us to become aware that D68 exists and could strike us at any time.
Clara Vinh, Pharm. D.