Enterovirus May Have Peaked

Enterovirus-D68 could soon be in the rearview mirror, according to a Hartford, CT, pediatric intensivist who has treated more than 20 children hospitalized with the infection.

“We may have plateaued,” said Christopher Carroll, MD, an asthma specialist at Connecticut Children’s Medical Center. While children are still being admitted for respiratory problems, “Now it’s more a mix of symptoms, not those of classic enterovirus.”

Though he could not say for certain the outbreak has peaked, he did say that “things are not continuing to get worse.”

It is also far from clear how extensive the outbreaks are, since testing for EV-D68 is not mandatory. So many states are sending their specimens to the US Centers for Disease Control and Prevention (CDC) that the facility has a mounting backlog. Carroll said the CDC has asked the hospital to stop. “They said don’t send any more samples; they are overwhelmed,” Carroll said.

Meanwhile, as EV-D68 continues to make headlines and parents may pressure family doctors to tell them whether a sick child has the virus, making that diagnosis in a primary care setting is just not practical, Carroll said.

The role of primary care physicians in fighting the outbreak is simply to continue to treat patients’ symptoms, and “it makes no sense for a primary care physician to provide testing,” Carroll said.

Confirming EV-D68 is of interest mostly from the standpoint of epidemiology, he said. The virus is not a “superbug” and not hard to treat in a hospital setting. There are no anti-virals effective in treating it or vaccines to prevent it. The tests require a PCR laboratory, a very expensive and specialized testing facility.

In New York, where more than a dozen EV-D68 cases have been confirmed, the tests were done in-state. NY is one of the few states that has a facility equipped to process submitted specimens. It is located at the Wadsworth Center in Albany, NY, run by the NY State Department of Health (NYSDOH).

The first stage of testing rules out rhinovirus and determines that there is sufficient enterovirus (EV) to test, a NYSDOH spokesman explained. The next test is “nested conventional RT-PCR, followed by bi-directional dideoxysequencing,” he said.

Once the virus is sequenced, it is edited and compared to an international online data base to see which of the more than 100 types of EV is the best match. “It can take at least 3 days and can take 5 or more,” he said.

That is why most states are relying on the CDC to do the tests, even though EV-D68 reporting is not mandatory. Since the virus can also cause a mild cold, it is also likely that most cases are not being reported.

But if there were a quick test, it might be useful. “Parents always like to know what’s wrong with their child,” he said.

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