A Medical Expert Gives the Low-Down on the Flu and EnterovirusesB

What is influenza?

Dr. Kevin A. Slavin: Influenza, or flu, is an infection caused by a virus. Typical symptoms begin suddenly, usually with fever, chills, body aches, headaches and fatigue as the first sign of disease. Respiratory symptoms such as runny nose, sore throat and cough, may not occur in the earliest stages of disease. Children are more likely than adults to have vomiting and diarrhea.

What causes influenza?

Dr. Slavin: There are two types of flu viruses that cause illness in people: influenza A and B. Each type of virus can have many different strains. Small changes in the strains from year to year can cause seasonal flu epidemics. When a brand new strain of influenza A circulates, one that has never caused illness in people before, a pandemic occurs.

When is “flu season?”

Dr. Slavin: In the northern hemisphere, flu typically occurs during the late fall and winter. In New Jersey, peak activity is usually in January and February. In recent years, flu has occurred as early as September and as late as June. 

How is flu spread?

Flu is spread mostly through the air. When an infected person talks, coughs or sneezes the virus may travel as far as six feet, landing on someone else’s mouth or nose. Less often, virus on a surface (such as a doorknob) can get on someone’s hand and they might accidently get infected by touching their mouth or nose.

How can we stop the spread?

Dr. Slavin: Hand washing with soap and water or using hand sanitizers can prevent the spread of infection. Frequently touched surfaces should be cleaned frequently. Avoid touching your mouth or nose. Eating utensils and drinking glasses should not be shared and should be washed with soap and water. Practicing “cough etiquette” is another way to prevent spread of infection to others. Cough or sneeze into a tissue and wash hands after. If a tissue is not available, coughing or sneezing into the upper sleeve or elbow is a way to decrease spread of virus to others. People who are sick with the flu should stay home until they recover.

How can I keep from getting sick?

Dr. Slavin: Influenza vaccination is the best way to prevent flu and its complications. Vaccine has been shown to prevent hospitalization and severe complications for adults and children with chronic illnesses, including diabetes, chronic lung disease and heart disease. Pregnant women are at high risk for severe influenza and vaccination during pregnancy has been shown to be safe and provides protection for newborns that are too young to be vaccinated.

Who should be vaccinated for influenza?

Dr. Slavin: Flu vaccine is recommended for everyone age six months and older.

Who should not be vaccinated for flu?

Dr. Slavin: Infants younger than six months and people with a severe allergy to the vaccine or its components should not be vaccinated. People who have had Guillan-Barre syndrome should discuss vaccination with their physician. People with severe egg allergies may be able to receive flu vaccine in an appropriate medical setting.

What are vaccine options?

Dr. Slavin: There are a few options for different types of flu vaccine available. Discuss the different vaccines available with your physician to decide which is best for you.

What if I can’t be vaccinated?

Dr. Slavin: There are very few reasons why someone cannot receive the vaccine. If you cannot safely receive flu vaccine, an antiviral drug may decrease your risk of influenza if you are exposed.

Is there treatment for influenza?

Dr. Slavin: Antiviral drugs may be helpful for some people with influenza, especially people with certain chronic conditions. They work best if they are started very early during the illness. If you think you might have the flu, you should see your doctor as quickly as possible to discuss treatment options.

What are enteroviruses?

Dr. Slavin: Enteroviruses are a family of viruses closely related to rhinovirus (the cause of the common cold). There are more than 100 different types of enteroviruses and each type can have typical illnesses associated with them. For example, in the United States, the most common cause of hand, foot and mouth disease is coxsackievirus A16, which is a type of enterovirus. However, other types of enterovirus can also cause hand, foot and mouth disease.

When do enterovirus infections occur?

Dr. Slavin: In the United States, infections typically occur during the summer and fall. Many different strains or types of enterovirus circulate each year, often simultaneously. Millions of enterovirus infections occur each year in the United States.

What is EV-D68?

Dr. Slavin: Enterovirus D68 is a virus that was first found in California in 1962. It is a type of enterovirus that can cause respiratory illnesses. Although it had been uncommon in the United States, it has been known to cause illness and has been detected at low levels fairly consistently since it was first found.

What happened this year?

Dr. Slavin: In August, hospitals in Kansas City, Mo., and Chicago, Ill., noticed an increased number of severe respiratory infections in children. Early testing showed that an enterovirus was the cause of the illnesses. Subsequent testing confirmed that EV-D68 was the infecting strain. In an effort to understand how the virus was circulating, state health departments working with the Center for Disease Control and Prevention (CDC) began testing children admitted to the hospital and/or intensive care unit with viral respiratory infections.

What was learned from testing for EV-D68?

Dr. Slavin: EV-D68 has been the most common enterovirus strain circulating in the United States this year. Between Aug. 10, 2014 and Oct. 24, 2014, the CDC confirmed infection with EV-D68 in 998 people in 47 states. Testing was targeted mostly in children with very specific symptoms and with more severe illness. It is likely that many more people, both adults and children, have been infected and had milder disease.

Who has been affected?

Dr. Slavin: Most identified infections have been in infants, children and teenagers. More severe infection seems to occur in children with previously diagnosed wheezing or asthma.

What types of illnesses do children with EV-D68 have?

Dr. Slavin: Because this is the first year that the virus has circulated so broadly, the full range of disease is not yet known. Most of the people who have been infected have had mild respiratory symptoms. Fever seems to be uncommon with EV-D68. Some children have had more severe symptoms of coughing, shortness of breath and wheezing. Some of these children have needed to be cared for in the hospital. This is more likely in children who have other respiratory diseases, especially children with asthma.

Is there any treatment for EV-D68?

Dr. Slavin: There are no antiviral drugs that treat EV-D68. Most people with mild symptoms can be cared for safely at home. For any significant symptoms or concerns, medical care should be sought. Children with asthma should have an Asthma Action Plan; that plan needs to be followed if any symptoms develop. If the child does not have an action plan, one should be developed with the child’s physician as soon as possible.

How do I get tested for EV-D68?

Dr. Slavin: Specific virus testing is not usually done and is not generally available. Since the type of virus causing illness does not affect treatment decisions, testing is generally not needed. If your doctor feels that specific testing is needed, then your doctor should consult with the Department of Health for further guidance.

How is EV-D68 spread?

Dr. Slavin: Since this is the first year the virus has circulated broadly, virus transmission is not as well understood. Most likely, the virus is spread through direct contact with infected secretions, which can contaminate hands and surfaces. It is also likely that EV-D68 can be spread through the air from someone who is infected and coughing or sneezing.

How can we stop the spread?

Dr. Slavin: Hand washing with soap and water can prevent the spread of infection. EV-D68 is probably less susceptible to hand sanitizers than other viruses, although hand sanitizers may provide some protection when soap and water is not available. As with other respiratory viruses, “cough etiquette” is another way to prevent spread of infection to others. This includes coughing or sneezing into a tissue and washing hands after. If a tissue is not available, coughing or sneezing into the upper sleeve or elbow is a way to decrease spread of virus to others. People who are sick should stay home until they recover.

By Kevin A. Slavin, MD

Kevin A. Slavin, MD, FAAP, is Pediatric Infectious Diseases, Chief, Section of Quality and Safety, at the Joseph M. Sanzari Children’s Hospital, Hackensack University Medical Center.

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