HEV 68 is a human illness first recognized in 1962 as a cause of pneumonia and wheezing. It has occurred on occasion over the years since then but is being recognized as a major cause of respiratory illnesses in children in 2014 in the Midwest states. There was a cluster of cases in children in St. Louis, Missouri prior to the illness appearing in large numbers in August and beyond in Central Ohio. Cases are occurring throughout the Midwest as well. Children are more ill than adults with HEV 68. The peak age nationally has been 4-5 year olds, with an age range of 6 weeks of age to 16 years of age. Many children may have mild upper respiratory illness symptoms with HEV68, but some children will wheeze with the illness (even if they have never wheezed before) and show signs and symptoms of respiratory distress.
The enterovirus family of viruses also causes hand-foot-and-mouth disease, aseptic meningitis, and paralysis, along with more milder illnesses with rashes or vomiting and diarrhea illnesses. The HEV68 also called EV-D68) has typically caused nose and throat congestion, cough, headache, chills, achiness, runny nose, sore throat and occasionally fever. Like other upper respiratory viruses, HEV 68 is believed to be spread by coughing, sneezing, and touching items after touching the face, nose, or mouth. Because it is a virus, antibiotics have no effect on the course of the illness. Although we believe all eligible children should receive a flu vaccine each year, the flu vaccine will not effect whether someone becomes ill with HEV68.
What is causing hospitalizations with HEV 68 is respiratory distress and oxygen requirement. These children are breathing faster, coughing frequently, retracting (muscles of the chest, belly, and neck working to help them breath), and often wheezing such that you can hear it without a stethoscope. The cough sounds moist and mucousy, not dry and barky (such as with croup -- which is also going around). The wheezing and other breathing problems caused by HEV 68 have responded well to the same treatments that we use for asthma: albuterol and prednisone. The albuterol is often given as a nebulized or aerosol treatment. Some children, especially older children, will respond to albuterol treatments with an inhaler. The prednisone helps the breathing issues by fighting the inflammation in the chest. Children not responding to outpatient treatments with albuterol and prednisone may need to be hospitalized at Nationwide Children's Hospital for close monitoring, further treatments, and possibly oxygen.
Since most children have milder symptoms, who needs to be seen promptly for respiratory symptoms? It turns out, the same signs and symptoms we would always caution you about:
1. Breathing rapidly (especially more than 50-60 breaths a minute).
2. Retracting (seeing the skin around the neck, chest, or belly sink in and move out with each breath).
3. Wheezing you can hear without a stethoscope.
4. Frequent coughing (if your child is coughing every 30-60 seconds, they need to be seen).
5. Blue lips or blue color around the nose and mouth.
6. Passing out because of difficulty breathing (if this occurs, call 911).
If these are going on, your child needs to be seen right away: call during routine hours, come in for walk-ins at 8 a.m., go promptly to Nationwide Children's Hospital, or to the emergency department at Nationwide Children's Hospital. So many cases have occurred at the hospital (and because it is acting like asthma), it is being referred to as "Asthmageddon".
If your child has routine upper respiratory symptoms without the worrisome symptoms, watch carefully over the first few days or week of the illness to make sure the symptoms do not worsen as detailed above. The children we have seen so far seem to have milder symptoms for a day or two before worsening -- it does not take much time into the illness to notice worsening symptoms if they are to occur. Most of the children with worse symptoms seem to improve after about a week.
Many things we do not know yet: How long this outbreak will last? Just how contagious is it? Will many families with one child with it have it spread throughout the house? Are most children in the community with "just a cold" ill with this virus? How many children are getting a fever with HEV 68? Will these children go on to develop further wheezing episodes or asthma down the road? We will know more in the coming months.