10/08/2014 06:20 pm ET Updated Oct 08, 2014

7 Questions We Still Have About Enterovirus D68, Answered

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By now, you've probably heard of the rapid spread of a severe respiratory infection among children across the U.S. called enterovirus D68. From the middle of August to October 8, there have been 664 confirmed cases of the virus in people in 45 states and Washington D.C., according to the Centers for Disease Control and Prevention (CDC).

Little is known for sure about the virus, which causes symptoms like fever, runny nose, sneezing, cough, muscle and body aches, and possible muscle paralysis in very rare cases. The current outbreak is believed to be the cause of at least one death. Children are most at risk, and particularly those with asthma, it seems, while adults may only show mild symptoms. There is currently no treatment for the virus, because most symptoms resolve without requiring medical care.

To prevent the spread of EV-D68, the CDC recommends regular handwashing, avoiding touching your eyes, nose and mouth, avoiding close contact with people who are sick, covering coughs and sneezes with a tissue or sleeve, disinfecting frequently touched surfaces at home like toys and doorknobs and staying home when sick.

However, questions linger, so we turned to Jennifer Lighter Fisher, M.D., pediatric epidemiologist at New York University's Langone Medical Center to help clear up some of the confusion.

Why are adults less likely to develop severe symptoms?
"Enterovirus infections occur commonly during early childhood. Most school-aged children have antibody evidence of prior enteroviral infections. Thereby, adults are less frequently infected with enteroviruses than children because they have immunity against the enteroviruses."

Could an adult with mild symptoms pass an infection to a child who could then have more serious symptoms?
"Yes, adults could transmit the infection, but are less likely to than children because they have lower numbers of the virus and are less likely to shed virus and thereby transmit the virus."

How can people tell the difference between EV-D68 symptoms and cold or flu symptoms?
"Influenza usually causes fever, fatigue, headache, cough, sore throat and a runny or stuffy nose. The enterovirus D68 currently circulating in the U.S. causes a mild to moderate respiratory illness, and there may not be a fever. The common cold, often caused by rhinovirus, presents clinically very similar to the current EV-D68."

What about this virus could cause paralysis?
"The CDC is investigating a cluster of pediatric patients hospitalized with acute neurologic illness of undetermined etiology characterized by focal limb weakness and inflammation of the spinal cord gray matter on MRI. It is unsure if this is related to enterovirus D68. Six out of eight cases were rhino/enterovirus positive on respiratory panel [a virus detection device], and four of the six were positive for EV-D68 on molecular typing."

Why do EV-D68 infections decline in late fall?
"Enteroviruses are most prevalent in temperate climates (June-October)."

Why is asthma a risk factor?
"Patients with severe EV-D68 often have underlying chronic pulmonary disease. It is not uncommon with children who have chronic respiratory illness to have pulmonary exacerbations with the viruses that cause respiratory illnesses."

What caused the current outbreak of EV-D68 when it's been around for years?
"There have been clusters time and again through the years. I am unsure of the details why this virus became an epidemic this season."



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