Hit By A Virus: Symptoms determine how to strike back.

Henrico Monthly

By Mark A. Flanzenbaum, MD, FAAP
Henrico Monthly
November 2014

The daily news always seems to be filled with stories about viruses. There is the yearly flood of stories about the flu virus. Recently, there have been reports of the awful Ebola virus. Everyone reading this has probably known someone who lost information due to a computer virus. Now, of course, we are hearing daily accounts of the outbreak of Enterovirus D68.

So, what exactly are viruses and should we be concerned about them? Let me first explain that either bacteria or viruses cause most infections. Bacteria are microscopic organisms that can thrive in many different environments both inside of living hosts and away from living hosts. Bacteria that cause disease in humans can often be treated with antibiotic medications.

Viruses, on the other hand, are even smaller than bacteria and need a living host such as humans, animals or plants to survive and multiply. In the human body, viruses get into some of the cells where they reproduce and cause illness. Luckily, the vast majority of viruses that we encounter are generally harmless, such as the common cold virus. Others, such as HIV, Ebola and polio, have been known to be deadly. Viruses cannot be treated with antibiotics. Most viral infections resolve spontaneously.

Infants and children are particularly prone to myriad common viral infections such as colds (caused mostly by rhinovirus), flu (caused by influenza virus A or B), hand-foot-mouth disease (caused by coxsackievirus A), fifth disease (caused by parvovirus B19) and roseola (caused by HSV-6). Most children with these illnesses have symptoms that may be uncomfortable but are rarely dangerous.

Routine childhood vaccines have been successful in protecting children not only from deadly bacterial infections, but also from many serious or deadly viral infections such as polio, measles, mumps, rubella (German measles) and chicken pox. The flu vaccine must be obtained yearly to protect against the flu since the predominant strain of flu virus changes yearly. For many other viruses there is no vaccine at the current time.

Beginning in mid-August of this year, a previously little known virus identified as Enterovirus D68 (EV-D68) has made headlines because there were larger than normal outbreaks of respiratory illnesses in children. Many viruses (including the common coxsackievirus and rhinovirus) are in the large family of enteroviruses. EV-D68 was discovered in 1962, but not much attention has been paid to it since it has not been commonly reported.

EV-D68 is a respiratory virus like the common cold virus and RSV (respiratory syncytial virus). It can cause both mild and severe respiratory symptoms. The mild symptoms tend to be runny nose, sneezing, coughing, fever and body aches. The more severe symptoms can be wheezing and difficulty breathing. Children with asthma have been shown to be at the highest risk for the more severe symptoms.

Just like the common cold virus, EV-D68 is spread from one person to another through respiratory secretions. Coughing, sneezing, sharing drinks or utensils or touching surfaces contaminated with saliva or nasal secretions can all spread the virus. There is no vaccine for this virus currently and no specific antiviral medication available to treat it. Infants, children and teenagers are more likely to have symptoms related to this virus since they most often do not have any protection (immunity) related to previous exposure to enteroviruses.

The treatment for children suspected of infection with EV-D68 is the same as it is for any viral respiratory illness. Supportive care such as hydration and treatment of fever with acetaminophen or ibuprofen is important to keep infected children comfortable. Parents of children with asthma should make sure to keep a rescue inhaler or nebulizer with a bronchodilator medication, such as albuterol, readily available.

Any child showing signs of respiratory distress should be evaluated by a pediatric physician. These signs include rapid or deep breathing, use of abdominal or chest muscles when breathing, or grunting. Children might have wheezing or they may feel like they have to work harder to breathe. The pediatric-trained physicians and staff at KidMed are fully prepared to care for any child with respiratory distress. If you are not sure whether your child is in distress, please do not take matters into your own hands. Let a pediatric medical professional evaluate your child. Any child who is having severe difficulty breathing, is unresponsive or turning blue needs help immediately and 911 should be called.

Unlike a computer virus, respiratory viruses cause real disease in real children and should be taken seriously. Since the test for EV-D68 is not readily available, parents should not worry about whether their child has this particular virus. Instead, it is much more important to recognize the signs and symptoms of respiratory illness and to act accordingly. The symptoms of EV-D68 cannot be distinguished from the symptoms of the cold virus or RSV in most children, but the treatment is ultimately the same.

Your school-age child may have heard news reports about this virus and about the children who have been hospitalized as a result of it. It is extremely important for parents to discuss this with their children, both to inform them of the symptoms to be aware of and to alleviate any unnecessary anxiety.

The vast majority of children exposed to EV-D68 will have nothing more than mild cold symptoms. Even children with asthma have recovered quickly from this infection. Most children who have required hospitalization have been discharged home in a relatively short period of time. Parents of children with asthma should have an active asthma plan prepared with the assistance of their pediatrician or pediatric specialist.

Viruses are everywhere and we are all exposed to them on a regular basis. Most are not dangerous but can still make children feel miserable. Some can make them quite sick. The news can be quite scary when it comes to stories about virus infections at home and around the world. Understanding the symptoms and treatment options for the ones your children are likely to be exposed to will go a long way in making the sea of information easier to navigate.

Dr. Mark A. Flanzenbaum received his medical degree from the University at Buffalo School of Medicine (SUNY) in 1990. He completed a combined internal medicine/pediatrics internship and residency at the Medical College of Virginia and is board certified in pediatrics. He practiced pediatric and adult emergency medicine for 14 years prior to co-founding KidMed.