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Column originally published Oct 28, 2014

Enterovirus D68 Can Make Children Very Sick

Question: I have been hearing terrifying news about an Enterovirus that makes children very sick. I have two sons, and both of them have asthma. They are not too bad most of the time; but when they get sick, they often get very sick, and end up in emergency room. Both of them have been hospitalized multiple times for their asthma. I want to know whether there is anything that I can do to prevent them from getting this Enterovirus infection.


In the last few months, there have been reports of children admitted to hospitals in North America because of Enterovirus D68 infection. Some of them became very sick and required ventilator support, and a few died. Most of those have underlying respiratory problems like asthma. You are correct to be concerned about this virus because your children have asthma.

There are more than 100 strains of Enteroviruses. The most famous ones are polioviruses, which can cause polio. These polioviruses were rampant around the world, infecting children and leaving many with varying degrees of paralysis and occasional death, until the invention of polio vaccines. Nowadays, there are only pockets of polio infection around the world, especially in war torn countries.

It is interesting to know that this strain of Enterovirus D68 was first isolated in California in 1962. We have not heard much about it because it usually causes mild respiratory infections like common cold. As a result, these children were not tested; so we really don’t know how common this virus is in our community, until this year. For reasons that are still unclear, a small number of children infected with Enterovirus D68 became very sick this year, and require hospitalization.

More disturbing was the discovery that some of these children developed weakness or paralysis in their extremities. It is still too early to know whether the paralysis is temporary or permanent, like children who have polio.

Unfortunately, there is no medicine to treat Enterovirus D68 infection, and no effective vaccine in the near future. However, because most children have only mild respiratory infection, I don’t think we should overreact to this outbreak. Furthermore, Enterovirus infections are more common in summer and early fall. Once the weather turns colder in Canada, the number of children infected with Enterovirus D68 will likely decrease.

Since children with asthma tend to develop more serious respiratory problem and may require hospitalization, I would suggest that you review their asthma management with your doctor. Some children need daily prevention medicine to keep their lungs as healthy as possible. You should also have an action plan that tells you how to increase their asthma medications if they do get sick. With quick action and diligent treatment, many children with asthma can recover at home without emergency visits or admission to hospital.

In the last few years, we have also learned a great deal on ways to prevent the spread of respiratory viruses. You may recall the H1N1 influenza pandemic several years ago. By increasing vaccination of the public, as well as advising people to stay home when they were sick, the pandemic was literally stopped in its track. It has been estimated that when a person with influenza goes to work, he can potentially infect as many as 100 people around him. Staying home when one is sick can reduce the spread of respiratory viruses significantly. The same can apply to enterovirus infection.

Children with asthma can become very sick when they get influenza infection. Some will require hospitalization, and unfortunately, a few will die every year. This is the reason why influenza vaccine, or flu shot, is recommended for children who have asthma.

This year, it is even more important to get the flu shot. You likely have heard about the Ebola virus epidemic in West Africa. In recent weeks, this virus has spread to United States and to Europe. Both Canada and United States are working diligently to prevent an epidemic in North America. The early symptoms of Ebola infection and influenza are very similar: high fever, vomiting, and diarrhea. In order to prevent unnecessary stress and strict isolation, it is best to avoid contracting influenza virus and get the Ebola scare. Flu shot is the only vaccine that can prevent influenza infection.

I don’t recommend the use of hand-sanitizer all the time, or disinfecting every surface and every door knob around the house. We need healthy germs around us to keep us healthy. Over-exposure to disinfectants may be more harmful in the long run. If someone is sick and coughing, he should cover his mouth when he coughs. The infectious droplets can reach one meter (or 3 feet) around a coughing person. He should also wash his hands with soap and water for 20 seconds, and possibly use hand-sanitizer afterwards. Keeping your hands from the nose and mouth can reduce the chance of infection.

I hope these suggestions will reduce your fear of Enterovirus D68, and your family can stay healthy this fall and winter.