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Entries in Outbreak (2)


In the news: Outbreak of Respiratory Virus Hitting Kids Hard

You may have seen a news report about Enterovirus D68, a virus which has sickened more than 1,000 children across 12 states in the US over the past few weeks.

According to a report from the CDC, the first cases occurred in Missouri, where over 300 children have been hospitalized in the past month and 15% of those children have ended up in the intensive care unit!  This Enterovirus D68 is causing these kids to have trouble breathing.  Over half of the children who have been hospitalized had asthma or had previously had wheezing.   Children affected with the virus have ranged from 6 months to 16 years of age.  Since the initial reports from Kansas City, MO a similar outbreak has occurred in Chicago, IL and now a total of twelve states have contacted the CDC for help in investigating enterovirus — including North Carolina (though state health department officials reported this morning that no confirmed cases have been identified yet in NC).

Seeing cases of Enterovirus in the late summer and early fall is expected (cases typically peak in September) but the severity of illness occuring now is quite unusual.  Typically, enteroviruses (there are over 100 types of Enteroviruses) cause rashes and cold-like symptoms such as runny nose, cough, fevers, etc.  Some strains can cause more serious illness (like viral meningitis or encephalitis).

But recently one strain in particular, Enterovirus D68 (EV-D68) is causing severe respiratory illnesses in children. Symptoms include coughing, difficulty breathing and rash. Sometimes they can be accompanied by fever or wheezing.  This EV-D68 strain is uncommon, but not new. It was first identified in the 1960s but there have been fewer than 100 reported cases over the past 50 years.

The good news is that Enterovirus resolves on it's own (we have no ant-viral treatment for this and because it is not a bacterial disease, antibiotics do not help with this illness) within a week or two.  There typically are no long term complications from an Enteroviral infection.  

So what can parents do?  

WASH HANDS!  Enteroviruses are spread from person to person through contact with nasal secretions, saliva, stool, or by contact with contaminated surfaces.  So wash those hands with soap and water for at least 20 seconds very, very often!  Also, avoid touching eyes, nose and mouth with unwashed hands.  Disinfect frequently touched surfaces such as doorknobs.  

KEEP YOUR KIDS HOME IF THEY ARE SICK: Like many other respiratory viruses, EV-D68 appears to spread through close contact with infected people.  If your child is sick, especially with cough and any trouble breathing, keep them home to let them recover and prevent spreading the illness to others.

MONITOR CHILDREN WITH COLD SYMPTOMS CAREFULLY: If your child develops cold symptoms give them Tylenol or Ibuprofen as needed for any aches or fevers and watch their breathing closely.  Signs that they need to be evaluated include:

  • Breathing very quickly (more than 60 times per minute for infants, more than 40-50 times for older kids)
  • Sucking in between their ribs or flaring out their nostrils with each breath
  • Change in color (if your child is coughing and congested and appears blue - call for help immediately)
  • Lethargy (if your child will not respond to questions, is having trouble keeping their eyes open during the day when they are normally awake and is struggling to breathe this may be a sign their oxygen level is too low).

When in doubt, call our office!  Our nurses are available 24 hours a day to speak with you and listen to your concerns to help determine if your child needs to be seen in clinic or sent to the WFBH Emergency Department or is safe to be cared for at home. 



In the News: Norovirus (Stomach Bug) Runs Rampant 

You may have seen the news reports in the last few days, that a new strand of Norovirus is spreading rapidly here in the US.

The new virus strand, "GII.4 Sydney" was identified in Australia last March.  More than half of 266 norovirus outbreaks reported during the last four months of 2012 were caused by the Australian strain, according to data released from the Centers for Disease Control and Prevention. 

And although it is often referred to as the "stomach flu" - Norovirus has no connection to the influenza virus. 

What symptoms does Norovirus cause?

The illness often begins suddenly. You may feel very sick, with body aches, stomach cramping, vomiting and/or diarrhea.

Symptoms typically appear within 12-48 hours after exposure to the virus and people remain contagious for approximately 3 days after their symptoms resolve.

How common is Norovirus?

The CDC estimates that each year more than 20 million cases of acute gastroenteritis are caused by noroviruses (so about 1 in every 15 Americans will get norovirus illness this year).

How does Norovirus spread?

Norovirus is tough to beat for two main reasons

1. It spreads rapidly and takes a very tiny amount of exposure to make someone sick.  One British scientist referred to it as the "Ferrari of the virus field" for its spreading speed. Fewer than 20 virus particle are enough to infect someone. 

2. Someone who is sick is contagious before they have symptoms:   Someone infected with Norovirus is shedding billions of viral particles (and start shedding virus without any symptoms, so they don’t know they have it and there’s no way to advise them about how to avoid spreading it).

Its rapid spread can be especially devastating in crowded, closed places such as daycare centers, schools, hotels, and cruise ships.

The viruses are found in the vomit and stool of infected people and are typically spread by the following ways:

  • Eating food or drinking liquids that are contaminated with norovirus (someone gets stool or vomit on their hands, then touches food or drink).
  • Touching surfaces or objects contaminated with norovirus and then putting your hand or fingers in your mouth.
  • Having direct contact with a person who is infected with norovirus (for example, when caring for someone with norovirus or sharing foods or eating utensils with them).

How serious is Norovirus?

For most otherwise healthy people, Norovirus is usually not serious, just very uncomfortable.  Most people get better within 1­ to 2 days.

But, norovirus illness can be very serious in young children, the elderly, and people with other health conditions (like Diabetes). 

Norovirus is estimated to cause over 70,000 hospitalizations and 800 deaths each year in the United States.  Deaths are typically due to the main complication from Norovirus - dehydration.

Symptoms of dehydration to watch for in children:

- Decrease in frequency of urniation (fewer than 6 wet diapers in 24 hours in a young infant under 6-9 months and urinating fewer than 3-4 times in 24 hours in older children).

- Dry mouth and throat

- Feeling dizzy when standing up

- No tears when crying

What treatment is available for Norovirus?

There is no particular treatment for Norovirus.   

And, unfortunately, you can get norovirus illness more than once during your life.

Antibiotics will not help if you have norovirus illness. This is because antibiotics fight against bacteria, not viruses.

While infected, the most important thing is to ensure you (or your child) remains well hydrated.  Usually sipping small amounts of fluids frequently is the best approach (water or Pedialyte are best as juice and sugary drinks can worsen dehydration). 

Do not give an anti-diarrhea medication (such as Immodium) to your child. Anti-diarrhea medications usually allow the virus to increase reproduction and make the illness worse.

How to protect yourself from Norovirus?

1. Practice Hand Hygiene: Wash your hands carefully with soap and water (especially after using the restroom or changing diapers) and always before prepping food or eating.  Alcohol-based hand sanitizer is better than nothing, but is not equivalent to washing with soap and water if possible.  And if you've been an unlikely victim of the Norovirus, do not prepare food for others while you have symptoms and for 3 days afterwards.

2. Be careful in the kitchen:  Carefully wash fruits and vegetables and cook shellfish thoroughly before eating.

3. Clean contaminated surfaces: If someone in your home falls victim to the Norovirus (or any stomach bug), immediately clean and disinfect contaminated surfaces using a beach-based household cleaner (as directed on the product label).  You can make your own cleaning solution by mixing 5 tablespoons to 1.5 cups of household bleach per 1 gallon of water.

Of note: On hard surfaces in the environment, the Norovirus can survive for up to 12 hours. On contaminated carpet, noroviruses have been found to survive for up to 12 days.

4. Wash laundry!:  Immediately remove and wash clothing or linens that have been contaminated with vomit or stool.  Items should be washed with detergent at the maximum available cycle length and then machine dried. If available, wear rubber or disposab le gloves while handling soiled clothing or linens and wash your hands after reomving them.