Maryland prepares for cases of enterovirus

Local health officials on the lookout for unusual strain of enterovirus already confirmed in neighboring states

September 18, 2014|By Meredith Cohn | The Baltimore Sun

As an unusual strain of virus continues its march across the country — showing up most recently in Pennsylvania and Virginia — health officials in Maryland are warning doctors to be on the lookout and advising parents to prepare.

Enterovirus is common, with millions in the United States sickened every year, most with mild cases.

But the relatively rare strain called EV-D68 can cause severe respiratory illness in children with asthma or other health conditions, the U.S. Centers for Disease Control and Prevention warns.

"We've not seen any cases, but we've asked the provider community to be on the alert," said Gregory Reed, a program manager with the Maryland Department of Health and Mental Hygiene. "It's circulating around the country, so we'll try and identify it and manage it if it pops up."

The virus might already have turned up in Maryland, officials said. Doctors are not required to test for enterovirus, or to report cases to authorities.

A spokeswoman for Johns Hopkins Children's Center said doctors there have tested patients with asthma for the virus, but results are not expected for up to a week.

Spokeswoman Ekaterina Pesheva said the hospital was prepared for cases.

"Our pediatric infectious disease specialists want to reassure parents that most healthy children who get the virus should recover swiftly and experience mild illness," Pesheva said.

There could also be cases at Greater Baltimore Medical Center, according to Dr. Melissa Sparrow, the hospital's clinical director for the pediatric inpatient and emergency services. She said the hospital has asthma patients whose treatment has required longer periods on medications than usual.

"They've all had some asthma or wheezing in the past," she said. "And we usually see them as the weather changes this time of year. But this is a little bit of a notch up.

"The question is, is this enterovirus?"

She said GBMC wasn't likely to test any of its patients because treatment of symptoms would be no different. But she said the hospital will inform state health officials of potential infections.

The CDC is recommending testing only for serious and unexplained cases. The tests are done mainly at the CDC. The agency has found 153 cases in 18 states since mid-August, and is investigating cases in other states. Many of the patients had a history of asthma or wheezing.

The virus seems to spread in the same way as influenza: from person to person through coughing, sneezing or touching contaminated surfaces. But Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases, told reporters this week that officials don't know a lot about this strain.

With the flu season approaching, health officials, schools and day care facilities are already warning the public to wash hands, sneeze into sleeves, disinfect surfaces and stay home when sick.

"In order to ensure that your children stay healthy, good hygiene habits are going to be essential," leaders from Stonewall Day Care in Fallston wrote to parents in a blog post about the potential for enterovirus.

"But knowing that children should practice good hygiene and convincing them to do so are two different stories altogether. So, the first thing you should do is practice what you preach and make sure your own hygiene habits match what you want your children to be doing."

Anne Arundel County Public Schools spokesman Bob Mosier said "we are continuing to encourage students and employees to practice good hygiene."

There is no vaccine for enterovirus, but Mosier said the school system was partnering with the county's department of health to provide free flu vaccines for elementary students to help stave off the disease that is generally widespread over colder months.

There is no specific treatment for flu or enterovirus, though pain and fever medications can relieve symptoms that generally pass after several days.

Parents should make sure children stay hydrated. Officials are recommending that those who have trouble breathing, or have symptoms that are worsening, see their doctors.

In Baltimore City, where rates of asthma are high, the Health Department is providing information to prevent both enterovirus and flu. Officials are holding flu vaccine clinics next week for seniors and are immunizing uninsured children for free.

The city schools and health staff are monitoring students for signs of respiratory distress, providing information on good hygiene and asking parents to inform school nurses of students with asthma and other chronic conditions that put them at risk for more severe illness.

"It is important that appropriate medications are available in school for administration in case of emergency, up-to-date emergency contact information is on file and that students with chronic health conditions follow up with their health care provider as instructed for care," said Dr. Judith F. DeBose, medical director of the Bureau of School Health at the Baltimore City Health Department.

Enterovirus D68

The virus appears to sicken mainly children, but most cases are brief and mild, resembling a common cold. More serious problems can occur in those with underlying chronic conditions such as asthma, cystic fibrosis, sickle cell disease, heart disease or compromised immune function.

There is no specific treatment. Children should drink fluids and rest. Over-the-counter fever reducers and pain medications can be used to treat symptoms.

Washing hands, avoiding touching the face, coughing or sneezing into sleeves, and disinfecting surfaces are ways to hinder the spread of infection.

Most children do not require emergency care or hospitalization, but medical attention is recommended when children struggle to breathe, have severe or prolonged vomiting, a fever greater than 103 degrees for more than two days or lethargy.

Source: The Centers for Disease Control and Prevention, Johns Hopkins Children's Center

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