Area doctors say use ‘common sense’ preventive measures
By Judy O’Gorman Alvarez
Enterovirus-D68, the respiratory illness sweeping the country, affecting children and causing parents to wring their hands and lose sleep, has emerged here in the Two River area.
But, doctors think some concentrated vigilance and common sense practices can keep children healthy and minimize illness.
The virus, called EV-D68, can cause mild to severe respiratory illness and has been found in infants, children and teens in 40 states and the District of Columbia.
Steven Kairys, M.D., chairman of pediatrics at Jersey Shore Medical Center’s K. Hovnanian Children’s Hospital in Neptune, said he’s seen a 30-percent increase in emergency room visits and admissions, including some in the pediatric intensive care unit.
“When we would usually see four or five, now we’re averaging nine to 10,” he said. “That’s typical of all the other states involved in this particular epidemic.
“Asthma adds to the phenomena as two-thirds (of patients) already have asthma.
“Some get very sick and need to be in ICU, but most don’t,” Kairys said. “Many of them have mild infections.”
The children are only hospitalized when they need more care than what the family can give them at home.
As Kairys explained, there are more than 100 strains of enterovirus and this particular strain has resulted in an unusually high number of cases.
“This has been around a long time but rarely has caused this kind of an epidemic,” Kairys said. “In the past there have been clusters – in Japan, the Philippines. It’s not unique to us but this particular spread has been very unusual.”
Symptoms include fever, runny nose, sneezing, coughing and body and muscle aches in mild cases and wheezing and difficulty breathing in more severe cases. Some patients may develop a rash.
“There is no antibiotic for a virus so we treat the symptoms,” Kairys said.
Kairys said he doesn’t know why so many children – usually ages 3 to 6 but also some older – have been impacted. “We don’t know exactly why we’re not seeing it in the adult population,” he said. “Perhaps adults have had exposure to this strain and kids have not.”
Kairys says the age-old advice about how to avoid illness and viruses and the like are the same: “Be consistent and precise in hand washing – with soap and water, no (hand sanitizer) – for at least 20 seconds.”
Those tips are especially important while changing diapers because the virus can get into gastrointestinal system.
“Avoid touching eyes and noses; avoid kissing, hugging. Disinfect toys, doorknobs with bleach. Don’t send your child to school if infected,” he said.
To reassure parents Kairys reminds them: “No one has died from this virus. It’s not causing brain problems or longtime morbidity,” he said. “It’s acting like a bad flu.” He encourages parents to “use common sense.”
Margaret Fisher, M.D., medical director of the Unterberg Children’s Hospital at Monmouth Medical Center, who specializes in pediatric infectious diseases, said, “The virus has definitely arrived in New Jersey.”
Although area doctors are treating the littlest patients for the enterovirus, the diagnosis has not yet been verified by the Centers for Disease Control and Prevention.
“The major disease being caused by this is a respiratory infection,” Fisher said.
“Every year we see enteroviruses throughout the summer and fall, so it’s not surprising to see an enterovirus.” In rare cases it “can sometimes cause meningitis or infections of the heart,” Fisher said.
“But hospitals are seeing an increase in the number of children with respiratory complaints and an increase in the number of children with respiratory distress and having to be hospitalized.
“The good news is,” she said, “the children are getting better.” A new concern, according to Fisher, is a development last weekend from Colorado where nine children, who were suffering from enterovirus, were seen with extremity weakness.
“Now that wouldn’t be all that surprising to us because in the enterovirus family is polio. Poliovirus can cause a weakness in an extremity, which could be transient or permanent,” she said.
“We don’t know how common it is but we do know that many of those kids have respiratory complaints and also weakness in one or more extremities.”
More typically though “the respiratory illness is causing much more trouble in children with underlying asthma,” Fisher said. For those families with asthmatic children, “they should escalate their therapy and be even more vigilant.”
Fisher also encourages common sense advice: frequent hand-washing, covering mouths – with tissue or into a sleeve, not with hands. “Especially with people going back to school,” she said. “There should be no sharing sodas; be careful about saliva.”
Instead of worrying, parents should watch their children with caution.
“Certainly if a child gets a bluish tinge, get them to an emergency room where they could get appropriately treated,” Fisher said.
The message, she said, is: “There’s no need to panic but this is the time to be particularly vigilant.”
