Keeping enterovirus at bay

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      Jennifer Ferguson admits that she’s been bordering on obsessive when it comes to local coverage of the enterovirus. It’s a highly contagious illness that can have severe complications, particularly in children with a history of asthma—just like her seven-year-old daughter.

      “I’m having a little bit of a freak-out,” Ferguson says in a phone interview. “I really, really don’t want her to get this. I’m seeing a lot of scary stuff on the news.”

      It doesn’t help that several kids in her daughter’s class have been away from school or sent home recently with fevers, which is a symptom of the virus. None of the kids has received a diagnosis of enterovirus, but the risk of getting sick has been enough for Ferguson to voluntarily keep her daughter home from school a few times in the past several weeks.

      The outbreak is one that the B.C. Centre for Disease Control (BCCDC) is monitoring closely. Of the 100 different types of the virus, one called D68 is associated with paralytic symptoms and, much more rarely, death.

      As of October 16, the B.C. provincial laboratory had confirmed 36 cases of enterovirus D68 (EV-D68) in people aged one to 80. Thirteen cases were in kids under five, 10 in kids aged five to nine, six in those aged 10 to 14, one in the 15-to-19-year range, and six in people aged 20 and up.

      Two cases have been associated with paralysis. One young male adult patient died. He had a history of severe asthma and developed respiratory failure in hospital, according to the BCCDC’s most recent influenza-surveillance report. Of all the confirmed cases in B.C., 24 cases (67 percent) are male. The illness has been reported in every regional health authority in B.C.

      Also as of October 16, the U.S. Centers for Disease Control and Prevention had recorded seven patients with EV-D68 who have died since the outbreak began in mid-August. Three deaths were reported during outbreaks in the Philippines in 2008-09 and in Japan in 2010.

      Although enterovirus typically circulates in the late summer and fall, B.C. is also experiencing an early start to flu season.

      “We are still picking up cases [of enterovirus],” says BCCDC physician epidemiologist Danuta Skowronski in a phone interview. “The most recent specimen collection of D68 was confirmed and detected on October 6, so that’s still fairly recent.…I suspect entero will start to decrease and influenza will start to increase. There’s never a peaceful moment.

      “We’re already getting some early indicators of influenza activity in the province in terms of viral circulation,” adds Skowronski, who is the centre’s epidemiology lead for influenza and emerging respiratory pathogens. “We’re already picking up the A(H3N2) subtype, which is nasty for the elderly. We typically have worse seasons when H3 is in circulation, so it`s not a good sign so far.”

      Skowronski notes that most people who are infected with enterovirus either will experience no symptoms at all or will feel like they have a mild cold. There’s neither a vaccine nor an antiviral medication for it, but she recommends early supportive care.

      She also urges people to get a flu shot, even though it doesn’t guarantee protection. (The BCCDC says that—depending on the type of vaccine and the age of the recipient—the shot boasts an efficacy rate of between 60 percent and 80 percent.)

      Most important when it comes to staying healthy is practising basic preventive measures, starting with hand-washing, a simple act that many people still don’t do properly. “Basic hygiene measures can help reduce the risk, like frequent hand-washing with soap and water for 20 seconds at a time,” Skowronski says. “That’s the first step, but the second step is don’t touch your face. People do that a lot, and that’s what’s introducing the virus. What we haven’t been emphasizing as well as we have hand-washing is don’t bring your hands to your face: eyes, ears, nose, or mouth.

      “When you touch a surface that’s contaminated, the virus gets on your hands, and frequently through the day you bring your hands to your face and inoculate your eyes, nose, and mouth. Those mucous membranes are portals of entry for the virus into the respiratory tract. That includes influenza, RSV [human respiratory syncytial virus], entero, Ebola, and other viruses.”

      Cough etiquette is also critical to reducing transmission: cough or sneeze into your sleeve or elbow instead of onto your hands. Immediately and properly disposing of used tissues helps too.

      Then there’s staying home when you’re sick, and keeping your kids home if they’re ill.

      “People want to push on with their day, and feel they have obligations, but people are likely to be most infectious when they have projectile symptoms: so symptoms that project virus-laden droplets into the air, whether it’s coughing, sneezing, or when you clearly have florid discharge from your nose. When there’s lots of mucus, you’re likely to be shedding the most virus; that’s when you want to stay out of circulation. We had a slogan from the [flu] pandemic 2009 that was ‘Fever and cough: take the week off.’ That slogan, that still applies.

      “With influenza, you feel like you’ve been hit by a truck,” she says. “You’re achy all over and it comes on really suddenly, fever and cough. You can be shedding virus for five days at least.”

      For parents who may be concerned their child has the enterovirus, particularly with a history of asthma, Skowronski says to watch for fever, difficulty breathing, and weak muscles.

      “Get care early,” she says. “Don’t delay in getting supportive care. If there’s sudden onset of muscle weakness, parents know that’s not usual. Trust your instinct.”

      Comments

      2 Comments

      D Taylor

      Oct 25, 2014 at 10:29am

      enterovirus..."its a highly contagious illness", yet noone will tell us where the 20-25 year old man who just died lives.

      Whats the point of paying taxes to government if we cant even access information that can protect ourselves?

      0 0Rating: 0

      Martin Dunphy

      Oct 25, 2014 at 1:16pm

      D Taylor:

      Where he lived is irrelevant. If you read the article, you will see this: "most people who are infected with enterovirus either will experience no symptoms at all or will feel like they have a mild cold."

      The very unfortunate death was extremely rare and came about as the result of a severe asthma attack, also explained above.

      0 0Rating: 0