Respiratory Virus

Dear Lisa,

I am worried about the Respiratory Virus that I keep hearing about in the news.  My son is three years old and had a couple of bouts of wheezing, but my Pediatrician said he did not have Asthma.  I heard children are dying from this Respiratory Virus and I am worried about my son.   Is there anything that I can do to prevent him from catching it?    I heard that it is only a problem if your child has Asthma.  Since my son doesn’t have Asthma does that mean he won’t catch it?

“Worried about the Respiratory Virus”

The Respiratory virus that has been causing children to become ill in the Midwest is due to Enterovirus D68.   Enteroviruses are very common and typically affect children during the summer and fall months.  Enteroviruses have been circulating in the community for a very long time.  Poliovirus, Coxsackie Virus and Echoviruses are all examples of viruses in this category.   This particular Enterovirus D68 was first identified in California in 1962.  There has been an increased number of children needing hospitalization due to  severe respiratory symptoms caused by this virus.  According to the CDC, there have been 538 cases in people in 43 states and the District of Columbia (1).  Enterovirus D68 has been detected in specimens from four patients who died (1).

The virus can be found in an infected person’s respiratory secretions including nasal discharge, respiratory droplets from coughing or sneezing, saliva, or sputum.  Since the germs are spread through respiratory secretions it is important to cover mouths during coughing and sneezing and to dispose soiled tissues properly.  The virus may also spread from person to person from surfaces touched by an infected person.  These surfaces may include toys, counter tops, doorknobs, desks, or hand held electronic devices.

Measures to take in order to help reduce the spread of infection include limiting contact with other children who are ill.  Do not let your child share toys, drinks or food with other children, especially if they have symptoms of a cold or virus.  Avoid hugging or kissing people who show signs of illness.  Eliminating practices that promote hand mouth activity, such as using a pacifier can also help avoid the spread of germs.  Caretakers should exercise caution and maintain good hand washing and proper disposal of contaminated items (such as dirty tissues) to help decrease the spread of infection.  It is also important to clean and disinfect surfaces, especially in child play areas, including the toys in order to reduce the spread of infection. 

Yes, it is true that children infected with Enterovirus D68 who also have Asthma or a history of wheezing tend to suffer from more severe symptoms.  I understand your concern since your child has a history of wheezing.  Even if he is not officially diagnosed with Asthma, he is still at risk because he has a history of recurrent wheezing.   But there are some measures that you can take to protect him.  First of all, it is important to follow your doctor’s direction regarding treatment for his wheezing. 

Some children have medication on hand to use as needed for episodes of wheezing.  Medication to relieve acute symptoms include Albuterol, ProAir Ventolin or Xopenex.   These medications are bronchodilators and work by opening up the bronchial tubes and promoting the clearance of mucus and secretions from the airways.  Inhaled steroids are another category of medication that is used in children to treat Asthma and wheezing.  This type of medication addresses the inflammation that is present in the airways of children with Asthma.  Examples of this type of medication include Flovent , Qvar and Pulmicort. 

If your doctor has prescribed these medications it is important to use them as directed.  Questions you should ask your doctor include; when should I give the medication, how often do I give it, and for how long.  It is also important to make sure the medications that you have on hand are not expired and the equipment is in good working order, especially if you have a nebulizer or spacer device.  Make sure you keep the follow appointments as prescribed by your doctor.  It is a good idea to take a pen and paper to the doctor’s visit  and write down instructions regarding medication administration, follow up appointments and any questions that you may have.  The most important thing to do is trust your instinct.  If your child does not appear well, seems to be having difficulty breathing, turns grayish, pale or blue, you should seek medical attention immediately. 

Be assured that the health departments, doctors and nurses are monitoring the situation and will communicate outbreaks.  In some cases there may be recommendations to avoid large crowds or to stay home from school or daycare.  It is important that parents and caregivers follow the direction from the public health department and health care professionals.   The instructions may be inconvenient, but the goal is to ensure the spread of infection.  It is essential that children with signs of illness stay home from daycare and school during their illness.  In particular, children should stay home from school and daycare until they are fever free for 24 hours, without the use of fever reducing medication.  

I wish you the best.

Lisa-ann Kelly R.N., P.N.P.,C. Certified Pediatric Nurse Practitioner 

References

(1)The Centers For Disease Control.   Enterovirus D68 in the United States, 2014. Available at: http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-outbreaks.html.  Accessed October 4, 2014.