Scale of enterovirus outbreak still unknown, but no need to panic

A nasty respiratory virus that has sickened hundreds of children in the United States has found a firm foothold in Canada, but it’s not yet clear how severe.

Alberta is the only province to officially confirm cases of enterovirus D-68 thus far. Tests show that at least 18 children, including 10 in Calgary and five in Edmonton, have tested positive.

There’s also been a sudden increase in the number of young people admitted to Windsor Regional Hospital with breathing problems, but a spokesman for Public Health Ontario said the agency has not confirmed the cause yet as EV-D68.

Ontario hospitals began testing for the virus following a spike in children being admitted to American hospitals with breathing problems, mostly in Midwestern and southeastern states. The tests are being analyzed by Public Health Ontario’s lab.

“Within the week we expect to have results,” Dr. Bryna Warshawksy, the agency’s public health physician, told Yahoo Canada News.

The cluster of potential EV-D68 cases has so far been limited to southwestern Ontario, but Warshawsky doubts it stops there.

“We haven’t heard specifically of any elsewhere, but given the widespread nature in the United States, it’s probably in other places as well,” she said in an interview.

Doctors in other parts of the country may not be aware of a cluster of infections, as they can easily be mistaken as any of the usual summer-fall colds normally seen around this time of year.

“It’s not a reportable disease so people aren’t required to report to local public health,” said Warshawsky. “There’s no formalized system to monitor infections like that.”

[ Related: Enterovirus D-68 may be behind admissions at Ontario hospital ]

Another obstacle to monitoring the virus is a lack of testing facilities in some provinces. They have to send samples to the Public Health Agency of Canada’s national microbiology lab in Winnipeg, which can further delay identification.

The federal agency issued a public statement Tuesday, saying it was aware of the Alberta cases and multiple clusters of mild and severe respiratory illnesses in children in several other provinces.

“A public health alert has been sent to more than 4,000 health professionals across the country to increase awareness and to remain vigilant for possible enterovirus infections causing respiratory illness,” the statement read.

The U.S. Centers for Disease Control (CDC) reported that as of Tuesday, there were 130 confirmed cases in 12 states. So far, no one has died.

Talbot said it will take DNA sequencing to determine whether the Alberta cases are the same strain of EV-D68 reported in the United States, but so far there appears to be no direct connection.

“In our investigations so far, we’re not seeing a connection epidemiologically to people who had travelled to the Midwest,” he said. “We would depend on a lab result to show us whether or not it resembled [the strain that] the CDC sent out the advisory on.”

What is enterovirus D-68?

EV-D68 comes from a large family of viruses that, for the most part, are little more than a nuisance. Adults and most children will suffer through it like a cold — indeed, people who get an enterovirus often experience it as a summer cold.

In some cases, especially among children, EV-D68 can cause breathing difficulties, and those with asthma are particularly vulnerable.

“It’s important to remember that enterovirus is a common infection and we see enterovirus at this time of year every year,” said Warshawsky.

“The unique part of this one is it’s a different strain that seems to be causing some respiratory symptoms that can sometimes be a bit more severe.”

Flareups of enterovirus and other respiratory diseases are common at the beginning of the school year, Talbot said, adding the investigation so far suggests this year is no more serious than usual.

“We know there’s lots of transmission because kids come back from their vacation, visiting family and friends, and then they all get together in school and they all share those viruses with one another,” he said.

“A very small percentage of them end up with illness serious enough to require them to be seen in hospital.”

Polio is also in the enterovirus family but not related to EV-D68. However, the CDC’s information on enteroviruses notes that severe cases can cause infections of the heart and brain, and even paralysis and death. Children and people with weakened immune systems are the most vulnerable to such complications.

[ Related: Enterovirus D-68: 8 things parents should know ]

Some enteroviruses, possibly including EV-D68, can cause meninigitis, an inflammation of the lining of the brain and spinal cord, said Talbot, but it is generally less severe than bacterial meningitis. With proper rest and care, people can recover within days or weeks.

According to the CDC, the enterovirus virus is present in an infected person’s saliva and mucus, likely spreading through coughing, sneezing or contaminating surfaces that others then touch.

It’s not clear why children seem to be hit harder by the virus than adults, she said. One theory is that immunity can be built up through previous exposures, though there were documented adult cases during an outbreak in 2009-10.

The question for parents, then, is when to seek medical help. EV-D68 often starts out like a common cold before spiraling into something worse, something that could require hospitalization and aid from a ventilator.

Warshawsky advises parents to observe their sick children’s responses closely for wheezing or breathing problems, especially if they have asthma.

“So if your child has asthma and they’re not getting better with their usual puffers, then that’s the time to seek medical care,” she said.

How can we guard against EV-D68?

Unfortunately, there are no vaccines against enteroviruses other than polio. Talbot said that’s largely because research brainpower and dollars has focused on common, easily transmissible illnesses that can have serious outcomes such as polio, measles, chicken pox, diphtheria and whooping cough.

“That’s the sweet spot for a vaccine,” he said.

Enteroviruses, while common, rarely cause serious, long-lasting problems, said Talbot.

The precautions to prevent contracting and spreading enterovirus are the same as for a cold or flu, says the federal public health agency:

• Wash hands regularly with soap and water for at least 20 seconds after eating, going to the toilet, touching common surfaces and after coughing or sneezing.

• If you’re sick, stay home, keep your hands away from your face.

• Cough and sneeze into your arm, not your elbow.

• Discard soiled tissues.

“It’s basically influenza 101,” said Talbot.

It’s hard to know how long this EV-D68 outbreak could last, said Warshawsky. “Viruses do come and go. They usually have a seasonality,” she said.

“Enterovirus tends to be [around during] summer and fall, so it’s probably here for a few more weeks to months.”