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ADVANCE Perspective: Respiratory Views

Beware: Respiratory Illness On The Loose

Published September 10, 2014 3:05 PM by Rebecca Hepp
It seems unexplained outbreaks are the name of the game this year ... and this time it's hitting home in the U.S. The CDC has reported a recent outbreak of enterovirus 68 (EV-D68 ) in Illinois and Missouri, with warnings that it could spread to neighboring states.

It's time for pediatric RTs to strap on their battle gear with this one, as EV-D68 is a severe respiratory illness with no available vaccines or specific treatments. While there were only 79 EV-D68 reports during 2009-2013, at least 30 pediatric patients have tested positive for the virus in the past month, and the number seems to be growing. Patients exhibit a fever, coughing and general cold-like symptoms, and almost all have been admitted to a pediatric ICU for respiratory distress -a few even required PAP or mechanical ventilation.

Not surprisingly, children with a previous history of asthma or wheezing seem to be more susceptible. 68% of those with the virus at Children's Mercy Hospital in Kansas City and 73% at the University of Chicago Medicine Comer Children's Hospital had previous run-ins with respiratory issues. So RTs should be on the lookout for some familiar patients if EV-D68 keeps spreading.

So what can RTs do to prepare for the possible onslaught of this respiratory illness? The CDC gives little guidance, noting there is no specific treatment. And while those with a mild case typically only need symptom treatment and recover relatively quickly, pediatric patients seem to struggle more with recovery. Ultimately, though, RTs and the rest of the pediatric care team can only offer supportive clinical care, which at times may be extreme, depending on the individual patient's medical history and current symptoms.

"Some patients are sick and coughing for a week or two," Pia Hauk, MD, clinical director of ambulatory pediatrics at National Jewish Health, a respiratory hospital in Denver, told The New York Times. She also noted children may be more vulnerable now with school starting.

As it stands, EV-D68 has only cropped up in the pediatric population, but that's no excuse for not protecting yourself when coming face to face with this patient population. The CDC notes that, as a rare strain, EV-D68 is less studied and the way it's spread isn't as well-understood as other strains. But, it likely spreads through coughing, sneezing, or touching contaminated surfaces. Be sure to wash your hands often, avoid close contact when you can, and clean and disinfect frequently touched surfaces to ensure you minimized the chances of EV-D68 spreading.

Has your facility seen a spike in pediatric respiratory illnesses? What are you doing to prepare for a possible outbreak?

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From the CDC:

"What is enterovirus D68?

A: Enterovirus D68 (EV-D68) is one of many non-polio enteroviruses. This virus was first identified in California in 1962, but it has not been commonly reported in the United States."

J, September 17, 2014 8:21 AM

What is happening is terrible. It almost seems as though it is man made and a form of chemical warfare. We were warned that such things will happen since 911.  What's your thoughts on this observation?

Steve Cooper, LTACH - RCP, Select Specialty Hospital September 16, 2014 12:47 PM
Chandler AZ

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