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A respiratory virus has infected hundreds of children in the U.S., sending them to emergency rooms across the country. The rare strain causes asthma-like symptoms and can exacerbate the disease. Jeffrey Brown learns more from Dr. Anne Schuchat of the Centers for Disease Control and Prevention and Dr. Gregory Conners of Children's Mercy Hospital in Missouri.
Hundreds of children across the country have been hospitalized by a virus that has come on suddenly and strongly.
Jeffrey Brown gets the latest on what you need to know.
It's called Enterovirus 68, and it's led to a surge of emergency room visits. In many ways, it starts off much like a regular cold, but some children soon have wheezing or breathing difficulties.
The virus has been confirmed in at least six states so far, Colorado, Illinois, Iowa, Missouri, Kansas, and Kentucky, and at least six others are reporting cases.
We talked with two people who are dealing with it directly, Dr. Anne Schuchat of the Centers for Disease Control, and Dr. Gregory Conners of Children's Mercy Hospital in Kansas City, one of the first hospitals to report it.
And, Dr. Conners, let me start with you. What did you and your colleagues see that caused alarm and caused you to reach out to the CDC?
DR. GREGORY CONNERS, Director, Division of Emergency and Urgent Care, Children's Mercy Hospital: Sure.
Well, about five or six weeks ago, a couple of my colleagues realized that we were seeing more than expected, quite a bit more than expected, in the number of children presenting to emergency departments and our urgent care centers with complaints of, as you said, wheezing, coughing, lower respiratory symptoms.
And so this got to our infectious disease folks, who said this looks like a novel or unusual viral outbreak, let's get in contact with the CDC. And testing began and we came to realize that it was this enterovirus that you just described.
And how many — when you say more than usual, how many cases? How big a deal has it become?
DR. GREGORY CONNERS:
Well, in the past four or five weeks, we have seen an average of over 100 kids a day beyond our usual, so we're seeing about 100 kids a day with this now.
So, Dr. Schuchat, what do we know about the virus and why it's spread now?
DR. ANNE SCHUCHAT, Centers for Disease Control and Prevention: Enteroviruses are quite common. There are 10 million to 15 million infections each year.
But Enterovirus 68 is quite unusual. It's been seen — it's been known of since 1962, but we haven't seen very many of these infections here in the U.S. What we're seeing this year in a couple of places is an increase over expected of severe respiratory illness in children, worsening of asthma in particular.
We think that the virus is spread person to person through coughs and sneezes, and that it's really important for people to wash their hands, cover their cough, keep their kids home if they're sick, those sorts of things, really what we call respiratory hygiene or good etiquette, to try to reduce that spread of respiratory virus from one person to another.
Do we know why it suddenly flares up? You said it's been around since the '60s, but in very low — low levels, I guess.
DR. ANNE SCHUCHAT:
We wish we knew more about this virus. It's relatively new. We know that the strains circulating this year are quite similar to last year's and the year before, so it hasn't suddenly changed.
But, for some reason, we're seeing increases in particular communities. CDC is working closely with states and local health departments around the country to understand whether the increases or clusters of respiratory illness are caused by this. There are many other causes of respiratory illness. And in some of the clusters we have looked into, this hasn't been present. So it's early days, and we will know a lot more in the next weeks.
And do we know why it hits — seems to hit children with respiratory problems already? Is that correct?
Enteroviruses in general cause more symptoms in young people than in adults. Adults can get milder asymptomatic infections with these viruses. The Enterovirus 68 seems to worsen asthma. So many of the cases we have seen have been children who have asthma who have a worse time recovering from the virus.
We think it's important for parents who have children with asthma to make sure their kids are taking their medicines regularly. And flu season is coming. And influenza vaccine is an important protection for children with asthma and others with asthma. They just don't handle viral infections as well as others do.
Well, so, Dr. Conners, tell — what has happened in the cases that you have seen? What's been — when have children come in and what has sort of been the progression as they come in?
We have seen quite a lot of kids. And they have come in with symptoms suggestive of asthma. Many of them — many of them have asthma, and many of them haven't had asthma in the past, but yet look like they do have asthma.
We have had to admit about one in six of those children to the hospital, some even to intensive care, and the rest we have been able to treat with enough medication in the emergency department, and we can then send them home to continue their management at home.
But some kids, especially the ones with underlying health problems already, including asthma, some of them have ended up in intensive care.
And what kind of treatment is it?
Well, we use really standard asthma stuff, inhaled medicines, and then usually oral steroids. That will get through most of the kids who have an asthma-like picture. The ones who come into the hospital, we have to use those more intensively than you would use at home. And then the ones in intensive care often need extra oxygen and intravenous medications as well.
And what do you tell parents or what would you tell parents about when they should bring a child in either to the doctor or clearly to an emergency room if necessary?
Sure. That's a great question.
What we tell parents is to bring their kids in if they're having trouble breathing or symptoms that really need an emergency or an urgent care visit. We have had several families who have come in since they have learned more about it on the news with concerns that — concerns that this might be that virus, and the children actually weren't that sick, looking for specific testing or that sort of thing.
And we tell parents, no need for that. Come in if your child needs help because they're sick to the level of needing emergency or urgent care. But if you're looking for specific testing, we will just examine your child, says it looks like that what it probably is. No need for specific testing.
And there is no specific therapy even if the tests were positive. So just take care of your child as you usually would and consider the emergency department and urgent care to be kind of a backup if your child is having trouble breathing or some other important health care problem like that.
And let me ask you, Dr. Schuchat, briefly, finally, is there any — does history tell us anything about how long something like this might last or how big it might grow?
We're reviewing the information that's available from outbreaks around the world.
Usually, this is the right time of the year. August and September are when enteroviruses peak. But we really don't know exactly how long this will last in the different communities or how widespread it will be. We do think that, in the weeks ahead, it will be important to be looking for other viruses as well, because we will be heading into the season when different viruses circulate.
So it's not likely to go on for months, but this is the right time of year for this kind of respiratory problem.
All right, Dr. Anne Schuchat of the CDC, Dr. Gregory Conners of Children's Mercy Hospital in Kansas City, thank you both very much.
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