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Rare Virus Has Sickened Hundreds More Children, Rapid Test Needed

From mid-August to September 19, 2014, a total of 160 people in 22 states in the U.S. were confirmed to have respiratory illness caused by enterovirus-D68, or EV-D68.  However, hospitals around the country say they are treating hundreds of children who have been sickened by the rare virus.

"We have some of these cases now in our ICU," says Dr. Giovanni Piedimonte, a pediatric pulmonologist and chairman of Cleveland Clinic's pediatric institute. Children with the virus can have serious trouble breathing, he says, enough so that they have to be put on a ventilator or lung bypass machine.

But Ohio isn't on the CDC's list of six states with confirmed cases of enterovirus-D-68 – they are Colorado, Illinois, Iowa, Kansas, Kentucky and Missouri. Official numbers always lag in a fast-moving outbreak, but the gap appears to be particularly big with enterovirus-D68. That may be because it appears to spread easily, because milder cases often look like a cold, and because there's no swift test to identify it.

"It would be great to have a rapid test, because we could identify children more at risk of rapidly developing symptoms," Piedimonte told Shots. He's particularly concerned because children can get worse suddenly and have trouble breathing. They then need immediate medical care.

What the Cleveland Clinic and other hospitals have is a PCR test that can tell if the bug in question is an enterovirus, but not if it's EV-D68. Those samples get sent to the CDC for further testing.

"To be honest, everyone we've tested with the exception of one since Sept. 1 has tested positive with this," Elizabeth Ann Esterl, pediatric nurse manager at National Jewish Health in Denver, a hospital that specializes in asthma and respiratory disease, tells Shots.

Children with asthma appear to be particularly vulnerable to EV-D68, with one-half to two-thirds of cases in children with asthma.

Although the CDC has confirmed 19 cases in Colorado, Esterl says she thinks National Jewish has seen 41 cases. And other children's hospitals in the Denver area say they've seen hundreds more.

"This virus knows no boundaries," Esterl says. "If you think you don't have it in your area, just wait."

Because there's no vaccine or specific medication for enterovirus-D68, the lack of a rapid test doesn't affect treatment. Instead, children are being given fluids, oxygen and other supportive care while they fight the virus. "The good news is that it looks like it's self-limiting, and in a few days they get better," Piedimonte says.

But that doesn't mean that parents should just wait it out if their child seems to be getting worse, he cautions. "When someone has the symptoms of a bad cold that seems to be progressing fast, report as soon as possible to an emergency room," Piedimonte says. "Time is of the essence in case a child requires oxygen and other care."

As more samples make their way to state health departments and the CDC, epidemiologists will have a better idea of why EV-D68 has suddenly morphed from being a rare and rarely dangerous virus to a surprisingly vigorous foe.

"We want to reduce the spread by doing things we know how to do," Esterl says. Number one on her list: Hand washing. Children should cover their coughs, she says, and consider skipping school even if it just seems like a mild cold. "It's a great time to watch movies at home."

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