Enterovirus D68 has providers, parents on alert

Nearly 600 people in 43 states and DC have been confirmed with the virus that afflicts mostly children

State health departments across the country are investigating several reported cases of severe respiratory illness in children, many attributed to enterovirus D68 (EV-D68), a nonpolio enterovirus that can cause mild to severe respiratory illness.

Health officials said they will continue to provide updates that can help providers, patients, and caregivers know how to detect the virus and take action against it.

Pharmacists are being called upon to provide consistent public health information and public assurance.

“The current public health concern is a lesson for all health care providers, including pharmacists, who may be the first to encounter a patient with symptoms that are consistent with a particular infectious disease,” said APhA Executive Vice President and CEO Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA, in a statement.

Since mid-August, nearly 600 people in 43 states and the District of Columbia have been confirmed with EV-D68 infection. On October 3, the New Jersey Department of Health reported that a specimen from a 4-year-old boy in the state who died had tested positive for EV-D68. The boy is the fifth patient who died and has tested positive for EV-D68 since late September, according to CDC.

In general, infants, children, and teenagers are more likely to get infected with enteroviruses because they lack immunity to them, and children with asthma may have a higher risk for respiratory infection caused by EV-D68.

If a patient presents with acute, unexplained, severe respiratory illness, CDC said health care providers should consider EV-D68 as the cause and proceed with testing. EV-D68 can only be diagnosed with a specific lab test using samples from the patient’s nose and throat, which is typically done at a local or state health department.

CDC said providers should also report any suspected clusters to local and state health departments that may have additional guidance for reporting.

Unfortunately, no vaccine nor any antiviral medications are currently available to treat EV-D68. But patients can relieve symptoms with OTC medications for pain and fever. Aspirin should not be given to children, according to CDC guidelines.

CDC guidelines also included certain measures that can go a long way to prevent the spread of EV-D68: washing hands often with soap and water for 20 seconds; avoiding touching eyes, nose, and mouth with unwashed hands; avoiding close contact such as kissing, hugging, and sharing cups or eating utensils while sick or with people who are sick; covering coughs and sneezes with a tissue or shirt sleeve, not hands; cleaning and disinfecting frequently touched surfaces, such as toys and doorknobs, especially if someone is sick; and staying home if sick.

Children with asthma are especially at risk for severe symptoms from EV-D68 and other respiratory illnesses. They should be particularly vigilant about control of their illness during this time, according to CDC.

APhA encourages patients to fill all their prescriptions with one pharmacy, get to know their pharmacist on a first-name basis, discuss their medications with their pharmacist, carry an up-to-date medication and vaccination list, and share all medical information with each of their health care providers. In addition, they advise following good cough and sneeze hygiene (i.e., sneeze or cough into your elbow), washing hands, and staying home from school or work if someone has a cold or flulike symptoms.

Although EV-D68 has been reported in small clusters since 1987, CDC said that this year, the number of people reported with confirmed EV-D68 infection is much greater than in previous years.

In the United States, people are more likely to get the virus in the summer and fall. CDC said EV-D68 infections are likely to decline later this fall.

For health care professionals who want more information, please visit the CDC website

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